Evaluation of adnexal masses with transvaginal color ultrasound.

Abstract

We evaluated 14,317 asymptomatic or minimally symptomatic women for ovarian carcinoma with transvaginal color Doppler ultrasound. The resistance index was calculated for at least five separate cardiac cycles in each case, and the mean was calculated. We discovered 624 benign adnexal masses: in every case except one the resistance index was >0.40. There were 56 malignant adnexal masses, 16 of which were stage I ovarian cancers. Neovascularization was found in six 0 varian carcinoma is the major lethal gynecological neoplasm in Western countries.1 Yugoslavia is no exception. The poor prognosis of this neoplasm is generally due to its late presentation. Symptoms do not appear in most cases until the primary lesion has spread. Diagnosis of ovarian carcinoma at an early stage was very unusual before we introduced color Doppler ultrasound in 1987 for examination of the pelvic organs.1 Color Doppler detects blood flow in small low-resistance vessels 1 · 3 that form in neoplastic tissue. 4 Pulsed Doppler is then used to quantify such color-coded flow using Pourcelot's resistance index." Ovarian malignancy is thus differentiated from other lesions that produce similar but not identical patterns of flow. • 3 • 6We present 14,317 asymptomatic or minimally symptomatic women evaluated for ovarian carcinoma with color Doppler ultrasound and followed up with this technique.Received from the Ultrasonic Institute, University of Zagreb, Zagreb, Yugoslavia.Address correspondence and reprint requests to Dr. PATIENTS AND METHODSClinics referred 8620 asymptomatic women for color Doppler examination. Gynecologists referred 5697 women because of suspected adnexal mass. Of these women 7495 (87%) were premenopausal (age 18-51; mean 42) and 1125 were postmenopausal (age range 49-72; mean 56). Each woman was examined by one of three doctors experienced in the technique of color Doppler ultrasound. Every examination included abdominal B-mode and vaginal color Doppler scanning with pulsed-Doppler examination.The equipment used was an SSD-680 with a 5-MHz transvaginal probe (Aloka, Japan). The uterus and in· dividual adnexal organs were examined. The resistance index (Rl) 5 was calculated from at least five separate cardiac cycles, and the mean of these was calculated. Observer differences between the three examining doctors were not statistically significant; in 10 cases examined by three observers the maximum difference in the RI obtained in any one case was 0.09 (12%).In premenopausal women the examinations were carried out between days 3 and 10 of the menstrual cycle to avoid false positive results as a consequence of increased ovarian flow during the luteal phase.

Transabdominal color Doppler ultrasonography of the painful adolescent ovary.

“…-5,12,13 Recently, color flow Doppler imaging has been shown to aid in identifying the cause of adnexal lesions in women beyond adolescence.7-. 9 Fleischer and colleagues 7 have suggested that waveforms and pulsatility indices can help to separate benign and malignant lesions in women. These authors noted that malignant masses tended to have abnormal flow centrally and lower pulsatility indices (mean less than 1.0), whereas benign lesions had peripheral flow and higher pulsatility indices (mean greater than 1.0).…”

“…Recent studies in women have attempted to differentiate ovarian mass lesions on the basis of flow patterns on color Doppler ultrasonography?- 9 The lesions in these series differ significantly from those seen in childhood, which limits the usefulness of the data. The purpose of this study is to evaluate the usefulness of transabdominal color Doppler ultrasonography in adolescent girls for the diagnosis of painful ovarian masses based on the pattern of blood flow.…”

Evaluation of adnexal masses with transvaginal color ultrasonography

“…The visualization of the ovaries by transvaginal sonography in our study was 983 in premenopausal women (7,495) and 953 in postmenopausal women (1,125). The high rate of visualization in the premenopausal ovaries can be explained by the presence of ovarian follicles, which act as a landmark to visualize the ovary.…”

Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses

“…While grey scale sonography is highly sensitive in identifying ovarian cancer, its diagnostic specificity has been poof. In an attempt to improve the specificity of ultrasound, the use of color Doppler sonography 2,[11][12][13]19,22,25,27 in addition to grey scale imaging has been proposed. In present study, 70 patients were evaluated using morphologic scoring system 14,21,26,28,30 proposed by JP Lerner et al and colour flow directed Doppler measurements were taken.…”

“…The minority of patients discovered with early stage disease have 5year survival rate of 80-90%. There are various screening methods 15 for detection of ovarian cancer like bimanual pelvic examination, ultra sound examination (TVS and TAS) 3,5,7,10,23,28,30 with or without colour Doppler flow imaging 2,[11][12][13]17,19,22,25,27,29 and measurement of various circulating proteins like CA 125. 1,6,8,20 In analyzing the screening test by measuring CA 125 level and performing transvaginal ultrasound examination 26 appears to provide the highest specificity and positive predictive value for the detection of ovarian cancer.…”