Abstract

Background: Ultrasonography (USG) is considered the primary imaging modality for confirmation of the ovarian origin of the mass and characterization of the nature of the mass as benign or malignant. However, when morphologic features alone are applied to the prediction of ovarian malignancy, there is a tendency to over diagnose malignant tumors because of a substantial overlap between malignant and benign-appearing masses. Transvaginal color Doppler imaging with pulsed Doppler spectral analysis improves the characterization of ovarian masses by means of quantitative blood flow measurements obtained from tumor vessels. Color Doppler ultrasound helps identify solid, vascularized components in a mass. Objectives: To evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray scale sonography in differentiating benign from malignant adnexal masses.
Materials and Methods: Patients with abdominal lump were screened for sonography. If on sonography patient having ovarian lesion then detailed study was carried out by gray scale, color, power Doppler and by spectral waveform analysis. Morphologic indexing of the adnexal masses was performed using the Sassone score. Flow results were recorded as being absent or present and further characterized as normal or increased, vessel location, and arrangement.
Results: A total of 50 patients with 53 adnexal masses were enrolled into the study. Benign lesions were common in premenopausal age (30 [81%]) and malignant lesions (10 [77%]) were more common in the postmenopausal state. 23 out of 49 masses were considered suspicious of malignancy (Sassone score = 9), of which, 18 were malignant (including bilateral ovarian metastasis as a separate lesion) and 8 were benign. The sonomorphologic evaluation following Sassone scoring system had a sensitivity of 90%, specificity 75%, positive predictive value (PPV) 69% and negative predictive value (NPV) 92%. The sensitivity, specificity, PPV, and NPV of gray scale USG alone were 70%, 72.22%, 58.33%, and 81.25% respectively. While for gray scale with combined color and spectral Doppler USG the values were 90%, 91.66%, 85.71%, and 94.28%, respectively. Conclusion: Adding color Doppler to conventional sonography produced a specificity and PPV higher than those of conventional sonography alone and so gray scale USG in combination with Color Doppler and Spectral Doppler is proposed as the first and foremost diagnostic modality in patients with ovarian lesions.