Three-Dimensional Power Doppler Evaluation of Adnexal Masses. Which Parameter Performs Best?

Abstract

Objective: To evaluate the role of 3D power Doppler in assessment of adnexal masses vascularity, its ability to discriminate benign from malignant adnexal masses.  Then, to determine which one of the 3D power Doppler parameters has the highest reliability for detection of adnexal malignancy.

Materials and Methods: A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Woman’s Health Center, Assiut University, Egypt between October 2012 and October 2013.  All patients were evaluated by 3-DPD ultrasound for assesement of tumor vascularization with calculation of vascular indices using Virtual organ computer-aided analysis program.  A definitive histopathological diagnosis was obtained in every case to be used as a gold standard.

Results: One hundred sixty-one patients were recruited, 115 with benign masses, 46 with malignant masses.  The mean vascularization index (16.36 versus 10.98; p<0.05), and the mean vascularization-flow index (3.91 versus 2.13; p<0.01) were significantly higher in malignant tumors.   No significant difference was found in the mean flow index. Chaotic arcitecture of vessels was significantly associated with malignancy (80.4% versus 6.1%; p<0.001) than benign possibility of masses.   Also, complex branching pattern of vessels was more signifcantly present in malignant masses than benign ones (47.8% versus 4.3%; p<0.001).  3D power Doppler had a sensitivity of 80%, specificity of 94%, PPV of 84% and NPV of 92% in detection of malignant adnexal masses.

Conclusion: Careful evaluation of the architectiure of vessels was the best parameter in evaluation of the masses with 3D power Doppler.   Evaluation of branching pattern had a low sensitivity and specificity in detection of malignancy. In spite of no clear cut-off values for vascular indices to be accurate in differentiation of adnexal masses, higher values of vascularization index and vascularization-flow index were strongly associated with adnexal malignancy.