The Aredictive Value of Transvaginal Color and Pulsed Doppler in Evaluation of Adnexal Masses

Abstract

Objective:      To evaluate the role of transvaginal color Doppler assessment of amount of blood flow and the areas of vessels distribution within the adnexal masses, besides the accuracy of pulsed Doppler vascular indices in differentiation between benign and malignant adnexal masses.

Materials and Methods:        Two Hundred and thirty one women with adnexal masses underwent Doppler sonography at Woman's Health Center, Assiut University, Egypt between August 2013 and July 2014. Resistance index, pulsatility index, color score and area of vessels distribution were detected and assessed for their significance. A definitive histopathological diagnosis was obtained in every case and used as a gold standard.

Results:          Out of 189 benign masses, color Doppler study could diagnose 184 cases as benign, while out of 42 malignant masses, 36 masses were diagnosed as malignant. Our study showed a sensitivity of 85.7% and specificity 97.4%. In addition, peripheral localization of vessels was observed in benign masses (71.4%), while septal or central vessel localization (42.9% and 38.1%) was observed in malignant masses. Our cut-off PI value of ≤ 1.0, gave a sensitivity and specificity of 88.1% and 95.8%, respectively. Considering RI value ≤ 0.42 as the cut-off point, the sensitivity and specificity were 52.4 % and 97.9% respectively. P-value was <0.001 for both RI and PI between both groups, being of significant value in prediction of malignancy.

Conclusion:   Application of Doppler sonography is important in differential diagnosis of adnexal masses. Evaluation of blood vessels location using color Doppler is the most sensitive parameter in diagnosis of malignancy. In addition, using RI cut-off value ≤0.50 and PI cut-off value ≤1.0 has a higher sensitivity in detection of adnexal malignancy.