ArticlePDF Available

Role of Combining Colour Doppler and Grey Scale Ultrasound in Differentiating Benign from Malignant Ovarian Masses

Authors:

Abstract and Figures

The aim of this study was to evaluate ovarian masses with conventional grey scale ultrasonography and colour Doppler flow imaging and to assess the diagnostic reliability of these methods in differentiating benign and malignant ovarian masses. We assessed 56 patients with an ovarian mass. Morphological characterisation of the mass was performed utilising the Sassone score. Colour Doppler parameters were recorded for each patient, and the Caruso vascular score was also applied. The results were compared with surgical/pathological and/or follow-up scans. Using the Sassone score, overall reliability in differentiating ovarian masses had a sensitivity of 89.5% and a specificity of 78.4%. Using the Caruso score alone, we found a sensitivity of 89.5% and a specificity of 86.5%. Using the Sassone and Caruso scores together, we found a sensitivity of 94.7% and a specificity of 89.1%. Combining both morphological and colour Doppler scores in the evaluation of ovarian masses obtained higher specificity, sensitivity, and accuracy than was obtained using a single score only.
Content may be subject to copyright.
1
oriGinal scientific PaPer oriGinalni naUČni rad oriGinal scientific PaPer
Corresponding author: Qays Ahmed Hassan,
University of Baghdad, Al-Kindy College of Medicine, Al-Nahdha square
Postal address: 10071 University of Baghdad, Baghdad, Iraq, E-mail: qtimeme@yahoo.com, Cell phone: 9647722604163
Ser J Exp Clin Res 2017; 1-1
DOI: 10.2478/SJECR20180069
aBstract
e aim of this study was to evaluate ovarian masses with
conventional grey scale ultrasonography and colour Doppler fl ow
imaging and to assess the diagnostic reliability of these methods in
diff erentiating benign and malignant ovarian masses.
We assessed 56 patients with an ovarian mass. Morpho-
logical characterisation of the mass was performed utilising
the Sassone score. Colour Doppler parameters were recorded
for each patient, and the Caruso vascular score was also ap-
plied.  e results were compared with surgical/pathological
and/or follow-up scans.
Using the Sassone score, overall reliability in diff erentiat-
ing ovarian masses had a sensitivity of 89.5% and a specifi c-
ity of 78.4%. Using the Caruso score alone, we found a sensi-
tivity of 89.5% and a specifi city of 86.5%. Using the Sassone
and Caruso scores together, we found a sensitivity of 94.7%
and a specifi city of 89.1%.
Combining both morphological and colour Doppler
scores in the evaluation of ovarian masses obtained higher
specifi city, sensitivity, and accuracy than was obtained using
a single score only.
Keywords: Ovarian mass, Ultrasonography, Vascular
score, Malignant, Benign.
role of coMBininG coloUr doPPler and GreY scale
UltrasoUnd in differentiatinG BeniGn
froM MaliGnant oVarian Masses
Muna Abid Al-Ghani Zghair1, Qays Ahmed Hassan2, Rana Ahmed Mahdi3
1Assistant Professor, Section of Radiology, Department of Medicine, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq.
2Assistant Professor, Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq.
3Radiologist Specialist, Department of Radiology, Al-Yarmook Teaching Hospital, Baghdad, Iraq.
UloGa KoMBinoVane color-doPPler i GraY-scale
UltraZVUČne Metode U diferenciJaciJi BeniGnih
od MaliGnih oVariJalnih ProMena
Muna Abid Al-Ghani Zghair1, Qays Ahmed Hassan2, Rana Ahmed Mahdi3
1Odsek za radiologiju, Katedra za medicinu, Medicinski fakultet, Al-Mustansiriyah Univerzitet, Bagdad, Irak
2Odsek za radiologiju, Katedra za hirurgiju, Al-Kindy medicinski fakultet, Univerzitet u Bagdadu, Bagdad, Irak
3Katedra za radiologiju, Al-Yarmook univerzitetska bolnica, Bagdad, Irak
Received / Primljen: 16. 03. 2018. Accepted / Prihvaćen: 17. 07. 2018.
introdUction
The diagnosis of ovarian masses is a frequent dilemma
in clinical work. Most ovarian masses are benign (1,2).
The most crucial step following identification of the ovar-
ian mass is the perception of a level of malignancy; deter-
mining the level of malignancy will have a great impact on
patient survival. It is the danger of malignancy that drives
us to reliable and immediate diagnosis to decrease mor-
bidity and mortality. Ovarian cancer represents a prin-
ciple surgical difficulty in that it requires exhaustive and
usually complicated therapies, and it greatly affects the
patient’s psychological and physical state. It has the great-
est case fatality rate of all the gynaecological malignan-
saŽetaK
Cilj ove studije bila je evaluacija ovarijalnih tumora
konvencionalnom crno-belom ultrasonografi jom kao i ko-
lor-dopler metodom sa ciljem diferentovanja benignih i ma-
lignih osobina tumora.
Uključili smo 56 pacijenata sa tumorima ovarijuma.
Morfološka karakterizacija tumora je urađena pomoću
Sasson skora. Za svakog pacijenta određeni su parametri
pomoću kolor-dopler metode kao i Karuzo vaskularni skor.
Ovi rezultati su upoređivani sa hirurškim i/ili patološkim
nalazima.
Korišćenjem Sasson skora, opšta pouzdanost u proceni
vrste ovarijalnih tumora ima senzitivnost od 89,5% i speci-
čnost od 78,4%. Korišćenjem Karuzo skora, pronašli smo
senzitivnost od 89,5% i specifi čnost od 86,5%. Upotrebom
oba skora, Sassone i Karuzo, senzitivnost je bila 94,7% a
specifi čnost čak 89,1%.
Kombinovanjem morfoloških i kolor-dopler skorova u
evaluaciji i dijagnostici ovarijalnih tumora dobijamo veću
specifi čnost, senzitivnost i tačnost dijagnoze u odnosu na po-
jedinačno upotrebljene metode.
Ključne reči: Ovarijalni tumor, ultrasonografi ja, vasku-
larni skor, maligni, benigni
2
cies (3). Therefore, it is necessary to have a diagnostic tool
for its immediate discovery and conventional treatment
and to increase survival. Therefore, we want diagnostic
means that allow proper classification of ovarian masses
before surgery; hence, it is essential to identify the nature
of the tumour before surgery. Ultrasonography (USG) is
regarded as the basic imaging modality for recognising
the nature of the ovarian mass as benign or malignant
(4). USG morphologic assessment is still the most com-
mon modality for detecting ovarian cancer (5). USG re-
lates morphologic images with gross macroscopic patho-
logic characteristics of ovarian masses. However, when
morphologic characteristics only are used to predict the
ovarian malignancy, there is a tendency to over-diagnose
malignant tumours because of a large overlap between
malignant and benign masses. Accordingly, the addition
of colour Doppler imaging with pulsed Doppler spectral
analysis enhances the characterisation of ovarian masses
by means of quantitative blood flow measurements ob-
tained from tumour vessels and thus improves sensitivity
and specificity of the characterisation of ovarian masses
(1-4). High operator dependence and extreme variability
in the characteristics of ovarian tumours make a definite
diagnosis still difficult. To overcome these limitations, ap-
plying scoring systems has been promoted. These scoring
systems, joining various parameters of USG and colour
Doppler, raise the sensitivity and specificity of diagnosis
with excellent accuracy (6).
The purpose of this study was to evaluate the ovar-
ian masses with conventional grey scale and colour Dop-
pler flow imaging and to assess the diagnostic reliability
of these methods in differentiating benign and malignant
ovarian masses.
Materials and Methods
This prospective study was carried out between Au-
gust 2015 and January 2017. The study included 56 pa-
tients who were clinically suspected to have ovarian neo-
plasm and referred for USG and Doppler examinations.
Ethical clearance for the study was obtained from our lo-
cal institutional scientific and ethics committee with ap-
proval number 32 / 2015 before the commencement of the
study. Informed consent for all participating patients was
obtained. All patients were examined on GE Voluson E6
Color Doppler Machine with 3.5–5 MHz convex and 7.5
MHz transvaginal transducers and with grey scale, power,
and spectral Doppler. The detailed history of all patients
was studied, and complete examination was performed.
USG preferably was performed during the proliferative
phase of the menstrual cycle in premenopausal women.
The same radiologist evaluated all the cases. Scanning
was performed in the supine position. The whole of the
abdominal cavity was scanned in longitudinal and axial
plane with particular reference to the pelvic cavity. The
ovaries were recognised. Ovarian masses in either ova-
ry, if seen, were assessed. In uncertain cases of ovarian
masses on transabdominal USG, transvaginal USG was
done to exclude extra-ovarian masses. The Sassone scor-
ing system on the basis of morphological parameters was
applied where a score ≥9 is considered to be probably ma-
lignant. Table 1 shows the Sassone scoring system, which
is based on the visualisation of the inner wall structure,
wall thickness, septae and solid part echogenicity. Sub-
sequently, power and Doppler flow imaging and spectral
analysis were performed. Doppler parameters were opti-
mised for detection of flow and calculation of impedance
indices. Flow results were recorded as being absent or
present and further characterised as normal or increased.
Normal flow was characterised by fine branching vessels,
no evidence of “hot-spots”/aliasing, and presence of pe-
ripheral flow. The flow was classified as increased if di-
Table 1. Criteria used in Sassone score for sonomorphological characterisation (7)
Inner wall
structure Smooth Irregularity
less than 3 mm
Papillarities
more than 3 mm Not applicable -
Septae No septa in less than
3 mm
ick more
than 3 mm - -
Wall thickness in less than
3 mm
ick more
than 3 mm
Not applicable
mostly solid - -
Echogenicity Sonolucent Low echogenic
Low echogenic
with echogenic
core
Mixed
echogenicity
High
echogenicity
Benign: <9; Malignant: ≥ 9
Table 2. Criteria used in Caruso score (8)
Vessels location
Absent 0
Present 1
Peripheral 0
Septal 1
Central 2
Arrangement of vessels
Regular 0
Random 2
Waveform pattern
Sharp with diastolic notch 0
Smooth without notch 2
Lowest RI More than 0.43 0
Less than 0.43 2
*Benign: <5; Malignant: ≥ 5. RI: Resistive index
3
lated prominent parenchyma vessels were present; “hot-
spots” and aliasing were seen in colour flow mapping.
The vessel location (peripheral, central, and septal), ar-
rangement (regular/random) and morphology (normal-
fine tapering vessels versus abnormal dilated prominent
vessels, focal stenosis, aneurysms, blind-ending lakes and
dichotomous branching) were also noted. Spectral Dop-
pler study including RI (Resistivity index), PI (Pulsatil-
ity index), PSV (Peak systolic velocity) and presence or
absence of dicrotic notch were recorded in each patient.
Caruso score (Table 2) was applied for further characteri-
sation of the mass where a score ≥5 was supposed indica-
tive of malignancy. Benign and malignant classification
of the ovarian masses was done depending upon the grey
scale and colour Doppler USG. The results were corre-
lated with the histopathological findings.
Statistical analysis
Statistical Package for the Social Sciences version 20
(SPSS 20) was used for both data entry and data analysis.
Discrete variables were displayed as a number (%). Chi-
square test (or Fisher’s exact test when appropriate) was
used to test the significance of the relationship for the dis-
crete variable. P-value of < 0.05 was regarded as significant.
RESULTS
Fifty-six patients were included in this study. Thirty-
eight (68%) patients were pre-menopausal, and 18 (32%)
were postmenopausal women. The mean (± SD) age of pa-
tients included in the study was 45.0 ±15.5 years (range 20-
67 years) for malignant masses and 38.2±12.2 years (range
20-67 years) for benign masses. In correlation with the
parity, the malignant masses were significantly noted more
among nulliparous and para 3 women, while the benign
masses were more among para 1 women. Table 3 shows
the distribution of the ovarian masses according to age and
parity. Table 4 summarises the histopathological diagnosis
of 56 ovarian masses studied where 37 (66.07%) were be-
nign and 19 (33.93%) were malignant.
Table 5 shows the distribution of 56 patients accord-
ing to the Sassone, Caruso and combined scoring systems
and its correlation to the finally confirmed histopathologi-
cal diagnosis. Out of 37 benign cases, the Sassone scoring
system alone was able to diagnose 29 (78.3%) cases, the Ca-
ruso scoring system alone was able to identify 32 (86.4%)
cases, and the combined scoring system was able to identi-
fy 33 (89.1%) cases. Out of 19 malignant cases, the Sassone
scoring system alone was able to diagnose 17 (89.4%) cases,
the Caruso scoring system alone was able to diagnose 17
(89.4%) cases, and the combined scoring system was able
to diagnose 18 (94.7%) cases. These findings, regarding the
Sassone scoring system alone, had a sensitivity of 89.5%,
a specificity of 78.4%, a positive predictive value (PPV) of
Table 3. Distribution of ovarian masses according to age and parity.
Histopathology
Malignant
%
Benign
%
P value
Age
<30 21.1 29.7 0.287
30---39 15.8 32.4
40---49 15.8 13.5
=>50 47.4 24.3
Mean±SD (Range) 45.0±15.5(20-67) 38.2±12.2(20-67)
Parity
Nulliparous 26.3 16.2 0.016
P1 10.5 37.8
P2 10.5 29.7
P3 26.3 10.8
P4 & more 26.3 5.4
Mean±SD (Range) 2.3±1.8(0-5) 1.5±1.1(0-4)
SD: Standard deviation, P: Para.
Table 4. e histopathological diagnosis of the studied ovarian masses.
Histopathological diagnosis No. (%)
Serous cystadenoma 8 (14.29)
Mucinous cystadenoma 4 (7.14)
Mature teratoma 13 (23.21)
Haemorrhagic cyst 5 (8.93)
Benign Fibrothecoma 2 (3.57)
Serous cystadenofibroma 2 (3.57)
Endometriosis 2 (3.57)
Epidermoid cyst 1 (1.79)
Total 37(66.07)
Serous cystadenocarcinoma 5 (8.93)
Mucinous cystadenocarcinoma 3 (5.35)
Endometroid adenocarcinoma 2 (3.57)
Malignant Immature teratoma 7 (12.50)
Brenner cell 1(1.79)
Fibrosarcoma 1(1.79)
Total 19 (33.93)
4
86.0%, a negative predictive value (NPV) of 93.5% and an
accuracy of 82.1%; the findings of the Caruso scoring sys-
tem alone had a sensitivity of 89.5%, a specificity of 86.5%, a
PPV of 77.3%, an NPV 94.1% and an accuracy of 87.5%. Us-
ing both the Sassone and Caruso scores together, we found
a sensitivity of 94.7%, a specificity of 89.1%, a PPV of 81.8%,
an NPV of 97.0% and an accuracy of 91.0%.
Table 6 gives comparative efficacy of Sassone, Caruso,
and combined scoring systems in differentiating benign
from malignant ovarian masses and shows that the com-
bined scoring system is a better performing scoring system.
DISCUSSION
Today, the commonly applied means for distinguishing
between malignant and benign ovarian masses are the phys-
ical examination, serum tumour markers, and grey scale and
colour Doppler USG (9). Colour and pulsed Doppler can
improve preoperative diagnosis of ovarian tumours when
compared to transvaginal sonography alone or tumour
marker assessment (10). Although grey scale USG is sensi-
tive in identifying ovarian carcinoma, its reliability has not
been enough to preclude further invasive methods, such as
laparoscopy and laparotomy. Colour Doppler imaging and
spectral Doppler imaging have been reviewed as potential
means of increasing the specificity of grey-scale USG in dif-
ferentiating benign from malignant masses (11,12).
Timmerman D et al.(13) in their prospective valida-
tion study, which was conducted in 19 USG centres in
eight countries, concluded that the use of the simple USG
rules (shape, size, solidity, and results of colour Doppler
examination) to distinguish benign from malignant ovar-
ian masses has the potential to improve the management
of women with an ovarian mass.
Characteristics that raise the suspicion of malignan-
cy in USG include the presence of thick septa, papillary
projections, heterogeneous echotexture, and septa great-
er than 3 mm in thickness or which have flow on colour
Doppler USG (14,15). Neovascularisation in the tumour
always offers lower resistance to blood flow in malignant
neoplasms (Fig 1).
Benign tumours have been characterised as being uni-
locular, with thin septae, homogenous iso echogenicity
and thin wall capsule (16).
In our study, using only a grey scale Sassone scoring
system, out of 37 benign tumours, 29 were correctly di-
agnosed and 8 were misdiagnosed. Out of 19 malignant
tumours, 17 were correctly diagnosed as malignant and 2
were misdiagnosed as benign. Using Caruso scoring sys-
tem, out of 19 malignant masses, 17 were correctly diag-
nosed. Using the combination of both scoring systems, out
of 19 malignant cases 18 were correctly diagnosed. The
only case, which was not diagnosed, was of immature tera-
toma. In this case, the tumour was of mixed echogenicity
without solid mass or vascularisation. Accordingly, out of
37 benign masses, 33 were correctly diagnosed as benign
and 4 were misdiagnosed as malignant; these were 2 cases
of fibrothecoma and 2 cases of serous cystadenofibroma.
In these cases, the tumours were encountered as unilocu-
lar cysts with solid areas and central flow.
In our study, Colour Doppler results showed predomi-
nantly peripheral localisation of vessels in benign masses
(65%) and predominantly central or septal vessel locali-
sation (81.8%) in malignant masses. This agrees with the
results of Jokubkiene et al. (17) who found that 57% of be-
nign masses showed peripheral vascularisation versus 70%
of malignant masses that showed central vascularisation.
In our study, the RI alone was an insufficient discrimi-
nating parameter, as there was overlap between benign and
Table 5. Comparison between Sassone, Caruso and combined scoring
systems and histopathology
Benign Malignant Total
Sassone score
Benign (0-8) 29 2 31
Malignant (≥9) 8 17 25
Caruso score
Benign (<5)
Malignant (≥5)
Combined score
Benign
Malignant
37
32
5
37
33
4
37
19
2
17
19
1
18
19
34
22
34
22
Table 6. Statistical comparison between two scoring systems
Statistical
parameter
Sassone scoring
system %
Caruso scoring
system %
Combined
scoring
system %
Sensitivity 89.5 89.5 94.7
Specificity 78.4 86.5 89.1
PPV 68.0 77.3 81.8
NPV 93.5 94.1 97.0
Accuracy 82.1 87.5 91.0
PPV: Positive predictive value, NPV: Negative predictive value
Figure 1. Spectral Doppler USG of 47 year-old patient shows complex
ovarian mass with internal vascularity and low RI=0.37 diagnosed as se-
rous cyst adenocarcinoma on histopathology
5
malignant masses. The RI cut-off value of <0.43 used had
a significant p-value (<0.0005). Pulsatility index <1.0 had
a sensitivity of 73.6% and a specificity of 64.9%, and there
was a significant overlap between malignant and benign
masses. Ueland et al. (16) reported sensitivity and specific-
ity of 52.8% and 77.6%, respectively, using the cut-off value
of PI < 1. In spite of that, Abbas et al. (18) reported that PI <
1 was an important feature of malignancy (80.4%), but PI <
1 was also found in 15.7% of benign masses. Thus PI alone
cannot be a reliable parameter to detect malignancy. Shah
D et al. (19) reported sensitivity (97.5 %) and specificity
(84.1%) withPIandRIvalues of <1.0 and <0.6, respective-
ly, in their multi-parameter analysis utilising B-mode USG
along with Colour Doppler and Spectral Doppler to dif-
ferentiate between malignant and benign ovarian tumours.
These findings are correlated with our result.
In the present study, B mode USG along with Doppler
showed a sensitivity of 94.7%, a specificity of 89.1%, a PPV
of 81.8%, an NPV of 97.0% and an accuracy of 91.0%. These
results agreed with those of Abbas et al. (18) who were us-
ing a new scoring model (Assiut Scoring Model {ASM}),
in which they used two-dimensional USG and Doppler
features and showed a sensitivity of 93.5%, a specificity of
92.2%, a PPV of 82.7% and an NPV of 97.3%, with overall
accuracy of 92.6%. Our results also agree with the results
of Dhwani et al. (20), who conclude that using the combi-
nation of both grey scale and colour Doppler in differenti-
ating benign from malignant ovarian masses gives results
with more accuracy. Furthermore, our results agree with
those of Malhotra A et al. (21), who conclude that grey
scale USG combined with Colour and Spectral Doppler
is superior to grey scale USG alone in differentiating be-
nign and malignant adnexal masses. Gagandeep et al. (22)
evaluated 30 patients with ovarian mass in their study, and
they showed a sensitivity of 91.7% and a specificity of 77.7%
when using the Sassone score alone, a sensitivity of 83.3%
and a specificity of 88.9% when using Caruso score alone,
and a sensitivity of 90.9% and a specificity of 93.3% when
using both scores together. These findings are well corre-
lated with our results.
Based on the results of our study, patients with masses
score < 5 can be managed in the gynaecological unit by a
gynaecologist, either conservatively or surgically, accord-
ing to their features. Patients with masses score ≥ 8 must
be referred to a gynaecological oncologist and be managed
in specialised oncology centres. Patients with masses score
4-6 are suspicious with high possibility of malignancy if
score ≥ 6, so further investigations may be ordered such
as MRI.
CONCLUSION
There is significant overlap in the morphologic features
of different ovarian masses. The combination of grey scale
USG with colour and spectral Doppler is recommended as
the leading diagnostic modality in patients with an ovarian
tumour. This combination gives better diagnostic achieve-
ment than an individual method and accordingly will es-
tablish the definite diagnosis of malignancy early in the
course of the disease.
references
1. Barney SP, Muller CY, Bradshaw KD. Pelvic masses.
Med Clin North Am. 2008;92:1143-1161.
2. Ackerman S, Irshad A, Lewis M, Anis M. Ovarian cys-
tic lesions: a current approach to diagnosis and man-
agement. Radiol Clin North Am. 2013;51:1067–1085.
3. Valentin L, Ameye L, Franchi D, Guerriero S, Jurkovic
D, Savelli L, et al. Risk of malignancy in unilocular cysts:
a study of 1148 adnexal masses classified as unilocular
cysts at transvaginal ultrasound and review of the lit-
erature. Ultrasound Obstet Gynecol. 2013;41:80–89.
4. Medeiros LR, Rosa DD, da Rosa MI, Bozzetti MC. Ac-
curacy of ultrasonography with color Doppler in ovar-
ian tumor: a systematic quantitative review. Int J Gyne-
col Cancer. 2009;19:1214–1220.
5. Laing FC, Allison SJ. US of the ovary and adnexa: to
worry or not to worry? Radiographics. 2012;32:1621–
1639.
6. Alcázar JL, Mercé LT, Laparte C, Jurado M, López-
García G. A new scoring system to differentiate benign
from malignant adnexal masses. Am J Obstet Gynecol
2003;88:685-692.
7. Sassone AM, Timor-Tritsch IE, Artner A, Westhoff C,
Warren WB. Transvaginal sonograpihic characteriza-
tion of ovarian disease: evaluation of a new scoring
system to predict ovarian malignancy. Obstet Gynccol
1991;78:70-76.
8. Caruso A, Caforio L, Testa AC, Ciampelli M, Panici
PB, Mancuso S. Transvaginal color Doppler ultraso-
nography in the presurgical characterization of adnexal
masses. Gynecol Oncol.1996;63: 184-191.
9. Van Calster B, Timmerman D, Bourne T, Testa AC, Van
Holsbeke C, Domali E, et al. Discrimination between
benign and malignant adnexal masses by specialist
ultrasound examination versus serum CA-125. J Natl
Cancer Inst. 2007;99:1706–1714.
10. Jung SI. Ultrasonography of ovarian masses using
a pattern recognition approach. Ultrasonography.
2015;34:173-182.
11. Levine D, Brown DL, Andreotti RF, Benacerraf B, Ben-
son CB, Brewster WR, et-al. Management of asymp-
tomatic ovarian and other adnexal cysts imaged at US:
Society of Radiologists in Ultrasound Consensus Con-
ference Statement. Radiology. 2010;256:943-954.
12. Gupta KP, Jain SK. Role of Ultrasonography and Color
Doppler to Diagnosis of Pelvic Masses and its Corre-
lation with Histopathological Findings. Int J Sci Stud
2016;4:147-153
13. Timmerman D, Ameye L, Fischerova D, Epstein E,
Melis GB, Guerriero S, et al. Simple ultrasound rules
6
to distinguish between benign and malignant adnexal
masses before surgery: prospective validation by IOTA
group. BMJ. 2010 Dec 14;341:c6839.
14. Secil M, Dogra VS. Color Flow Doppler Evaluation of
Uterus and Ovaries and Its Optimization Techniques.
Ultrasound Clinic 2008; 3: 461–482.
15. Farnaz, Wahab S, Hassan L. Women with Ovarian
Masses. J Postgrad Med Inst 2012; 26: 73-78.
16. Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, van
Nagell JR. Preoperative differentiation of malignant
from benign ovarian tumors: the efficacy of morphol-
ogy indexing and Doppler flow sonography. Gynecol
Oncol. 2003;91:46-50.
17. Jokubkiene L, Sladkevicius P, Valentin L. Does three di-
mensional power Doppler ultrasound help in discrimi-
nation between benign and malignant ovarian masses?
Ultrasound Obstet Gynecol. 2007;29:215-225.
18. Abbas AM. Zahran KM, Nasr A, Kamel HS. A new
scoring model for characterization of adnexal masses
based on two-dimensional gray-scale and colour Dop-
pler sonographic features. Facts Views Vis Obgyn.
2014;6:68-74.
19. Shah D, Shah S, Parikh J, Bhatt CJ, Vaishnav K, Bala
DV. Doppler Ultrasound: A Good and Reliable Predic-
tor of Ovarian Malignancy. J Obstet Gynaecol India.
2013;63:186-189.
20. Dhwani D, Desai VA, Verma RN, Shrivastava A. Role of
gray scale and color Doppler in differentiating benign from
malignant ovarian masses. J Midlife Health. 2010;1:23–25.
21. Malhotra A, Tarafdar S, Tayade AT. Benign versus ma-
lignant adnexal masses: Does addition of Color and
Spectral Doppler over and above the Gray Scale Ultra-
sound improves diagnostic efficacy. Sch. J. App. Med.
Sci. 2016;4:62-74.
22. Gagandeep C, Avneet B, Gurinder S, Deepak G, Manjit
KM, Sanjay S. Role of combining colour Doppler and grey
scale ultrasound in characterizing adnexal masses. Jour-
nal of Family and Reproductive Health. 2012;6:42-47.
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
The Society of Radiologists in Ultrasound convened a panel of specialists from gynecology, radiology, and pathology to arrive at a consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. The panel met in Chicago, Ill, on October 27-28, 2009, and drafted this consensus statement. The recommendations in this statement are based on analysis of current literature and common practice strategies, and are thought to represent a reasonable approach to asymptomatic ovarian and other adnexal cysts imaged at ultrasonography.
Article
Full-text available
As a primary imaging modality, ultrasonography (US) can provide diagnostic information for evaluating ovarian masses. Using a pattern recognition approach through gray-scale transvaginal US, ovarian masses can be diagnosed with high specificity and sensitivity. Doppler US may allow ovarian masses to be diagnosed as benign or malignant with even greater confidence. In order to differentiate benign and malignant ovarian masses, it is necessary to categorize ovarian masses into unilocular cyst, unilocular solid cyst, multilocular cyst, multilocular solid cyst, and solid tumor, and then to detect typical US features that demonstrate malignancy based on pattern recognition approach.
Article
Full-text available
Objective: To determine the most discriminating two-dimensional gray-scale and colour Doppler sonographic features that allow differentiation between malignant and benign adnexal masses, and to develop a scoring model that would enable more accurate diagnosis with those features. 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 2D ultrasound for morphological features of the masses combined with colour Doppler examination of their vessels. The final diagnosis, based on histopathological analysis, was used as a gold standard. Results: One hundred forty-six patients were recruited, 104 with benign masses, 42 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; volume of mass, type of mass, presence and thickness of septae, presence and length of papillary projections, location of vessels at colour Doppler and colour score. A scoring model was formulated combining these features together; Assiut Scoring Model (ASM). The cut-off level with the highest accuracy in detection of malignancy, was ≥6, had a sensitivity of 93.5% and specificity of 92.2%. Conclusion: Our Scoring Model; a multiparameter scoring using four gray-scale ultrasound and two colour Doppler features, had shown a high sensitivity and specificity for prediction of malignancy in adnexal masses compared with previous scoring systems.
Article
Full-text available
Objective: To evaluate the adnexal masses with conventional gray scale and color Doppler flow imaging and to assess their diagnostic reliability to differentiate benign and malignant adnexal masses.Materials and methods: We evaluated 30 patients with adnexal mass. Morphological characterization of the mass was done using Sassone score. Color Doppler parameters noted down in each patient and Caruso vascular score was also used. The results were compared with surgical/ pathological and/or follow up scans.Results: Using sonomorphological score (Sassone) overall reliability of differentiating adnexal masses had sensitivity of 91.7% and specificity of 77.7%. Using Caruso score alone we had sensitivity of 83.3% and specificity of 88.9%. Using Sassone and Caruso score together we had sensitivity of 90.9% and specificity of 93.3%.Conclusion: In evaluation of adnexal masses combining both sonomorphological and color Doppler scores which gave higher specificity and positive predictive value (PPV) than using individual score alone.
Article
Objective: To determine the validity of serum CA125 levels in differentiating benign and ovarian cancer in patients with ovarian masses, using histopathology as a gold standard. Methodology: In this cross sectional study, blood samples were obtained from 85 women with ovarian masses who fulfilled the inclusion criteria and sent for the assay of serum CA125 levels. They were scheduled for elective surgery at Hayatabad Medical Complex Hospital between 1 st April, 2009 and 31st March 2010. Results: Of the 85 women enrolled, ovarian cancer was found in 27 cases (31.8%) and benign ovarian mass in 58 cases (68.2%). The sensitivity, specificity, and accuracy of serum CA125 at the cutoff level of 35 U/mL for prediction of ovarian cancer were 74.14%, 92.5%, 80% respectively; with 95.56% positive predictive value and 62.5% negative predictive value. Conclusion: As stand-alone modality, serum CA125 of more than 35 U/mL in predicting ovarian cancer revealed modest diagnostic accuracy.
Article
Objectives The aim of this study was to estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination and to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. MethodsA total of 3511 patients with an adnexal mass underwent transvaginal ultrasound examination between 1999 and 2007. Sonologists used the International Ovarian Tumor Analysis terms and definitions to describe their ultrasound findings. Only masses operated on within 120 days after the ultrasound examination were included in the analysis and the histopathological diagnosis of the mass was used as the gold standard. ResultsOf the 3511 masses, 1148 (33%) were classified as unilocular cysts on ultrasound. Of these, 11 (0.96% (95% CI, 0.48–1.71)) were malignant. The malignancy rate was lower in premenopausal than in postmenopausal women: 0.54% (5/931; 95% CI, 0.17–1.25) vs 2.76% (6/217; 95% CI, 1.02–5.92); P = 0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% vs 2%; P = 0.02) or ovarian cancer (18% vs 0.6%; P = 0.003). Hemorrhagic cyst contents on ultrasound were more common in malignant than in benign unilocular cysts (18% vs 2%; P = 0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. Conclusions The malignancy rate in surgically removed adnexal lesions judged to be unilocular cysts at transvaginal scan is c 1%. Postmenopausal status, personal history of breast or ovarian cancer and hemorrhagic cyst contents on ultrasound increase the risk of malignancy. To avoid misclassifying adnexal lesions as unilocular cysts at scan, it is important to scrutinize unilocular cysts for the presence of solid components. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Article
The primary imaging modality for evaluation of ovarian cystic lesions is pelvic ultrasonography. Most ovarian cysts are benign and demonstrate typical sonographic features that support benignity. However, some ovarian cystic lesions have indeterminate imaging features, and the approach to management varies. This article discusses how to recognize and diagnose different types of ovarian cystic lesions, including an approach to management. The learning objective is to recognize imaging features of ovarian cystic lesions.
Article
Aims The aim of the present study was to prove the efficiency of Color Doppler and Spectral Doppler in evaluation and characterization of the ovarian neoplasm. Materials and Methods In total, 104 patients with adnexal masses were examined sonographically to evaluate for morphologic characteristics, as well as pulsatility indices (PI), and resistance indices (RI) over a period of 2 years, of which 20 were excluded as the masses were not finally proven to be adnexal, and thus 84 patients with ovarian neoplasm were retained as the study subjects. The final diagnosis was based on histopathologic confirmation. Result Out of 84 cases, 44 were benign and 40 were malignant. Color Doppler showed vascularity in 97.5 % of malignant tumors in contrast to only 68.1 % of benign tumors. The present study showed that, 87.5 % of malignant tumors had PI less than 0.8 in contrast to only 4.54 % of benign tumors. Similarly, 82.5 % of malignant tumors had RI less than 0.6 in contrast to only 6.81 % of benign tumors. Conclusion Multiparameter analysis utilizing B-mode USG along with Color Doppler and Spectral Doppler is the mainstay in diagnosis of patients with ovarian tumors. A good specificity (84.1 %) and sensitivity (97.5 %) with PI and RI values of <1.0 and <0.6, respectively, was achieved with the present study which is highly significant in differentiating between malignant and benign ovarian tumours.
Article
Color flow Doppler (CFD) imaging provides valuable information about the vascularity of tissue, organs, or systems. CFD imaging is commonly used during the evaluation of uterus and ovaries in addition to gray-scale imaging and is a helpful imaging modality in the diagnosis of various pathologic conditions in gynecology and obstetrics. The main limitation of CFD imaging is its user dependency that may lead to misdiagnosis owing to the artifacts or pitfalls derived from improper technique, incorrect use of imaging parameters, and unawareness of physical properties of the modality by the user. This article summarizes the CFD imaging technique, the optimization of imaging parameters, and the useful findings in the evaluation of uterus and ovaries.