Sonographic morphological pattern in the pre-operative prediction of ovarian masses.

The study was undertaken to evaluate the accuracy of sonographic morphological pattern in the detection of ovarian malignancy. A total of 123 patients with a suspicion of ovarian pathology, who were scheduled for elective surgery at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University were included in the study. All patients underwent sonographic examination prior to surgery by the same physician. The sonographic morphological pattern of each patient was compared to the histological diagnosis of the ovarian tumors. Of the 120 patients with an ovarian lesion, the sonographic morphological pattern of 10 had a sensitivity of 88.6 per cent and a specificity of 89.4 per cent in detection of malignant ovarian tumors. The positive predictive value, negative predictive value, and the accuracy rate were 77.5, 95.0, and 89.2 per cent, respectively. In the present study, a score of 9 would be the best discriminator between benign and malignant ovarian masses, giving a sensitivity of 97.1 per cent and specificity of 82.4 per cent. As stand alone, the present results confirm that ultrasonography is still a useful diagnostic tool in the differentiation of benign from malignant ovarian masses.

Color Doppler ultrasonography for prediction of malignant ovarian tumors.

The purpose of this cross-sectional study was to evaluate whether the pulsatility index determined by the color Doppler sonography could be used to distinguish between benign and malignant ovarian tumors. A total of 120 patients who had their ovarian tumors removed surgically at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University were included in the study. Each patient had color Doppler sonography performed prior to laparotomy. The Doppler results were compared to the histological diagnosis of the ovarian tumors. Of the 113 patients whose intratumoral blood flow could be evaluated, the pulsatility index was significantly lower in malignant lesions than in benign lesions (0.85 +/- 0.46 vs 1.63 +/- 0.64, p<0.001). The sensitivity, specificity, and accuracy of the pre-operative pulsatility index (< or = 1.0) in detecting malignant ovarian tumors were 82.9 per cent, 80.8 per cent, and 81.4 per cent, respectively; with 65.9 per cent positive predictive value, 91.3 per cent negative predictive value, 19.2 per cent false positive rate, and 17.1 per cent false negative rate. The present results suggest that color Doppler sonography may be a useful clinical tool in the pre-operative evaluation of ovarian masses. However, the pulsatility indexes showed considerable overlap between benign and malignant lesions, indicating that color Doppler sonography has limitations in the differentiation of benign from malignant ovarian masses. The cost of the equipment and experience requirement also limits its use in general gynecologic practice.