Ultrasonographic and color doppler evaluation of adnexal masses

ABSTRACT

This is a prospective study conducted on 30 patients with adnexal masses, presented at El-Minia University Hospital at Gynecology department. The aim of this study was how to differentiate between benign and malignant adnexal swellings depending on morphological criteria of the lesion by abdominal and transvaginal gray scale ultrasonography and color Doppler and Pulsed Doppler parameters. The examined females ages ranged between 14 to 70 years with a mean age 42.5 year. Dermoid cyst and infected simple cysts were the most common benign lesions evaluated in our study. Mucinous cystadenocarcinoma was the most common malignant lesion detected. We followed an objective scheme for sonographic assessment of adnexal masses depending on morphological criteria including wall thickness, echogenicity, septations and inner wall structure. Our results revealed that this score is sensitive [100 percent] but less specific [56.3 percent]. As this score is numerical so changing the threshold to 10 instead of 9, the score will be less sensitive but more specific. Color Doppler assessment depends upon vessel location whereas central vessels usually indicate malignant lesions while peripheral detection of vascularity with benign lesions. Diastolic notch was present with benign lesions while absent at malignant lesions as neovascularity have no smooth muscle support. Resistive index [RI] at 0.6 was sensitive in differentiation between benign and malignant lesions [100 percent] but less specific [42.9 percent], changing the parameter to 0.4, the sensitivity become 78.6 percent and specificity 85.6 percent. As regards pulsatility index [PI] a cut off 1 gave sensitivity 100 percent and specificity 92.9 percent and accuracy of 96.4 percent. The combination of ultrasonographic scoring system with Doppler indices was able to discriminate between benign and malignant adnexal masses as this combination correctly identified 13 out of 14 ovarian cancer and rolled out the disease in 14 out of 16 benign cases