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Complex Pelvic Mass as a Target of Evaluation of Vessel Distribution by Color Doppler Sonography for the Diagnosis of Adnexal Malignancies

Results of a Multicenter European Study

Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy (S.G., S.A., M.B., M.G., G.B.M.); Department of Obstetrics and Gynecology, University of Navarra, Pamplona, Spain (J.L.A.); and Department of Obstetrics and Gynecology, University of Florence, Florence, Italy (M.E.C., G.S.).

Address correspondence and reprint requests to Stefano Guerriero, MD, Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy.

Objective. To compare the diagnostic accuracy of gray scale sonography and color Doppler imaging in the differential diagnosis of adnexal malignancies from benign complex pelvic masses in a multicenter prospective study. Methods. The study was performed as a collaborative work at 3 European university departments of obstetrics and gynecology. A total of 826 complex pelvic masses on which transvaginal sonography and evaluation of cancer antigen 125 plasma concentrations were performed before surgical exploration were included in the study. The scanning procedure was the same in the 3 institutions. An adnexal mass was first studied in gray scale sonography, and a probable histologic type was predicted. Second, solid excrescences or solid portions of the tumor were evaluated for vascular flow with color Doppler sonography (conventional or power). A mass was graded malignant if flow was shown within the excrescences or solid areas and benign if there was no flow. The overall agreement between the test result and the actual outcome was calculated by statistics. Results. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with gray scale sonography ( = 0.82 and 0.65, respectively) because of significantly higher specificity (0.94 versus 0.84; P < .001). The evaluation of the cancer antigen 125 plasma concentration did not seem to increase the accuracy of either method. Conclusions. The evaluation of vessel distribution by color Doppler sonography in complex adnexal cysts seems to increase the diagnostic accuracy of gray scale sonography in the detection of adnexal malignancies in a large study population.

Key Words: Color Doppler sonography • complex ovarian masses • ovarian cancer • sonography

Abbreviations: CA-125 • cancer antigen 125

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