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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:249-254 • 0278-4297

Three-dimensional Sonographic Morphologic Assessment in Complex Adnexal Masses

Preliminary Experience

Juan Luis Alcázar, MD, María José Galán, MD, Manuel García-Manero, MD and Stefano Guerriero, MD

Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain (J.L.A., M.J.G., M.G.-M.); and Department of Obstetrics and Gynecology, Ospedale San Giovanni di Dio, University of Cagliari, Cagliari, Italy (S.G.).

Address correspondence to Juan Luis Alcázar, MD, Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.

Objective. To evaluate the role of three-dimensional transvaginal sonography in assessing complex adnexal masses. Methods. Forty-one women (mean age, 49.5 years; range, 23–75 years) with the diagnosis of complex adnexal masses on the basis of two-dimensional transvaginal sonography were reevaluated by three-dimensional transvaginal sonography. Two different sonologists evaluated the two- and three-dimensional transvaginal sonograms. Criteria indicative of malignancy included the presence of gross papillary projections, solid areas, and solid echogenicity for both techniques. Three women (7%) had bilateral masses, giving a total of 44 masses that were ultimately assessed. A definitive histologic diagnosis was obtained in every case after surgical tumor removal. Results. Twenty-one tumors (47.7%) were proved malignant, and 23 (52.3%) were benign. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for two- and three-dimensional transvaginal sonography were 90%, 61%, 68%, 87%, and 75% and 100%, 78%, 81%, 100%, and 89%, respectively. There were no statistical differences between two- and three-dimensional transvaginal sonography (McNemar test, P = .687). The agreement between both examiners was high ({kappa} index = 0.71). Conclusions. The use of three-dimensional transvaginal sonography does not significantly improve the two-dimensional transvaginal sonographic morphologic assessment of complex adnexal masses; however, we found it useful for reinforcing initial diagnostic impressions.

Key Words: adnexal masses • sonography • three-dimensional • two-dimensional

Abbreviations: NPV, negative predictive value • PPV, positive predictive value • 3D, three-dimensional • 2D, two-dimensional • TVS, transvaginal sonography




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