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Three-Dimensional Quantification of Tumor Vascularity as a Tertiary Test After B-Mode and Power Doppler Evaluation for Detection of Ovarian Cancer

Departments of Obstetrics and Gynecology (S.G., S.A., S.P., M.G., S.F., N.G., A.M.P., G.B.M.) and Public Health (L.M.), University of Cagliari, Cagliari, Italy.

Address correspondence to Stefano Guerriero, MD, Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy. E-mail: gineca.sguerriero{at}tiscali.it

Objective. The purpose of this study was to investigate the role of 3-dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2-dimensional power Doppler sonography. Methods. One hundred fifty-seven consecutive pelvic masses in 153 patients were included in this study and underwent sonography before surgery. Masses that showed a typical benign pattern on B-mode sonography (n = 112) and indeterminate masses with peripheral or absent flow on power Doppler sonography (n = 10) were not evaluated by 3D sonography. Only masses with central vascularization were submitted to 3D power Doppler imaging (n = 35). The following 3D vascular parameters were calculated: relative color and flow measure (similar to the vascularization flow index obtained with other systems). Results. With receiver operating characteristic curve analysis, the best cutoff values for relative color and flow measure were 4.4 and 2.7, respectively. Flow measure had sensitivity of 68% and specificity of 40% in the overall population submitted to 3D power Doppler sonography. Accuracy slightly increased when masses with small papillary projections (<10 mL) were excluded. In this group (n = 22), sensitivity was 83%, and specificity was 50%. Conclusions. In masses with central vascularization on 2-dimensional power Doppler sonography, the use of 3D quantification of tumor vascularity had low diagnostic accuracy in the detection of adnexal malignancies, although an increase in accuracy in masses with a solid portion of greater than 10 mL was reported.

Key Words: angiogenesis • ovarian cancer • 3-dimensional power Doppler sonography • 3-dimensional sonography • transvaginal color Doppler sonography • transvaginal sonography

Abbreviations: CI, confidence interval • LR, likelihood ratio • RI, resistive index • 3D, 3-dimensional • 2D, 2-dimensional • VFI, vascularization flow index • VOCAL, Virtual Organ Computer-Aided Analysis

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