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Three-Dimensional Power Doppler Vascular Sonographic Sampling for Predicting Ovarian Cancer in Cystic-Solid and Solid Vascularized Masses

Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain (J.L.A.); and Department of Obstetrics and Gynecology, Hospital San Joan de Deu, University of Barcelona, Barcelona, Spain (D.R.).

Address correspondence to Juan Luis Alcázar, MD, Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain., E-mail: jlalcazar{at}unav.es

Objective. The purpose of this study was to explore the role of 3-dimensional (3D) power Doppler (PD) sonography to discriminate between benign and malignant cystic-solid and solid vascularized adnexal masses and to define cutoff values for 3D PD indices to be used in a clinical setting. Methods. A total of 143 consecutive women (mean age, 50.4 years; range, 17–82 years) with diagnoses of cystic-solid or solid vascularized adnexal masses on B-mode and 2-dimensional PD sonography were evaluated by 3D PD sonography before surgery. Three-dimensional PD sonography was used to assess vascularization within papillary projections and solid areas with a virtual organ computer-aided analysis program. Three-dimensional PD vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) were automatically calculated. A definitive histologic diagnosis was obtained in each case. Results. A total of 113 masses (74%) were malignant, and 39 (26%) were benign. Morphologic evaluation revealed 30 unilocular solid masses (19.7%), 43 multilocular solid masses (28.3%), and 79 mostly solid masses (52%). The mean VI (9.365% versus 3.3%; P < .001), FI (34.318 versus 28.794; P < .001), and VFI (3.233 versus 1.15; P < 0.01) were significantly higher in malignant tumors. No differences were found in the resistive index, pulsatility index, and peak systolic velocity. Receiver operating characteristic analysis revealed an area under the curve of 0.77 (95% confidence interval, 0.69–0.85), 0.71 (0.60–0.81), and 0.75 (0.66–0.83) for the VI, FI and VFI, respectively. For reducing the false-positive rate by almost one-third, sensitivity values for the VI (cutoff, 1.556%), FI (25.212), and VFI (0.323) were 92%, 95%, and 93%, respectively. Conclusions. Three-dimensional PD vascular indices could be helpful for reducing the false-positive rate in cystic-solid and solid vascularized adnexal masses.

Key Words: adnexal mass • ovarian cancer • 3-dimensional power Doppler sonography

Abbreviations: AUC, area under the curve • CI, confidence interval • FI, flow index • PD, power Doppler • PI, pulsatility index • PSV, peak systolic velocity • RI, resistive index • 3D, 3-dimensional • VFI, vascularization-flow index • VI, vascularization index • VOCAL, virtual organ computer-aided analysis