Clinical value of the ultrasound Doppler index in determination of ovarian tumor malignancy

Purpose of investigation: Clinical evaluation of the newly created Doppler index (DS) in preoperative early differentiation of ovarian tumor malignancy.

Patients and methods: The study involved data concerning 464 ovarian tumor examinations of women treated between 1994 and 2002. One hundred and sixty-five woman had malignant ovarian tumors, and the other 299 tumors were benign on histopathology. Menopausal status of the studied women was also considered. Created ROC curves compare the diagnostic value of the suggested index. The number of vessels, their location and arrangement, shape of velocity waves as well as presence of the protodiastolic notch in the arterial vessels of the tumor were analyzed. Each of the mentioned features could acquire a point-value of 0 or 1.

Results: A cut-off point for the suggested Doppler index was determined at the level of 4 for the following prognostic values: sensitivity, specificity and accuracy which amounted to 86.7%; 93.3% and 90.9%, respectively. In the group of 101 postmenopausal women accuracy was higher--94.1%, specificity and positive predictive value (PPV) was estimated as 100%.

Conclusions: The suggested Doppler index enables a precise prognosis of ovarian tumor malignancy and as a half-amount analysis helps in the decision making of the most effective therapeutic treatment.

Diagnostics; Doppler ultrasonography; Ovarian cancer; Ovarian tumors

[1] DePriest P.D., Shenson D., Fried A., Hunter J.E., Andrews S.J., Gallion H.H. et al.: "A morphology index based on sonographic findings in ovarian cancer". Gynecol. Oneal., 1993, 51 (1), 7.

[2] Sassone A.M., Timor-Tritsch I.E., Artner A., Westhoff C., Warren W.B.: "Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy". Obstet. Gynecol., 1991, 78 (1), 70.

[3] Valentin L., Sladkevicius P., Marsal K.: "Limited contribution of Doppler velocimetry to the differential diagnosis of extrauterine pelvic tumors". Obstet. Gynecol., 1994, 83, 425.

[4] Kurjak A., Predanic M., Kupesic-Urek S., Jukic S.: "Transvaginal color and pulsed Doppler assessment of adnexal tumor vascularity". Gynecol. Oneal., 1993, 50 (1), 3.

[5] Szpurek D., Sajdak S., Obrebowska A., Olejnik M., Danska A., Spaczynski M.: "Th e evaluation of ovarian tumor vascularization using color Doppler transvaginal ultrasonography". Ginekol. Pol., 1995, 66 (1), 32.

[6] Caruso A., Caforio L., Testa A.C., Ciampelli M., Panici P.B., Mancuso S.: "Transvaginal color Doppler ultrasonography in the presurgical characterization of adnexal masses". Gynecol. Oneal., 1996, 63 (2), 184.

[7] Szpurek D., Sajdak S., Moszynski R., Roszak A.: "Estimation of neovascularisation in hyperplasia and carcinoma of endometrium using a "power" angio-Doppler technique". Eur. J. Gynaecol. Oncol., 2000, 21 (4), 405.

[8] Kurjak A., Zalud I., Jurkovic D.: "Transvaginal color Doppler for the assessment of pelvic circulation". Acta Obstet. Gynecol. Scand., 1989, 68, 131.

[9] Tepper R., Lerner-Geva L., Altaras M.M., Goldberger S., BenBaruch G., Markov S. et al.: "Transvaginal color flow imaging in the diagnosis of ovarian tumors". J. Ultrasound Med., 1995, 14 (10), 731.

[10] Guerriero S., Ajossa S.，Risalvato A.: "Diagnosis of adnexal malignancies using color Doppler energy imaging as a secondary test in persistent masses". Ultrasound Obstet. Gynecol., 1998, 11, 277.

[11] Valentin L.: "Gray scale sonography, subjective evaluation of the color Doppler image and measurement of blood flow velocity for distinguishing benign and malignant tumors of suspected adnexal origin". Eur. J. Obstet. Gynecol. Reprod. Biol., 1997, 72 (1), 63.

[12] Folkman J.: "The role of angiogenesis in tumor growth". Semin. Cancer Biol., 1992, 3 (2), 65.

[13] Sawicki W., Spiewankiewicz B., Cendrowski K., Stelmachow J.: "Preoperative discrimination between malignant and benign adnexal masses with transvaginal ultrasonography and colour blood flow imaging". Eur. J. Gynaecol. Oneal., 2001, 22, 137.

[14] Priimpeller H.J., Madjar H., Sauerbrei W., Latterman U., Pfleiderer A.: "Quantitative flow measurements for classification of ovarian tumors by transvaginal color Doppler sonography in postmenopausal patients". Ultrasound Obstet. Gynecol., 1994, 4, 406.

[15] Roman L.D., Muderspach L.1., Stein S.M., Laifer-Narin S., Groshen S., Morrow C.P.: "Pelvic examination, tumor marker level, and gray-scale and Doppler sonography in the prediction of pelvic cancer". Obstet. Gynecol., 1997, 89 (4), 493.

[16] Tekay A., Jouppila P.: "Blood flow in benign ovarian tumors and normal ovaries during the follicular phase". Obstet. Gynecol., 1995, 86 (1), 55.