Cross Validation of Doppler Ultrasound and Grayscale Imaging for Discrimination of Benign and Malignant Adnexal Masses

Objective: To prospectively assess the diagnostic performance of Doppler ultrasound and grayscale imaging for the discrimination of benign and malignant adnexal masses. Study design: Observational study. Duration: January 2002 to December 2003. Setting: Mother and Child Health (MCH) Center, Unit II, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Subjects: Patients with an adnexal mass who were scheduled for surgery in the study. Patients managed conservatively were excluded. Methods: All subjects underwent a preoperative grayscale and color Doppler ultrasound. On the basis of subjective evaluation, each tumor was classified as benign or malignant. Results of diagnostic studies were correlated with pathological evaluations of the excised specimens. Main outcome measures: Sensitivity, specificity, positive predictive value, and negative predictive value of both modes of ultrasound. Results: A total of 117 patients were examined during the study period. Gray scale echopatterns considered ominous for malignancy were solid components, thick septae, papillary projections, and ascites. Using Doppler flow studies, malignant neoplasms offered lower resistance to blood flow, as measured by the resistance index (RI) and the pulsatility index (PI). The mean PI of benign tumors was 1.6 ± 0.4 vs. 0.7 ± 0.1 of malignant masses, and the mean RI was 1.2 ± 0.3 vs. 0.4 ± 0.1 of malignant tumors. The sensitivity and specificity of grayscale was 82% and 80%, while for Doppler imaging it was 91% and 95%, respectively. The positive predictive value of grayscale was 30.0% vs. a 66.7% predictive value of Doppler imaging, and the negative predictive value was 98% vs. 99% of Doppler