| Summary: | The aim of this study was to establish which of several commonly used parameters
performs best in the evaluation of adnexal masses by transvaginal color Doppler
sonography. A total of 79 adnexal masses in 73 consecutive patients were included
in the study. There were 43 (58.9%) premenopausal and 30 (41.1%) postmenopausal
patients. The median age was 45 years (range 20-78 years). The parameters
compared were: number of vessels detected in each tumor, tumor vessel location
(central vs. peripheral), peak systolic velocity (PSV), lowest resistance index
(RIlowest), mean resistance index (RImean), lowest pulsatility index (PIlowest)
and mean pulsatility index (PImean). Receiver operating characteristic (ROC)
curves were plotted to analyze the test performance of the parameters, except for
tumor vessel location, and to estimate the best cut-off value of the parameters
studied to differentiate between malignant and benign tumors. Definitive
histopathological diagnosis was obtained in every case and used as the 'gold
standard'. There were 20 (25.3%) malignant and 59 (74.7%) benign masses. Color
Doppler signals were detected in 100% of the malignant masses (20 out of 20) and
74.6% (44 out of 59) of the benign masses, and the difference was found to be
statistically significant (p < 0.001). Tumor vessel location was central in 18
out of 20 (90%) malignant masses, whereas it was peripheral in 39 out of 44
(88.6%) benign masses. ROC analysis showed that the best cut-off values for
number of vessels, PSV, RIlowest, RImean, PIlowest and PImean were three vessels,
25 cm/s, 0.45, 0.55, 0.90 and 1.50, respectively. However, for all these
parameters except RIlowest, there was a considerable overlap between benign and
malignant tumors, with a high false-positive rate. In conclusion, in our
experience, the parameters that performed best were the RIlowest with a cut-off
value of 0.45 (sensitivity 100%; false-positive rate 11.4%) and central tumor
vessel location (sensitivity 90%; false-positive rate 11.4%).
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