Significance of morphologic score and vascular index in the diagnosis of ovarian malignancy using ultrasonography

Lee, Jae Young; Park, So Jeong; Park, Ji No; Ki, Da Rin; Kim, Ki Min; Jo, Moon Kyoung; Kim, Chul Hong; Kim, Seok Mo; Choi, Ho Sun

Abstract

OBJECTIVE
The aim of this study was to know whether we can distinguish benign from malignant ovarian tumors according to morphologic scoring system (MS), blood flow characteristics (Resistance index (RI), Pulsatility index (PI)) using color doppler sonography and a combination of both in patients undergoing laparotomy or laparoscopy for a clinically diagnosed ovarian mass.
METHODS
From January 2001 to December 2003, 99 patients with ovarian tumors scheduled for laparotomy or laparoscopy were studied at our institute. Ultrasound was carried out to study the ovarian morphology followed by color doppler sonography. A score of > or =9 on MS, a PI< or =1 or a RI< or =0.4 was taken as suspicious for malignancy.
RESULTS
A score of > or =9 on MS as indicative of malignancy was associated with the following statistical parameters: sensitivity 69.6%, specificity 69.8%, positive predictive value (PPV) 75.0%, negative predictive value (NPV) 63.8%. A mean score of malignant tumor (9.8+/-2.64) is significantly higher than that of benign tumor (7.5+/-2.44). This was statistically significant (p[t]<0.05). A resistance index (RI) < or =0.4 was associated with sensitivity 19.6%, specificity 97.6%, PPV 91.6%, NPV 48.2%. A pulsatility index (PI) < or =1.0 was associated with sensitivity 44.6%, specificity 81.3%, PPV 75.7%, NPV 53.0%. A mean of RI in malignancy (0.64+/-0.277) is lower than that of RI in benign tumor (0.79+/-0.299). A mean of PI in malignancy (1.34+/-0.982) is lower than that of PI in benign tumor (2.06+/-1.310). These was statistically significant (p[t]<0.05). The addition of RI or PI to MS did not improve the accuracy in predicting ovarian malignancy.
CONCLUSION
Although RI or PI achieved better specificity and PPV compared to MS, the addition of RI or PI to MS did not increase its accuracy in the discrimination between benign and malignant ovarian tumors.