Sonography of ovarian masses: poor sensitivity of resistive index for identifying malignant lesions.

Levine, Deborah; Feldstein, Vickie A.; Babcook, Catherine J.; Filly, Roy A.

doi:10.2214/ajr.162.6.8191998

Cited by 73 publications

(38 citation statements)

References 13 publications

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“…It is factually correct that low impedance to blood flow with high velocity is suggestive of malignancy, whereas moderate-tohigh impedance to blood flow is correlated to benign tumors. Resistive indices less than 0.4-0.8 [3,5] and pulsatility indexes less than 1.0 are generally considered to be suspicious for malignancy [3][4][5][6]. In the present study, PI \ 0.8 and RI \ 0.6 were considered for analysis.…”

Section: Resultsmentioning

confidence: 99%

Doppler Ultrasound: A Good and Reliable Predictor of Ovarian Malignancy

Shah¹,

Shah

Parikh³

et al. 2012

J Obstet Gynecol India

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Aims The aim of the present study was to prove the efficiency of Color Doppler and Spectral Doppler in evaluation and characterization of the ovarian neoplasm. Materials and Methods In total, 104 patients with adnexal masses were examined sonographically to evaluate for morphologic characteristics, as well as pulsatility indices (PI), and resistance indices (RI) over a period of 2 years, of which 20 were excluded as the masses were not finally proven to be adnexal, and thus 84 patients with ovarian neoplasm were retained as the study subjects. The final diagnosis was based on histopathologic confirmation. Result Out of 84 cases, 44 were benign and 40 were malignant. Color Doppler showed vascularity in 97.5 % of malignant tumors in contrast to only 68.1 % of benign tumors. The present study showed that, 87.5 % of malignant tumors had PI less than 0.8 in contrast to only 4.54 % of benign tumors. Similarly, 82.5 % of malignant tumors had RI less than 0.6 in contrast to only 6.81 % of benign tumors. Conclusion Multiparameter analysis utilizing B-mode USG along with Color Doppler and Spectral Doppler is the mainstay in diagnosis of patients with ovarian tumors. A good specificity (84.1 %) and sensitivity (97.5 %) with PI and RI values of \1.0 and \0.6, respectively, was achieved with the present study which is highly significant in differentiating between malignant and benign ovarian tumours.

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Section: Resultsmentioning

confidence: 99%

Doppler Ultrasound: A Good and Reliable Predictor of Ovarian Malignancy

Shah¹,

Shah

Parikh³

et al. 2012

J Obstet Gynecol India

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“…[15][16] A comparison of various studies has shown that that RI 0.4 and PI <1 is highly suggestive of malignancy. [17][18][19][20][21][22][23] Conventional USG lacks specificity to differentiate between benign and malignant masses. So, this study is conducted to see the effectiveness of colour flow mapping and pulsed Doppler studies in determining the nature of tumour.…”

Section: Introductionmentioning

confidence: 99%

How successful is color flow mapping and pulsed Doppler studies in predicting histologically confirmed benign and malignant adnexal masses in perimenopausal women

Gangopadhyay

Chakraborty

Singh

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Adnexal masses in perimenopausal women presents a specific diagnostic challenge because benign masses outnumbers malignant masses. Majority of adnexal masses are benign but 25% are malignant. The objective of this study was to see the effectiveness of transvaginal colour Doppler in predicting malignancy in adnexal masses in perimenopausal women.Methods: Clinically detected adnexal masses were subjected to transabdominal ultrasound scan (for basic characterization of mass into solid, cystic, mixed) then transvaginal scan and neovascularization, resistivity index (RI) was measured. Subsequently all patients underwent laparotomy. Histopathological reports obtained, and correlation done between USG and histopathology.Results: Among cystic masses neovascularization was present in 4 cases, among them benign and malignant masses were equal in number. Among mixed masses neovascularization was present in 17 cases 9 were malignant 8 benign, among solid masses all cases where neovascularization was detected were malignant. Neovascularization was absent in 12 cystic masses and 11 mixed masses, and all were benign. Kappa value calculated for tumour status and neovascularization is 0.610 which is substantially agreement with neovascularization as predictor of malignancy. Sensitivity, specificity, positive predictive value and negative predictive value of neovascularization for cystic masses are 100, 85, 50, 100(%) respectively. Sensitivity, specificity, positive predictive value and negative predictive value of neovascularization for mixed masses are 100, 57.89, 52.94, 100(%) respectively. Sensitivity and positive predictive value of neovascularization for solid masses is 100(%). Sensitivity specificity positive predictive value and negative predictive value of RI for cystic masses: 100, 92.8, 66.6, 100 (%) respectively. Sensitivity specificity positive predictive value and negative predictive value of RI for mixed masses: 77.7, 89.4, 77.7, 89.4(%). Sensitivity positive predictive value of RI for solid masses 100%.ROC curve analysis shows cut off value for differentiating between benign and malignant masses is 0.4. Less than 0.4 has more chance of malignancy.Conclusions: Transvaginal Doppler ultrasound must be done preoperatively for adnexal mass characterization.

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“…The results of SCHNEIDER et al 35 , for RI <0.40 values were remarkably similar. Subsequent studies have also showed low rates of detection for ovarian cancer when using different cutoff values [36][37][38][39] . The false positive rates in these investigations varied from 2% to 48%.…”

Section: Discussionmentioning

confidence: 99%

Color Doppler sonography with contrast in the differentiation of ovarian tumors

et al. 2003

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The objective of this study was to differentiate benign ovarian tumors from malignant ones before surgery using color and pulsed Doppler sonography, and to compare results obtained before and after use of contrast medium, thereby verifying whether contrast results in an improvement in the diagnostic sensitivity.METHODS: Sixty two women (mean age 49.9 years) with ovarian tumors were studied, 45 with benign and 17 with malignant tumors. All women underwent a transvaginal color Doppler ultrasonographic exam. A study of the arterial vascular flow was made in all tumor areas, as well as an impedance evaluation of arterial vascular flow using the resistance index.RESULT: Localization of the vessels in the tumor revealed a greater proportion of malignant tumors with detectable internal vascular flows (64%) than benign tumors with such flows (22%). There was a considerable overlap of these findings. The use of contrast identified a greater number of vessels with confirmation in the totality of tumors, but did not improve the Doppler capacity in tumoral differentiation. Malignant tumors presented lower values of resistance index than the benign ones, whether or not contrast was used. The cutoff value for resistance index that better maximized the Doppler sensitivity and specificity was 0.55. Through this value, an increase of the sensitivity after contrast use was obtained, varying from 47% to 82%, while specificity remained statistically unchanged.CONCLUSION: Although the injection of a microbubble agent improved the sensitivity of the method detecting vascularization of tumors, a positive finding for vascularization by this method was not clinically useful in the differentiation of benign and malignant ovarian tumors. Considerable evidence indicates that neovascularization is responsible for the tumoral growth and invasion 1 . Ultrasonography with color and pulsed Doppler provides dynamic information concerning the distribution of tumor vessels and their impedance value through the determination of resistance (RI) and pulsatility (PI) indices. Preliminary data suggests that it is possible to detect vascular changes associated with angiogenesis in early ovarian cancer through this technique 2 . A possible explanation for these changes is that the new blood vessels present in the carcinomas have limited muscular tonus due to the absence of the medial layer and that together with numerous existing arteriovenous shunts, they would be responsible for the low impedance registered by the RI and PI indices. However, this method presents some restrictions associated with the inaccessibility to the small caliber vessels, thus demonstrating low sensitivity for the intended purpose 3 . The advent of echo-enhancing substances for endovenous use, according to experiences in other organs 4 , would allow better visibility of these vessels, thereby helping in the differentiation of the neoplastic process. 186REV. HOSP. CLÍN. FAC. MED. S. PAULO 58(4): [185][186][187][188][189][190][191][192] 2003 Color Doppler sonography with contrast...

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Sonography of ovarian masses: poor sensitivity of resistive index for identifying malignant lesions.

Cited by 73 publications

References 13 publications

Doppler Ultrasound: A Good and Reliable Predictor of Ovarian Malignancy

Doppler Ultrasound: A Good and Reliable Predictor of Ovarian Malignancy

How successful is color flow mapping and pulsed Doppler studies in predicting histologically confirmed benign and malignant adnexal masses in perimenopausal women

Color Doppler sonography with contrast in the differentiation of ovarian tumors

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