Validity of pulsatility and resistance indices in classification of adnexal tumors with transvaginal color Doppler ultrasound

Abstract

Transvaginal pulsed color Doppler ultrasound was used to examine 72 patients with a pelvic mass preoperatively. Tumor morphology was assessed, prominent areas of vascularization within the tumor were observed and the pulsatility index and the resistance index of tumor and uterine arteries were measured. Flow velocity waveforms with low pulsatility are considered to reflect neovascularization. The ultrasound diagnoses were compared with histopathological or cytological diagnoses. There were 61 benign, eight malignant and three borderline cases. In 75% of the malignant and 23% of the benign tumors, an intratumoral flow with a low pulsatility was detectable. The mean pulsatility index of tumor blood vessels was 1.2 in benign, 0.7 in malignant and 0.6 in borderline neoplasms. The corresponding mean resistance index values were 0.6, 0.5 and 0.5. The differences were not significant and the overlap between the malignant and benign lesions was large. The pulsatility index and resistance index of uterine arteries were significantly decreased in malignant tumors. The results show that, using a cut-off resistance index value of 0.6, the sensitivity and specificity of color Doppler in the detection of malignant and potentially malignant tumors were 82% and 72%, respectively. However, a practical cut-off level for either pulsatility or resistance indices, that could assist in differentiating between malignant or benign lesions, does not seem to exist.

Transvaginal color Doppler assessment of venous flow in adnexal masses

“…The results have been controversial. Some authors have found this technique useful 2 -10 , whereas others have not [11][12][13][14][15][16][17] . Some factors put forward to explain these conflicting results include differences in sonographers' experience, different sensitivity in ultrasound machines and the lack of standarization of Doppler measurements 27 .…”

“…Although some authors have found this technique useful [2][3][4][5][6][7][8][9][10] , others have questioned these results [11][12][13][14][15][16][17] .…”

Two‐ and three‐dimensional Doppler ultrasound analysis of abdominal wall clear cell carcinoma

“…In the past, individual sonographic, demographic, and biochemical variables were used to distinguish between benign and malignant adnexal masses 4 . However, used alone, the diagnostic accuracy of these variables was poor.…”

Tissue Block Ultrasound and Ovarian Cancer— A Pictorial Presentation of Findings

“…Despite now decades of observations and improved imaging technology, 2D images results in many surgeries for benign masses predicted to be cancer (PPV varying from 40-96 %). [3][4][5][6] The original description of "tumor vascularity" is credited to Strickland (1959). In his study of bone tumors, Strickland described a tumor vessel as one that was "deployed seemingly without purpose, and keeps to no set course and shows no progressive diminution in caliber."…”