Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses
Keywords:HPE, PI, RI, Ultrasonography
Background: Ovarian cancer is the most frequent cause of death from Gynaecological malignancies in the world. Most patients with epithelial ovarian cancer are asymptomatic in early stage disease and usually present with stage III or IV disease. There are various screening methods for detection of ovarian cancer like bimanual pelvic examination, ultrasound examination (TVS and TAS) with or without color Doppler flow imaging and measurement of various circulating proteins like CA 125. The Purpose of a study is to determine optimal cut off point for a morphological scoring system and color flow directed Doppler values to differentiate benign and malignant ovarian masses.
Methods: This study was done at Department of obstetrics and Gynaecology, Government Rajah Mirasudhar Teaching Hospital attached to Government Thanjavur Medical College, Thanjavur, Tamilnadu, India during the period of June – 2011 to October – 2012. This study consisted of 73 patients, 3 patients were not operated as they were not fit for surgery for medical reasons. Hence 70 patients were included in the study. A note was made of their main symptoms at admission, Parity, menopausal status, family history of carcinoma. Patients admitted with diagnosis of ovarian masses and clearly ovarian by sonomorphology and surgery were only included in this study. Morphological Score, RI and PI were calculated. All patients underwent exploratory laparotomy with surgical removal of the tumor. The final diagnosis obtained based on HPE were classified as either benign or malignant. The score of each mass and the Doppler values were assessed individually and in combination with regard to its relationship to final diagnosis.
Results: In summary the resistance to flow measurement obtained by Doppler had a higher sensitivity and specificity compared to the morphological scoring system in differentiating benign and malignant ovarian masses. The combination of morphological score and Doppler Measurements improved the specificity positive predictive value for differentiating benign and malignant ovarian masses.
Conclusions: The combination of ultrasound and Doppler values is better in differentiating benign from malignant ovarian masses. The cut off point for ultrasound guided morphological scoring system was 4 and Doppler velocimetry for differentiating benign and malignant ovarian masses was a RI of 0.55 and PI of 0.8.
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