Transvaginal color Doppler sonography in the prediction of adnexal malignancy

Background: The aim of this study was to assess the ability of transvaginal color Doppler sonography to predict adnexal malignancy. Materials and Methods: From July 1991 to June 1993 at Mackay Memorial Hospital, 801 cases of adnexal tumor were collected. Their tumor vascularization characteristics were investigated by transvaginal color Doppler sonography preoperatively. Results: Of the total number, 740 cases were found to be benign, six cases were borderline malignant and 55 cases were malignant. All benign tumors had a resistance index (RI) > 0.40 with most having an RI > 0.60. Five cases of borderline malignancy had an RI between 0.40 and 0.60. With the exception of three cases, all malignant tumors had an RI ≤ 0.40. There was an overlap of RI value (0.40-0.60) between benign and malignant adnexal tumors. Applying a cut-off value of 0.60, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 98.4%, 93.8%, 56.6%, 99.8% and 94.1%, respectively. For a cut-off value of 0.40, these were 85.2%, 100%, 100%, 98.8% and 98.9%, respectively. In addition, the blood vessels in malignant tumors tended to be located centrally, septally or in the papillae, whereas in benign tumors they tended to be peripherally located. There was no diastolic notch noted in the arterial waveform of malignant tumors. Conclusions: When combined with conventional transvaginal sonography, transvaginal color Doppler sonography with multiparameter analysis helps significantly in the prediction of adnexal malignancy.