Objective To analyze the usefulness of transvaginal color
Doppler assessment of venous flow in the differential diagnosis
of adnexal masses.
Material and Methods Ninety-one consecutive patients
(mean age: 46.6 years, range: 16–81 years) diagnosed as
having an adnexal mass were evaluated by transvaginal color
Doppler sonography prior to surgery. Color Doppler was
used to detect and analyze the flow velocity waveform from
arterial and venous blood flow within the tumor. For arterial
signals the resistance index and peak systolic velocity, and for
veins the maximum venous flow velocity, were calculated.
Receiver operator characteristic curves were plotted to
determine the best venous flow velocity cut-off. According
to our previous study using arterial Doppler, a tumor was
considered as malignant when flow was detected and the
lowest resistance index was ≤ 0.45. Using venous Doppler a
mass was considered as malignant when flow was detected
and the venous flow velocity was ≥ the best cut-off found
on the receiver operator characteristic curve. Definitive
histopathological diagnosis was obtained in all cases. Sensitivity,
specificity, positive predictive value and negative
predictive value for B-mode morphology (evaluation performed
according to Sassone’s scoring system), arterial
Doppler, venous Doppler, and a combination of both arterial
and venous Doppler were calculated.
Results Twenty-five masses (27.5%) were malignant and 66
(72.5%) benign. Arterial and venous flow was found more
frequently in malignant than in benign masses (92% vs. 41%
(P < 0.001) and 72% vs. 21% (P < 0.001), respectively).
The resistance index was significantly lower in malignant
tumors (0.42 vs. 0.60, P = 0.0003). No differences were
found in peak systolic velocity. Venous flow velocity was
significantly higher in malignant masses (18.1 cm/s vs.
8.9 cm/s, P = 0.0006). The best cut-off of venous flow
velocity was 10 cm/s. Sensitivity, specificity, positive predictive
value and negative predictive value for morphology,
arterial Doppler, venous Doppler, and the combination of
both arterial and venous Doppler were 92%, 71%, 45%,
96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and
88%, 91%, 79%, 95%, respectively.
Conclusions Our results indicate that preoperative evaluation
by venous flow assessment of adnexal masses may be useful
to discriminate between malignant and benign tumors.