Doppler and 3D ultrasound in prediction of the nature of adnexal swelling

Abstract

Background: An adnexal mass (mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic problem. Early diagnosis and intervention is essential especially in younger women to conserve the ovarian function. Aim of the Work: to evaluate the usefulness and value of Doppler and 3D Ultrasound as a method to enhance differentiation between benign and malignant pathologies before surgical intervention in women having adnexal swellings. Patients and Methods: This study was carried out in Obstetric and Gynecology Departments in Al-Azhar University Hospitals on 30 patients who had a preliminary diagnosis of an adnexal mass. After history taking and clinical examination, all patients underwent abdominal sonographically, Doppler examination and 3D ultrasound scan from April 2017 to September 2018. Results: Women with malignant masses were older than those with benign masses (46.00±9.76 vs 44.50±7.62 years) respectively. BMI in benign cases was lower than recorded in malignant cases (30.13±3.21 vs 38.57±0.81) with statistical significant difference between two them (P <0.01). Malignant cases were higher in postmenopausal 4(67 %) while Benign masses were higher in premenopausal 19 (79.2%) while, five cases (83%) of malignant cases were nulliparous. Regarding the diagnostic accuracy for the prediction of adnexal malignancy with 3DPD histogram analysis have been satisfied. Resistance index (RI) in benign cases ranged from 0.50-1.90 with mean value 1.18±0.41 and in malignant cases ranged from 0.30-1.50 with mean value 0.77±0.50. Sensitivity, specificity, PPV, NPV of RI was 78.8%, 75.0%, 77.2% and 76.1% respectively. Pulsatility index (PI) in benign cases ranged from 0.61-2.50 with mean value 1.80±0.52 and in malignant cases ranged from 0.80-1.37 with mean value 1.09±0.24. Sensitivity, specificity, PPV, NPV of PI was 90.9%, 88.0%, 91.0% and 86.5% respectively Peak systolic velocity (PSV) in benign cases ranged from 2.00-11.00 with mean value 6.88±2.71 and in malignant cases ranged from 14.00-35.00 with mean value 22.83±7.31. Sensitivity, specificity, PPV, NPV of PSV was 100%, 100%, 100% and 100% respectively. There was statistical significant difference between two studied groups regarding to resistance index, pulsatility index and peak systolic velocity (P < 0.05). The high risk was higher in malignant cases with 5 (83.3%) and lower in benign cases (1; 4.2%). There was statistical significant difference between two studied groups regarding to 3D ultrsound examination (P < 0.05). Conclusion: 3D ultrasound with color Doppler scan characteristics are found to be very important for discriminating benign from malignant tumors.