Three-Dimensional Power Doppler Angiography Improves the Diagnostic Accuracy for Malignant Uterine Body Tumor Prediction

Abstract

Uterine sarcoma comprises 3–5% of all malignancies of uterine body, with a worldwide annual occurrence rate of 1.55–1.95 per 100,000 population. The advance of resolution of gray-scale ultrasonography improves its utility in the diagnosis of lesions of the uterine corpus. However, its sensitivity and specificity were poor in the diagnosis of malignant uterine body masses. Power Doppler angiography can analyze the vascular pattern of the uterine corpus lesions and further improves the diagnostic rate. With the advance of computerized imaging processing, three-dimensional (3D) power Doppler angiography was available to assist the decision making for a huge or a rapid growth uterine body lesion. Our study design was proved by institutional review board. We launched a retrospective chart review. We reviewed chart from 2002 to 2014 in a tertiary medical center in the north Taiwan to collect patient who received 3D power Doppler angiography for uterine body tumors. Reports of 3D power Doppler angiography and pathology reports were analyzed. Sensitive, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated. Characters of 3D power Doppler angiography and its relationship with malignant uterine masses were also analyzed. There were 639 cases received 3D power Doppler angiography for uterine body tumors in 2002-2014. The initial reports were 285 cases had benign uterine body lesions and 101 cases had malignant uterine body lesions. 392 cases received operation such as hysterectomy or myomectomy for the uterine mass. Pathology reports showed 327 cases of benign lesions and 54 cases of malignant lesions. The sensitivity of our 3D power Doppler angiography for malignant uterine body lesions was 75.4% and specificity was 83.2%. Prevalence of malignant lesions in our study group was 15.9%. Positive predictive value was 46% and negative predictive value was 94.7% in our study group. Finally, positive likelihood ratio was 4.4 and negative likelihood ratio was 0.3. 3D power Doppler angiography is a useful tool in the screening of malignant uterine body tumors. It can exclude the patient with lower risk for malignant uterine body masses.