Sonographic Scoring Research Articles

A sonographic scoring system to assess the risk of thyroid malignancy.

Prediction of thyroid malignancy with fine needle aspiration cytology or individual ultrasound characteristics has several limitations. This study evaluates the usefulness of a combination of ultrasound characteristics in predicting malignancy in patients with thyroid nodules. We assessed 189 thyroid nodules using ultrasonography and histology. Each nodule was assigned a score based on ultrasonographic characteristics. This score was compared with histology to identify ability to predict malignancy. There were 28 malignant nodules. The scoring system was appropriate for clinical use, obtaining an area under ROC curve of 0.822 [p< 0.0001] 95% confidence. FNAC of nodules with a score of more than 4 can be recommended (100% sensitivity). Nodules with a score less than 8 can be offered total thyroidectomy when FNAC is inconclusive (97.5% sensitivity). A combination of ultrasonographic criteria increase the accuracy of predicting malignancy in thyroid nodules.

Preoperative axillary lymph node staging by ultrasound-guided cytology using a four-level sonographic score.

BackgroundThe staging of axillary lymph nodes is critical to the management and prognosis of breast cancer, the most frequent cancer in females. Neoadjuvant therapy and lymph node dissection are recommended when malignant cells invade the lymph nodes. Therefore the pre-operative examination of these lymph nodes is crucial to treatment.MethodsIn this study, we examined the effectiveness of cytology through ultrasound-guided fine needle aspiration (USG-FNA) and ultrasound (US) imaging using an established classification system in correctly identifying lymph node status compared to the final histological results after surgery.ResultsCytology by USG-FNA and US classification were found to be promising methods of axillary lymph node staging.ConclusionsUS and CB offer minimally invasive techniques to pre-operatively examine these lymph nodes in patients with primary breast cancer.

An overview of the development and application of the sonographic scoring system: differentiation of malignant from benign ovarian tumors.

Ultrasonography is routinely used for the examination of ovarian tumors regarding preoperative diagnosis and postoperative therapeutic evaluation. However, its sensitivity and specificity in determining benign from malignant tumors should be further improved. In this study, we review the methods of sonographic scoring system for differentiating benign from malignant ovarian tumors, and its development and application. We searched the Medline, EBSCO and China National Knowledge Infrastructure from inception to April 2015, we also used the Google Scholar search engine to obtain studies. The ultrasonic scoring system has important clinical value in the preoperative diagnosis of ovarian neoplasm, the sensitivity, specificity and accuracy are significantly higher than using conventional ultrasonography by various of ultrasonic techniques, including two-dimensional sonographic imaging, color Doppler imaging, power Doppler ultrasound, real-time three-dimensional ultrasound and contrast-enhanced ultrasonography. The sonographic scoring system can significantly improve the sensitivity, specificity and accuracy of ultrasonic diagnosis in ovarian tumors, and provides a semi-quantitative method for determining the nature of ovarian masses, guidance of the surgical treatment and evaluation of prognosis.

Valuation of the prenatal three-dimensional sonographic clubfoot classification system

Objective To develop a new methodology of prenatal sonography scoring to assess and dignose clubfoot. Methods Thirty-one fetuses suspected clubfoot(50 foots) and 62 normal fetuses(124 foots) were scanned with both 2D and 3D sonography, and were divided into normal feet group and clubfeet group. Our scoring system was made according to the Pirani-scoring for children, while considering the morphology of mid-foot and hind-foot of infants. The doctors would give final diagnosis for all fetuses after delivery or induced labor, and analyse the correlations among the abnormal signs, sonographic score and the clinical outcomes. Results The curve lat border, the medial crease, the empty heel and the post crease can be observed in the 3D reconstruction images. These four abnormal signs had close correlations with the clinical results. Conclusions The new prenatal clubfeet scoring system by 3D sonography is a promising methodology with clinical values. Key words: Ultrasonography, prenatal; Clubfoot

Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile.

Objectives-The nonstress test is currently the most widely used modality for antenatal surveillance in twin pregnancies, with a quoted false-positive rate of 11%-12%. Our objective was to report our experience with the sonographic portion of the biophysical profile in twin pregnancies as the primary screening modality.Methods-Women with twin pregnancies delivered by a single maternal-fetal medicine practice from 2005 to 2013 were included. We excluded monoamniotic twins. Twin pregnancies began weekly sonography for the biophysical profile starting at 32 to 33 weeks, or earlier if indicated. The nonstress test was performed if the sonographic biophysical profile score was less than 8 of 8. We reviewed biophysical profile scores and outcomes for all patients who delivered at 33 weeks or later to assess the false-positive rate for the biophysical profile, as well as the incidence of intrauterine fetal death (IUFD) after initiation of antenatal surveillance.Results-A total of 539 twin pregnancies were included. The incidence of IUFD per patient was 2 per 539 (0.4%; 95% confidence interval [CI], 0.1%-1.3%), and the incidence of IUFD per fetus was 2 per 1078 (0.19%; 95% CI, 0.05%-0.7%). The overall positive screen rate was 24 per 539 (4.45%; 95% CI, 3.0%-6.5%). The false-positive screen rate, defined as an abnormal biophysical profile that did not diagnose an IUFD or lead to delivery, was 10 per 539 (1.9%; 95% CI, 1.0%-3.4%).Conclusions-In twin pregnancies the use of the sonographic biophysical profile for routine antenatal surveillance has a low false-positive rate, with a very low incidence of IUFD. The sonographic biophysical profile should be considered as a primary mode for antenatal surveillance in twin pregnancies, with a reflex nonstress test for an abnormal score.

Sigmoid stenosis caused by diverticulitis vs. carcinoma: usefulness of sonographic features for their differentiation in the emergency setting.

To retrospectively evaluate the accuracy of ultrasound as a diagnostic method for differentiating acute diverticulitis from colon cancer in patients with sigmoid colon stenosis. Ultrasound examinations of 91 consecutive patients with sigmoid stenosis (50 diverticulitis and 41 colon cancers) were reviewed by two trained radiologists. Sixty-five (71%) patients presented with acute abdominal symptoms. Thirteen sonographic criteria retrieved from the literature were evaluated to differentiate benign from malignant strictures. A score including all parameters which showed significant differences between benign vs. malignant was built. Sensitivity, specificity, accuracy, and positive or negative predictive values of each sonographic sign, the overall diagnosis, and sonographic score were calculated. Loss of the bowel wall stratification was the most reliable criteria for the diagnosis of malignancy (92% and 94% of sensitivity and specificity, respectively), and the best inter-radiologist agreement (κ=0.848). Adjacent lymph nodes were the most specific feature (98%) for colon cancer, but its sensitivity was low. Global assessment could differentiate both diseases with high sensitivity (92-94.9%) and specificity (98-100%). Sonographic score >3 enabled differentiation of carcinoma from diverticulitis with 95% sensitivity and 92-94% specificity, with an area under the ROC curve of 0.98-0.987. There were no significant differences in the results between patients with acute and nonacute abdominal symptoms. The combination of several morphological sonographic findings using a score can differentiate most cases of diverticulitis from colon carcinoma in sigmoid strictures.

Effects of fatty infiltration in human livers on the backscattered statistics of ultrasound imaging.

Ultrasound imaging has been widely applied to screen fatty liver disease. Fatty liver disease is a condition where large vacuoles of triglyceride fat accumulate in liver cells, thereby altering the arrangement of scatterers and the corresponding backscattered statistics. In this study, we used ultrasound Nakagami imaging to explore the effects of fatty infiltration in human livers on the statistical distribution of backscattered signals. A total of 107 patients volunteered to participate in the experiments. The livers were scanned using a clinical ultrasound scanner to obtain the raw backscattered signals for ultrasound B-mode and Nakagami imaging. Clinical scores of fatty liver disease for each patient were determined according to a well-accepted sonographic scoring system. The results showed that the Nakagami image can visualize the local backscattering properties of liver tissues. The Nakagami parameter increased from 0.62 ± 0.11 to 1.02 ± 0.07 as the fatty liver disease stage increased from normal to severe, indicating that the backscattered statistics vary from pre-Rayleigh to Rayleigh distributions. A significant positive correlation (correlation coefficient ρ = 0.84; probability value (p value) < 0.0001) exists between the degree of fatty infiltration and the Nakagami parameter, suggesting that ultrasound Nakagami imaging has potentials in future applications in fatty liver disease diagnosis.

Impact of accreditation training for residents on sonographic quality in gynecologic emergencies.

To assess the impact of an educational intervention based on an original accreditation training program on the quality of emergency sonography performed by obstetrics and gynecology (Ob/Gyn) residents. We conducted a prospective before-after study on residents who performed bedside standardized sonographic examinations as first-line investigations in patients seen at our gynecologic emergency department. In both periods, the residents followed a 1-hour class taught by a board-certified Ob/Gyn sonography expert (opinion leader) and received a written standardized imaging protocol. An accreditation training process was implemented for the new residents at the beginning of the second period: 5 complete sonographic examinations were required for each resident, and facilitated feedback from the opinion leader was performed using a dedicated sonographic quality score. During both periods, all consecutive sonograms were collected and stored. The primary outcome was the sonographic quality score. A mixed model for repeated measures was used to compare scores in both periods from 20 consecutive sonographic examinations performed by 5 residents who were different in each period. The mixed model analysis showed an increase in quality scores in the post-accreditation training compared to the pre-accreditation training period (estimated coefficient ± SD, 4.13 ± 0.51; t = 8.16). The sonographic examination order also had a significant effect in both periods (estimated coefficient ± SD, 0.11 ± 0.03; t = 3.99). An accreditation training process including facilitated feedback from a local opinion leader improved the quality of sonographic examinations performed by Ob/Gyn residents in women presenting to a gynecologic emergency department.

A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta.

The purpose of this study was to evaluate a novel sonographic scoring system for risk assessment of complications in patients suspected of having morbidly adherent placenta. This retrospective study evaluated the association between maternal complications and a grayscale sonographic scoring system for adherent placenta before surgery. Criteria for adherent placenta included uteroplacental and uterobladder demarcation lines and the presence of lacunae. Placentas were classified into 4 stages: stage 0, normal placentation; stage 1, low probability of adherence; stage 2, moderate possibility of adherence; and stage 3, high suspicion of adherence. Placental adherence as assessed by a surgical team, estimated blood loss, and postoperative hospitalization days were determined for each group, as well as the rates of the need for packed blood cells, cryoprecipitate units, and hysterectomy. One hundred nine women were included in the study. Twenty-six (23.8%) women were given a score of stage 0, 22 (20.2%) stage 1, 28 (25.7%) stage 2, and 33 (30.3%) stage 3. Linear regression analysis demonstrated that the sonographic staging was the only variable significantly associated with the number of packed cells or cryoprecipitate units transfused (P< .001) and a clinical diagnosis of adherent placenta (P< .001). In addition, both sonographic staging and a history of cesarean delivery were significantly associated with hysterectomy (P = .01; P = .03, respectively), treatment with any blood products (P< .001; P= .01), and the duration of postoperative hospitalization (P< .001; P = .006). A scoring system based on simple grayscale parameters may be effective for antenatal risk assessment of maternal complications in cases of suspected morbidly adherent placenta.

Rhodococcus equi pneumonia in foals: An assessment of the early diagnostic value of serum amyloid A and plasma fibrinogen concentrations in equine clinical practice

Early diagnosis and prevention of Rhodococcus equi pneumonia in foals represent important goals for equine clinicians. Recent protocols for diagnosis and treatment of Rhodococcosis in foals typically rely on a multimodal approach based on sonographic evidence suggestive of pyogranulomas, sonographic abscess scores and laboratory findings including plasma fibrinogen concentrations, blood biochemistry testing and platelet and leukocyte counts. The aim of this study was to assess the utility of weekly testing of serum amyloid A (SAA) and plasma fibrinogen concentrations in foals to achieve early diagnosis of R. equi pneumonia prior to the onset of clinical signs. This testing was used to simulate a clinically practical screening procedure and compared with thoracic ultrasonography performed in parallel.The present study suggests that SAA does not represent a reliable early marker of Rhodococcosis when plasma concentrations are tested weekly. However, when clinical signs of R. equi pneumonia are present, SAA concentrations may allow clinicians to obtain ‘real-time’ indications concerning both the progress of infection and the effectiveness of therapy. This study raises the possibility that plasma fibrinogen monitoring starting at 1 week of age and repeated on a weekly basis, could serve as a screening test allowing clinicians to identify foals as suspected of R. equi infection. Future investigations regarding both physiological plasma fibrinogen concentrations in foals as well as fibrinogen kinetics in foals affected with R. equi pneumonia, including the establishment of appropriate reference intervals for the test method employed in this study, will be necessary in order to clarify this possibility.

P10.03: Valuation of the prenatal sonographic clubfoot classification system including the plantar and the ankle shape

The purpose of this study was to predict the severity of deformity using a new prenatal sonographic classification system to decrease the false positive rate of the prenatally identified clubfeet. The study group consisted of 50 feet (31 fetuses) who was suspected having talipes equinovarus at the roution sonographic examinations. The control group consisted of low-risk 440 feet (220 fetuses). Both 2D and 3D sonography were performed. Our classification system was made according to the pirani-scoring which was used for postnatal clinical diagnosis, and included mid-foot score and hind-foot score. Firstly, the each component was scored as 0 (normal), 1 (mildly or likely abnormal), 2 (severely abnormal). Then the sonogiaphic severity was classified into normal (0), mild (1), moderate (2-3), severe (4), according to the foot's total score of two components. Kendall's tau-b test was used in statistical analyses between the sonographic severity or score and the final clinical diagnosis. In the study group, 6 feet (3 fetus) scored failed because their oligohydramnion probably. Nobody got the “normal” sonographic diagnosis, 5 feet got the “mild” (all the feet were confirmed normal after birth), 13 feet got the “moderate” (6 feet were confirmed deformity) and 26 feet got the “severely” (all the feet were confirmed deformity). In the control group, there were 34 feet got the “mild” (2 feet were confirmed deformity), the other 306 feet got the “normal” (all the feet were normal). The Kendall's tau-b correlation between the sonographic severity and clinical diagnosis was 0.756, P = 0.00. The fetal foot classification system isr predictive of clinical severity after birth, and an isolated “mild” prenatally sonographic clubfoot is less likely to be a clubfoot at birth.

Bedside ultrasound curriculum for medical students: report of a blended learning curriculum implementation and validation.

Medical students on clinical rotations rarely receive formal bedside ultrasound (BUS) training. We designed, implemented, and evaluated a standardized BUS curriculum for medical students on their Emergency Medicine (EM) rotation. Teaching was aimed toward influencing four cognitive and psychomotor learning domains: BUS instrumentation knowledge, image interpretation, image acquisition, and procedural guidance. Participants viewed three instructional Web-based tutorials on BUS instrumentation, the Focused Assessment for Sonography in Trauma (FAST) examination and ultrasound-guided central venous catheter (CVC) placement. Subsequently, participants attended a 3-hour hands-on training session to discuss the same content area and practice with faculty coaches. A Web-based, multiple-choice questionnaire was administered before and after the session. During the final week of the rotation, students returned for skills assessments on FAST image acquisition and CVC placement. Forty-five medical students on an EM rotation were enrolled. Sonographic knowledge overall mean score improved significantly from 66.6% (SD ±11.2) to 85.7% (SD ±10.0), corresponding to a mean difference of 19.1% (95% CI 15.5-22.7; p < 0.001). There were high pass rates for FAST (89.0%, 40/45) and CVC (96.0%, 43/45) skills assessments. There was no significant difference between medical student posttest and EM resident test scores 85.7% (SD ±10.0) and 88.1% (SD ± 7.6) (p = 0.40), respectively. A formal BUS curriculum for medical students on EM rotation positively influenced performance in several key learning domains. As BUS competency is required for residency in EM and other specialties, medical schools could consider routinely incorporating BUS teaching into their clinical rotation curricula.

Patients with Inflammatory Bowel Disease have Higher Sonographic Enthesitis Scores than Normal Individuals: Pilot Study in Taiwan

Background If a patient has inflammatory bowel disease (IBD) and enthesitis, he/she can be classified as having peripheral spondyloarthritis according to criteria set by the Assessment of Spondyloarthritis International Society. In Taiwan, IBD patients visiting outpatient clinics can present without joint symptoms, so the prevalence of these musculoskeletal manifestations may be underestimated. We conducted this study to evaluate enthesitis by ultrasonography (US) in IBD patients, and compared these data with healthy controls (HCs). Materials and methods Fourteen IBD patients and 14 HCs underwent independent clinical and ultrasonographic examination of both legs at five entheseal sites. The Glasgow Ultrasound Enthesitis Scoring System (GUESS) was used to assess the degree of enthesitis in the two groups. The total score of enthesitis was calculated on the basis of US findings. All US examinations were undertaken by an experienced rheumatologist blinded to clinical and laboratory findings. Results Two hundred and eighty entheses in 14 patients and 14 HCs were examined by US, which revealed 42/140 (30%) and 21/140 (15%) abnormal entheseal sites in patients and controls, respectively. The GUESS score was significantly higher in IBD patients than in HCs ( p Conclusion These data suggest that US is more sensitive than radiography and clinical assessment for the detection of entheseal abnormalities.

AB0216 Serum Angiogenesis Markers and their Association with Ultrasound-Detected Synovitis in the Evaluation of Disease Activity in Juvenile Idiopathic Arthritis

BackgroundSynovial angiogenesis, defined as a complex process of developing new blood vessels from the existing microvascular bed, is considered to be an important early step in the course and pathogenesis...

Utility of the Ultrasound Examination of the Hand and Wrist Joints in the Management of Established Rheumatoid Arthritis

To investigate the usefulness of point-of-care hand and wrist joint ultrasound (US) examination in patients with established rheumatoid arthritis (RA). Fifty-one RA patients were evaluated using clinical disease activity measures and gray-scale and power Doppler (PD) US. Agreement between US and clinical findings and its impact on physicians' confidence and clinical decision were assessed. Agreement between intraarticular PD signal and joint swelling (JS) was moderate (82%; κ = 0.44). Agreement between PD signal and joint tenderness to palpation (TTP) was fair (75%; κ = 0.24). The greatest agreement between PD signal and clinical findings was seen in the 5th metacarpophalangeal (MCP) joint (96% JS, 88% TTP) and the poorest agreement was seen in the wrist (69% JS, 65% TTP) and 2nd (75% JS, 72% TTP) and 3rd (82% JS, 72% TTP) MCP joints. The presence of PD signal in nonswollen and/or nontender joints accounted for most of the disagreement in the wrists, while the opposite was true for the 2nd/3rd MCP joints. Agreement between sonographic synovial thickening and clinical findings was poor. Total sonographic synovial hypertrophy or PD score correlated significantly with physician-recorded, but not patient-recorded, clinical outcomes. US increased both physicians' confidence in their clinical decision (P < 0.0005, irrespective of Clinical Disease Activity Index score) and patients' confidence in physicians' medical decisions (88.4% of the cases). US modified biologic agent and/or disease-modifying antirheumatic drug (DMARD) use in 7 individual cases, but it did not affect the overall treatment plan (P > 0.15) or DMARD (P < 0.062) or biologic agent (P > 1.0) use in this group of RA patients. PD examination of the wrist and 2nd/3rd MCP joints might be feasible and clinically meaningful in evaluation of disease activity in patients with established RA. US examination of the hand/wrist joints in RA increases physicians' confidence in their clinical decision and can help to individualize DMARD and biologic agent use.

Sonography of Acne Vulgaris

The purpose of this study was to assess the sonographic morphology of the clinical and subclinical pathology of facial acne vulgaris. We studied patients with facial acne vulgaris diagnosed by certified dermatologists, and using a standardized protocol for sonographic examinations, we sequentially described the sonographic pathomorphologic characteristics. Lesions of particular interest to the referring clinician were also analyzed separately. Additionally, acne involvement was staged clinically and sonographically (SOS-Acne) using morphologic definitions of the relevant lesions and predefined scoring systems for gradation of the severity of acne lesions. A total of 245 acne lesions in 20 consecutive patients were studied. Sonographic abnormalities consisted of pseudocysts, folliculitis, fistulas, and calcinosis. Most conditions were subclinical and mostly due to lesion extensions deep into the dermis and hypodermis (52% of pseudocysts and 68% of fistulas). The statistical concordance between acne severity scores assigned by two separate clinicians was strong (κ = 0.8020), but the corresponding sonographic scores generally showed more severe and clinically occult involvement. Facial acne vulgaris often involves deeper tissues, beyond the reach of the spatially restricted clinical examination; these subclinical conditions can be detected and defined with sonography. Additionally, acne vulgaris is amenable to sonographic scoring.

Comparison of pelvic masses score (PMS) and Risk of Malignancy Index (RMI 3) in the evaluation of pelvic masses.

Ovarian cancer is the fourth cause of death from cancer in women worldwide and the majority of its diagnoses is made in an advanced stage of the disease. Several sonographic scoring systems have been created for a better preoperative discrimination between benign and malignant pelvic masses. The aim of this study was to evaluate the performances of the Risk of the Malignancy Index 3 (RMI 3) and the Pelvic Masses Score (PMS). This retrospective study was performed in 55 women admitted to the department of Obstetrics and Gynecology of University of Udine for surgical exploration of pelvic masses between 2009 and 2012. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both the scores. PMS showed a sensitivity of 100%, a specificity of 93.8%, a PPV of 70%, and a NPV of 100%, while RMI 3 yielded a sensitivity of 85%, a specificity of 91%, a PPV of 60%, and a NPV of 97.8%. The authors found that, in discriminating between benign and malignant pelvic disease, the PMS method was more reliable than RMI3. PMS is a simple scoring system which can be used in clinical practice.

Predicting Coverage of Transverse Subcostal Sonography With the Use of Previous Computed Tomography Before a Sonographic Liver Examination

The purpose of this study was to assess the coverage of transverse subcostal sonography in the supine position by using computed tomography (CT) performed before a sonographic liver examination as a predictor of sonographic coverage. A total of 124 patients (87 men and 37 women; mean age, 55.55 years; range, 24-79 years) who underwent abdominal CT and subsequent liver sonography were enrolled. All patients were assessed for the coverage of transverse subcostal sonography in the supine position by consensus of 2 radiologists. We evaluated the correlation between the level of the posterior rib against the liver dome on axial CT and a sonographic coverage scoring system using Spearman partial correlation analysis. The optimal cutoff value of the liver position and other potential factors associated with sonographic coverage were analyzed. Among age, sex, body mass index, interposition of bowel around the gallbladder fossa, atrophic changes from cirrhotic liver, and liver position, liver position was the only independent factor associated with sonographic coverage (P < .001). Liver position and the sonographic coverage score were moderately negatively correlated, with statistical significance (r = -0.44; P < .001). The optimal cutoff value for the level of the hepatic dome was at the 10th posterior rib on axial CT. Liver position is the only independent factor associated with the coverage of transverse subcostal sonography in the supine position. If it is above the 10th posterior rib level, we can predict difficulty in adequate sonographic coverage of the liver.

Prospective Evaluation of a Prenatal Sonographic Clubfoot Classification System

Background: The purpose of this study was to prospectively evaluate our recently described fetal sonographic classification system for prenatal diagnosis of clubfoot. Methods: Over 18 months, we prospectively enrolled consecutive pregnant patients evaluated for a prenatally diagnosed clubfoot. Prenatal sonographic scores assigned by a radiologist were compared to final clinical diagnosis and severity given by a pediatric orthopedic surgeon. Pearson's χ² test and logistic regression were used in statistical analyses on the subject level. Generalized estimating equations were used in analyses on the foot level to account for intrasubject correlation. Results: There were 50 subjects, with 26 unilateral and 24 bilateral clubfeet, according to the prenatal ultrasound (US). A total of 51 (69%) of 74 feet and 36 (72%) of 50 subjects had a postnatal diagnosis of clubfoot. The accuracy of diagnosis in cases of a severe, moderate, and mild US score was 94, 70, and 25%, respectively (p = 0.003 comparing moderate-severe vs. mild). US severity correlated with the Dimeglio classification scoring system (Spearman's correlation 0.30). Conclusion: The fetal sonographic scoring system is predictive of clinical severity after birth, and improves the ability to counsel families with a prenatal diagnosis of clubfoot.

Sonographic Discrimination Between Benign and Malignant Adnexal Masses in Premenopause

The aim of this study was to assess the diagnostic value of sonographic pattern recognition by experts, a standardized morphological scoring system, the risk malignancy index (RMI) and CA 125 assay for the preoperative assessment of ovarian lesions in premenopausal patients. Diagnostic work-up of 1320 patients who underwent surgical exploration due to an adnexal mass at a tertiary referral center were included. We assessed the discriminative value of pattern recognition, a sonographic morphological scoring system, RMI and CA 125 by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa for each diagnostic approach while using histopathology as the reference standard. Pattern recognition showed the highest discriminative power with an observed kappa of 0.53. Sensitivity and specificity yielded 0.76 and 0.97 respectively. Combining pattern recognition with CA 125 serum measurement in the context of a triage system diminished the diagnostic value (kappa: 0.24; sensitivity: 0.29 specificity: 0.97). For the RMI we observed a sensitivity of 0.54 and a specificity of 0.96 and estimated kappa value yielded 0.37. Omitting the CA 125 assay and using a morphological sonographic assessment system increased the kappa value to 0.45 with sensitivity and specificity observed at 0.61 and 0.97 respectively. Expert pattern recognition was found to be the method with the highest discriminative power in assessing an adnexal mass during premenopause. Additional assessment of serum CA 125 diminished the diagnostic accuracy. Standardized morphological sonographic assessment resulted in a moderate diagnostic accuracy. Supplementing the morphological sonographic assessment with CA 125 by using the RMI algorithm did not improve the diagnostic value.