Alcázar J L, López-García G
Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Ultrasound Obstet Gynecol. 2001 May;17(5):434-8. doi: 10.1046/j.1469-0705.2001.00394.x.
To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses.
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 < or = 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was > or = 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.
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.
Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors.
分析经阴道彩色多普勒评估静脉血流在附件包块鉴别诊断中的作用。
91例连续诊断为附件包块的患者（平均年龄46.6岁，范围16 - 81岁）在手术前行经阴道彩色多普勒超声检查。彩色多普勒用于检测和分析肿瘤内动脉和静脉血流的流速波形。计算动脉信号的阻力指数和收缩期峰值流速，以及静脉的最大静脉流速。绘制受试者工作特征曲线以确定最佳静脉流速截断值。根据我们之前使用动脉多普勒的研究，当检测到血流且最低阻力指数≤0.45时，肿瘤被认为是恶性的。使用静脉多普勒时，当检测到血流且静脉流速≥受试者工作特征曲线上找到的最佳截断值时，包块被认为是恶性的。所有病例均获得明确的组织病理学诊断。计算了B超形态（根据Sassone评分系统进行评估）、动脉多普勒、静脉多普勒以及动脉和静脉多普勒联合应用的敏感性、特异性、阳性预测值和阴性预测值。
25个包块（27.5%）为恶性，66个（72.5%）为良性。恶性包块中动脉和静脉血流的检出率高于良性包块（分别为92%对41%，P < 0.001；72%对21%，P < 0.001）。恶性肿瘤的阻力指数显著更低（0.42对0.60，P = 0.0003）。收缩期峰值流速未发现差异。恶性包块的静脉流速显著更高（18.1 cm/s对8.9 cm/s，P = 0.0006）。静脉流速的最佳截断值为每秒10厘米。形态、动脉多普勒、静脉多普勒以及动脉和静脉多普勒联合应用的敏感性、特异性、阳性预测值和阴性预测值分别为92%、71%、45%、96%；76%、95%、87%、91%；68%、94%、81%、89%；88%、91%、79%、95%。
我们的结果表明，术前通过评估附件包块的静脉血流来鉴别恶性和良性肿瘤可能是有用的。
