Czekierdowski A, Bednarek W, Rogowska W, Kotarski J
I Katedry i Kliniki Ginekologii Operacyjnej AM w Lublinie.
Ginekol Pol. 2001 Dec;72(12A):1281-6.
We have attempted to determine the accuracy of greyscale and color Doppler ultrasound in the differentiation of adnexal masses in pregnancy. The studied group included 2245 pregnant women from low risk population. Following criteria were evaluated: maximal diameter and volume of the tumor, echogenicity, presence of septa and papillary projections in grey scale sonography. Color Doppler analysis included blood vessel presence and arrangement and blood flow characteristics with the use of pulsatility (PI), resistive (RI) and systolic/diastolic (S/D) indices. Preoperative CA-125 serum levels were available in 11 patients. In 66 (2.94%) patients adnexal tumors were detected during routine ultrasound scan at the end of the first trimester. Twenty-seven masses (1.2%) persisted beyond 16 weeks of gestation and were subsequently surgically removed. Pathological diagnosis confirmed 19 serous cystadenomas, 4 endometriomas and 2 dermoids, one pedunculated myoma and one fibrothecoma. Mean size of the tumors was 79 Jmm (range: 43-245 mm), mean volume 166. lml (range: 30-1320 ml). Doppler indices values presented as mean, SD and range were as follows: PI = 1.26 +/- 0.71 (range: 0.57-3.84); RI = 0.61 +/- 0.15 (range: 0.33-0.89) and S/D = 2.62 +/- 0.98 (range: 1.17-4.91). Median serum concentration of CA-125 was 17 IU/ml (range: 8.4-1247 IU/ml). Only 3 of these women had elevated (> 35 IU/ml) levels: 2 endometriomas (344 IU/ml and 1247 IU/ml) and one myoma (37 IU/ml), respectively. Based on the sonographic findings two solid tumors were incorrectly classified as probably malignant (fibrothecoma and subserous myoma). Negative predictive value of ultrasound diagnosis in the studied population was therefore 92.6% (25 of 27). We conclude that although prenatal sonography has the potential to correctly classify most of adnexal masses, caution in risk assessment is needed especially when persistent solid tumor is found.
我们试图确定灰阶超声和彩色多普勒超声在鉴别孕期附件包块方面的准确性。研究组包括2245名来自低风险人群的孕妇。评估了以下标准：肿瘤的最大直径和体积、回声性、灰阶超声检查中隔的存在及乳头状突起。彩色多普勒分析包括血管的存在及分布以及使用搏动指数（PI）、阻力指数（RI）和收缩期/舒张期（S/D）指数评估血流特征。11例患者术前有CA-125血清水平数据。66例（2.94%）患者在孕早期末的常规超声扫描中发现附件肿瘤。27个包块（1.2%）在妊娠16周后持续存在，随后接受手术切除。病理诊断证实有19例浆液性囊腺瘤、4例子宫内膜异位症和2例皮样囊肿，1例带蒂肌瘤和1例纤维瘤。肿瘤平均大小为79mm（范围：43 - 245mm），平均体积为166.1ml（范围：30 - 1320ml）。多普勒指数值以平均值、标准差和范围表示如下：PI = 1.26 ± 0.71（范围：0.57 - 3.84）；RI = 0.61 ± 0.15（范围：0.33 - 0.89）；S/D = 2.62 ± 0.98（范围：1.17 - 4.91）。CA-125血清浓度中位数为17IU/ml（范围：8.4 - 1247IU/ml）。这些女性中只有3例水平升高（> 35IU/ml）：分别为2例子宫内膜异位症（344IU/ml和1247IU/ml）和1例肌瘤（37IU/ml）。基于超声检查结果，2例实性肿瘤被错误分类为可能恶性（纤维瘤和浆膜下肌瘤）。因此，研究人群中超声诊断的阴性预测值为92.6%（27例中的25例）。我们得出结论，尽管产前超声检查有可能正确分类大多数附件包块，但在风险评估时仍需谨慎，尤其是发现持续性实性肿瘤时。
