Carter J, Saltzman A, Hartenbach E, Fowler J, Carson L, Twiggs L B
Department of Obstetrics and Gynecology, Women's Cancer Center, Minneapolis, Minnesota.
Obstet Gynecol. 1994 Jan;83(1):125-30.
To assess flow characteristics of benign and malignant gynecologic tumors by transvaginal color flow Doppler.
Records of the Ultrasound Laboratory, Women's Cancer Center, University of Minnesota were analyzed retrospectively. Gray scale findings were recorded as either "diagnostic" or "nondiagnostic." Color flow assessment was performed on intratumor vessels or ovarian and/or uterine arteries. Flow was recorded as either "absent" or "present." Spectral analysis allowed determination of the systolic, diastolic, and mean velocities and calculation of the pulsatility and resistance indices. Malignancy was then predicted based upon color flow findings alone, with malignant tumors demonstrating increased color flow and a pulsatility index of at most 1.0 or a resistance index of at most 0.4. Color flow Doppler findings were then recorded as "giving additional useful information" that either confirmed questionable gray scale findings or changed the gray scale sonographic diagnosis, or as "not giving additional information" over the gray scale diagnosis.
Two hundred thirty-one patients had gray scale sonography, and 167 also had color flow Doppler performed. Gray scale sonographic findings were sufficient to make a diagnosis in 156 (93%) of the scans. Color flow Doppler findings added useful information in 49 scans (30%). Increased color flow was highly significant (P < .0001), as was the calculated pulsatility index (P < .02) and resistance index (P < .008), in distinguishing benign from malignant tumors. Ovarian and uterine artery and intratumor assessments of the systolic, diastolic, and mean velocities were not significantly different between the benign and malignant tumors. Regression analysis confirmed the presence or absence of color flow as an independent predictor of malignancy or benignity (P < .0001).
Our large study confirms the overall accuracy of gray scale scanning. When used alone, color flow Doppler--although specific--lacks sensitivity and predictive value as an independent predictor of malignancy. When findings were combined with those obtained from gray scale scanning, sensitivity, specificity, and predictive value were improved to acceptable levels. Significant differences existed between benign and malignant tumors for calculated pulsatility index and resistance index, but neither was sufficiently sensitive, specific, or predictive to be used alone as sole criteria of malignancy prediction. Other flow indices studied (systolic, diastolic, and mean velocities) in general did not differ significantly between groups. Physicians should be cautioned against using color flow findings alone for clinical decision making. We recommend a multi-institutional study to investigate the multiple vascular assessments to determine the role of color flow Doppler in the preoperative prediction of pelvic tumors and in screening for gynecologic abnormality.
通过经阴道彩色多普勒评估妇科良恶性肿瘤的血流特征。
对明尼苏达大学妇女癌症中心超声实验室的记录进行回顾性分析。灰阶检查结果记录为“诊断性”或“非诊断性”。对肿瘤内血管或卵巢及/或子宫动脉进行彩色血流评估。血流记录为“无”或“有”。频谱分析可测定收缩期、舒张期和平均速度，并计算搏动指数和阻力指数。然后仅根据彩色血流结果预测恶性肿瘤，恶性肿瘤表现为彩色血流增加且搏动指数至多为1.0或阻力指数至多为0.4。彩色多普勒结果记录为“提供额外有用信息”，即证实可疑的灰阶检查结果或改变灰阶超声诊断，或记录为“未提供超过灰阶诊断的额外信息”。
231例患者进行了灰阶超声检查，其中167例还进行了彩色多普勒检查。156例（93%）扫描的灰阶超声检查结果足以做出诊断。彩色多普勒结果在49例扫描（30%）中提供了有用信息。在区分良性和恶性肿瘤方面，彩色血流增加具有高度显著性（P <.0001），计算出的搏动指数（P <.02）和阻力指数（P <.008）也是如此。良性和恶性肿瘤之间卵巢和子宫动脉以及肿瘤内的收缩期、舒张期和平均速度评估无显著差异。回归分析证实彩色血流的有无是恶性或良性的独立预测指标（P <.0001）。
我们的大型研究证实了灰阶扫描的总体准确性。单独使用时，彩色多普勒虽然具有特异性，但作为恶性肿瘤的独立预测指标缺乏敏感性和预测价值。当与灰阶扫描结果相结合时，敏感性、特异性和预测价值提高到了可接受的水平。计算出的搏动指数和阻力指数在良性和恶性肿瘤之间存在显著差异，但两者都不够敏感、特异或具有预测性，不能单独用作恶性肿瘤预测的唯一标准。所研究的其他血流指标（收缩期、舒张期和平均速度）在各组之间一般无显著差异。应提醒医生不要仅根据彩色血流结果进行临床决策。我们建议进行一项多机构研究，以调查多种血管评估方法，以确定彩色多普勒在盆腔肿瘤术前预测和妇科异常筛查中的作用。
