Antonić J, Rakar S
Department of Obstetrics and Gynaecology, University Medical Center, Ljubljana, Slovenija.
Eur J Gynaecol Oncol. 1996;17(1):29-35.
Colour and pulsed Doppler flow imaging have been proposed as methods that may be useful in differentiating benign from malignant ovarian masses. It has been hypothesised that the detection of neovascularisation with abnormal, low-resistance blood flow peculiar to malignant tumours is possible, being characterised by angle-independent Doppler indices--PI and RI. The initial studies reported cut-off values of 1.0 for PI and 0.4 or 0.7 for RI, with values below the cut-off suggestive of malignancy. Tumour marker CA 125 SC was found to be elevated in 80-85% of patients with serous epithelial ovarian cancer (90% of all ovarian cancers) and in a lower percentage in other ovarian cancers, with levels over 35 U/ml suggestive of malignancy. In our study we wanted to determine whether colour and pulsed Doppler US and CA 125 SC could be used to differentiate benign from malignant ovarian masses and whether, by combining the methods, the results could even be improved.
Ovarian masses identified with sonography in 71 patients aged 35 years or more, were confirmed at surgery (n = 61) or endoscopy (n = 4) or followed up to resolution with US (n = 6). Colour and pulsed Doppler US were used to identify intratumoral areas of vascularisation and to calculate the lowest PI and RI for each ovarian mass. CA 125 SC were measured.
In 16 of 18 ovarian malignancies and 28 of 53 benign masses, areas of intratumoral vascularisation (colour flow) were detected with colour Doppler US (p = 0.002). Mean RI was lower in malignant than in benign masses (p = 0.198), as was PI (p = 0.248). Index values displayed considerable overlap between malignant and benign lesions and the differences were not significant. Mean CA 125 SC was higher in malignant than in benign masses (p = < 0.0001). For cut-off at 35 U/ml, SE, SP, PPV and NPV for identification of ovarian cancer were 83%, 74%, 79% and 75% respectively. Either CA 125 SC > 35 U/ml or intratumoral colour Doppler signal was detected in all 18 patients with ovarian cancer, but neither of them was detected in 25 patients all of whom had benign tumours. Thus, combining the two methods, SE, SP, PPV and NPV for ovarian cancer were: 100%, 47%, 32% and 100% respectively.
RI and PI values cannot be used to differentiate between benign and malignant ovarian tumours in women over 34 years of age. The determination of CA 125 serum level is useful in identification of ovarian cancer in women over 35 years of age. CA 125 SC under 35 U/ml together with the lack of detectable colour flow in the tumour, can reliably exclude ovarian malignancy in women over 35 years of age (NPV = 100%).
彩色及脉冲多普勒血流成像已被提出作为可能有助于鉴别卵巢良恶性肿块的方法。据推测，检测具有恶性肿瘤特有的异常、低阻力血流的新生血管是可行的，其特征为与角度无关的多普勒指数——搏动指数（PI）和阻力指数（RI）。最初的研究报告PI的临界值为1.0，RI的临界值为0.4或0.7，低于临界值提示恶性。肿瘤标志物CA 125 SC在80 - 85%的浆液性上皮性卵巢癌患者（占所有卵巢癌的90%）中升高，在其他卵巢癌中的升高比例较低，水平超过35 U/ml提示恶性。在我们的研究中，我们想确定彩色及脉冲多普勒超声和CA 125 SC是否可用于鉴别卵巢良恶性肿块，以及通过联合这些方法，结果是否能得到改善。
对71例年龄35岁及以上经超声检查发现的卵巢肿块患者进行研究，其中61例经手术确诊，4例经内镜确诊，6例经超声随访至肿块消退。使用彩色及脉冲多普勒超声识别肿瘤内血管化区域，并计算每个卵巢肿块的最低PI和RI值。检测CA 125 SC。
在18例卵巢恶性肿瘤中的16例以及53例良性肿块中的28例中，彩色多普勒超声检测到肿瘤内血管化区域（彩色血流）（p = 0.002）。恶性肿块的平均RI低于良性肿块（p = 0.198），PI也是如此（p = 0.248）。指数值在恶性和良性病变之间有相当大的重叠，差异无统计学意义。恶性肿块的平均CA 125 SC高于良性肿块（p = < 0.0001）。以35 U/ml为临界值，CA 125 SC用于识别卵巢癌的敏感性（SE）、特异性（SP）、阳性预测值（PPV）和阴性预测值（NPV）分别为83%、74%、79%和75%。在所有18例卵巢癌患者中均检测到CA 125 SC > 35 U/ml或肿瘤内彩色多普勒信号，但在25例均为良性肿瘤的患者中均未检测到上述任何一项。因此，联合两种方法，CA 125 SC用于卵巢癌的SE、SP、PPV和NPV分别为：100%、47%、32%和100%。
RI和PI值不能用于鉴别34岁以上女性的卵巢良恶性肿瘤。测定CA 125血清水平有助于识别35岁以上女性的卵巢癌。CA 125 SC低于35 U/ml且肿瘤内无可检测到的彩色血流，可可靠地排除35岁以上女性的卵巢恶性肿瘤（NPV = 100%）。
