Objectives: To evaluate the prognostic value of colour pulsed Doppler in a prospective study of pelvic masses comparing resistance index, serum CA 125 and echographic findings with histology results.
Methods: A prospective study included 91 patients examined at the Gynaecology-Obstetrics unit at the Croix-Rousse Hospital. Pelvic masses were classified as benign or malignant tumours on the basis of echography findings. Serum CA 125 was assayed before surgery; malignancy was suspected for levels above 35 IU/ml. A colour pulsed Doppler examination was performed at the same time as the echography. Tumours were classed as vascular or non-vascular. A resistance index < or = 0.5 was considered pathological. The sensitivity and specificity of each examination were determined. The ROC method was used to determine best threshold level for the resistance index. Finally, the performance of the 3 tests was analyzed with the Metha algorithm. All patients underwent exeresis of the pelvic mass. The pathology report was taken as the definitive diagnosis.
Results: A total of 80 benign masses were analyzed. Thirty percent of them had a vascularization detectable with colour pulsed Doppler. One case of dermoid cyst has a resistance index below 0.5. Echography gave doubtful results in 6 cases and CA 125 was higher than 35 in 9. There were 10 cancers of the ovary and 1 borderline tumour. Four had a resistance index above 0.5, but the operator reported a hypervascular tumour in all cases. Three of these tumours had been classified as benign after echography and CA 125 was < 35 IU in 4. The mean resistance index for benign tumours was 0.71 compared with 0.41 for malignant tumours. The sensitivity of colour pulsed Doppler was 0.66 with a specificity of 0.99 when the resistance index was below 0.5. For an index considered to be pathological; below 0.76, the sensitivity was 100% and the specificity 85%.
Conclusions: Colour pulsed Doppler gives valuable pre-operative information on ovarian masses. Its performance is as least as good as CA 125 assay or echography.