The objective of our study was to evaluate the predictive value of serum CA-125 levels and transvaginal ultrasound with color Doppler flow mapping (RI) in patients with benign and malignant ovarian tumors. The retrospective analysis included 78 women in whom 92 tumors were detected. Eleven patients had ovarian carcinoma (a total of 16 tumors). Predictive values were compared for tumor morphology, lowest resistive index (RI) < 0.40 and CA-125 > 35 IU/ml. Sensitivity, specificity, positive and negative predictive values in differentiating malignancy were highest for RI (94%, 87% 87% and 94%, respectively). Morphological criteria or CA-125 levels alone had lower predictive accuracy. Combining of the correctly identified all of the malignancies. It is concluded that preoperative transvaginal ultrasound with color Doppler flow mapping is valuable tool in the assessment of adnexal tumors and can be of assistance in prediction of ovarian cancer.