Diagnosis of pelvic masses with transabdominal color doppler, CA 125 and ultrasonography.

The objective of this study was to test the accuracy of transabdominal color Doppler imaging in the prediction of malignancy of adnexal tumors when integrated in combination with CA 125 levels and two-dimensional ultrasound. METHODS: We considered 129 consecutive patients with a suspected adnexal mass at clinical examination and transabdominal and transvaginal two-dimensional ultrasound. Serum CA 125 was measured in all cases. All the patients underwent color Doppler imaging to measure the Resistance index of the tumor associated blood flow profile and then surgery and histologic diagnosis. RESULTS: The median age of the patients was 44 years (range 12-91), 64.3% were premenopausal and the prevalence of malignancy was 28.7%. The sensitivity of color Doppler mapping was 75.7%, specificity 71.7%, positive predictive value 68.3% and negative predictive value 93.0%, compared with 75.7%, 68.5%, 49.1% and 87.5% for CA 125 and 83.8%, 83.7%, 67.4% and 92.8% for two-dimensional ultrasound. Blood flow was undetectable by color Doppler imaging in 17 of the 129 cases (13.2%). In 55 patients with three concordant tests, the positive and negative predictive values were 100%. When CA 125 values and two dimensional ultrasound results were discordant (35 patients), the color Doppler diagnosis was correct in 88.6% of the cases (93% in premenopausal women). CONCLUSION: Color Doppler imaging alone is not better than two-dimensional ultrasound in predicting malignancy of pelvic masses. Its use together with CA 125 and two-dimensional ultrasound may improve the accuracy of predictions when the three tests are concordant or when the other two are discordant.