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Liu Y, Zhang Q, Zhang F, Liu M, Zhang J, Cao X, Yin W. Is three-dimensional ultrasonography a valuable diagnostic tool for patients with ovarian cancer? Systematic review and meta-analysis. Front Oncol 2024; 14:1404426. [PMID: 39040447 PMCID: PMC11260635 DOI: 10.3389/fonc.2024.1404426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction This paper was to assess the diagnostic performance and clinical value of three-dimensional ultrasonography (3DUS), three-dimensional ultrasonography power Doppler (3DPD), and 3DUS combined with 3DPD in ovarian cancer (OC). Methods The study was registered with PROSPERO (CRD 42023405765). PubMed and Web of Science were searched from inception to 25 January 2022, and reference lists of potentially eligible studies were also manually searched. Patient and study characteristics were extracted by two independent reviewers. Any discrepancies were addressed through discussion. The sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR, respectively), and the area under the receiver operating characteristic curve (AUC) were pooled separately. Results We retrieved 2,566 studies, of which 18 were finally enrolled, with 2,548 cases. The pooled sensitivity, specificity, PLR, NLR, and AUC for 3DUS were 0.89 (95% CI: 0.85-0.93), 0.93 (95% CI: 0.88-0.96), 13.1 (95% CI: 7.3-23.4), 0.11 (95% CI: 0.08-0.16), and 0.90 (95% CI: 0.87-0.93), respectively. The pooled sensitivity, specificity, PLR, NLR, and AUC for 3DPD were 0.90 (95% CI: 0.80-0.95), 0.85 (95% CI: 0.71-0.92), 5.8 (95% CI: 3.0-11.2), 0.12 (95% CI: 0.06-0.24), and 0.94 (95% CI: 0.91-0.96), respectively. The pooled sensitivity, specificity, PLR, NLR, and AUC for 3DUS combined with 3DPD were 0.99 (95% CI: 0.73-1.00), 0.95 (95% CI: 0.85-0.99), 21.9 (95% CI: 6.1-78.9), 0.01 (95% CI: 0.00-0.37), and 0.99 (95% CI: 0.98-1.00), respectively. Conclusions 3DUS, 3DPD, and 3DUS combined with 3DPD are promising diagnostic tools for OC, alongside elevated sensitivity and specificity. However, the combination of 3DUS and 3DPD techniques has higher diagnostic efficiency. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42023405765.
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Affiliation(s)
- Yuan Liu
- School of Medical Imaging, Binzhou Medical University, Yantai, Shandong, China
| | - Qingdong Zhang
- Department of Ultrasonography, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Fang Zhang
- Department of Ultrasonography, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Meiyan Liu
- Department of Ultrasonography, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Jun Zhang
- Department of Scientific Research and Teaching, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Xiaoli Cao
- Department of Ultrasonography, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Weihong Yin
- Department of Ultrasonography, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
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Zhang JW, Yin SY, Zhou DK, Wen JX, Gao H, Chen L, Wang ZX. Quantitative Evaluation of Percutaneous Local Drug Perfusion Against Refractory Infantile Hemangioma via 3-D Power Doppler Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:610-619. [PMID: 31810804 DOI: 10.1016/j.ultrasmedbio.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
To assess the practicality of 3-D power Doppler angiography (3-D-CPA) for local drug perfusion dosage guidance of refractory infantile hemangioma (IH) treatment, 47 cases (48 lesions) of refractory IH were selected for local bleomycin infusion (once a month). Ultrasound was performed before treatment and 1 and 2 months after the first treatment. The 3-D volume (V) change of infantile hemangiomas and the ratio of bleomycin injection to 3-D V before treatment were calculated, and statistical analysis was performed. One month after percutaneous local drug perfusion, 37 participants (77.08%) exhibited significant improvement; controlled growth was observed on six lesions (12.5%); and treatment of the remaining 5 lesions (10.42%) failed to suppress growth. The calculated tolerable and effective dose of bleomycin for refractory IH was 0.34 ± 0.03 mL/cm3; the corresponding 3-D V decreased approximately 70.27 ± 6.27%. Three-dimensional CPA can provide abundant information on internal lesions. In particular, 3-D-CPA can quantitatively assess changes in lesion volume and guide the effective and rational use of interventional drugs.
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Affiliation(s)
- Jin-Wei Zhang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shu-Yue Yin
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - De-Kai Zhou
- Department of Hemangioma, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Xin Wen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Gao
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Chen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao-Xia Wang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Wang X, Yang S, Lv G, Liao J, Wu S, Zhang W. Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses. ACTA ACUST UNITED AC 2019; 65:959-964. [PMID: 31389505 DOI: 10.1590/1806-9282.65.7.959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.
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Affiliation(s)
- Xiali Wang
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou 362000, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Guorong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou 362000, China.,Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Jianmei Liao
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Shufen Wu
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Weina Zhang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
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Abbas AM, Sheha AM, Salem MN, Altraigey A. Three-dimensional power Doppler ultrasonography in evaluation of adnexal masses. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nieuwenhuis LL, Hehenkamp WJK, Brölmann HAM, Huirne JAF. 3D power Doppler in uterine fibroids; influence of gain, cardiac cycle and off-line measurement techniques. J OBSTET GYNAECOL 2017; 38:103-109. [PMID: 28780884 DOI: 10.1080/01443615.2017.1330323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study answers the question of whether ultrasound machine settings and the cardiac cycle can influence 3D power Doppler (3D PD) indices in the evaluation of uterine fibroid vascularisation. These parameters were reported to affect the vascular indices and cause undesired variation. 3D PD ultrasound was performed using three different gain settings: a fixed predetermined gain (50 dB), a higher gain (65 dB) and an individualised subjectively most optimal gain. Two consecutive 3D PD sweeps were taken to evaluate the effect of the cardiac cycle. A predetermined most optimal fixed gain setting was not different from the individually most optimal chosen gain in vascular assessment of fibroids. A higher gain corresponded with a significantly higher vascular index (VI). Potential variation during the cardiac cycle does not disturb the VI in fibroids.
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Affiliation(s)
- L L Nieuwenhuis
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
| | - W J K Hehenkamp
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
| | - H A M Brölmann
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
| | - J A F Huirne
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
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Niemi RJ, Saarelainen SK, Luukkaala TH, Mäenpää JU. Reliability of preoperative evaluation of postmenopausal ovarian tumors. J Ovarian Res 2017; 10:15. [PMID: 28288666 PMCID: PMC5348789 DOI: 10.1186/s13048-017-0309-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/02/2017] [Indexed: 12/26/2022] Open
Abstract
Background Preoperative evaluation of ovarian tumors is challenging. This study was undertaken to evaluate the performance of conventional two-dimensional (2D) ultrasound and CA125 in predicting malignant or benign nature of pelvic masses, and to investigate if three-dimensional power Doppler (3DPD) ultrasound provides any added value. Ninety-six postmenopausal and four perimenopausal women with supposed ovarian tumors were examined by standardized 2D and 3DPD ultrasounds preoperatively. The tumors were evaluated using the risk of malignancy index (RMI), International Ovarian Tumors Analysis (IOTA) group simple rules, expert opinion, IOTA logistic regression model 2 (LR2) and 3D vascular indices, and were postoperatively compared to histopathological results. Results Ninety-eight tumors turned out to be ovarian in origin. Of these, 66 were benign and 32 malignant. RMI (cut-off value 200), simple rules, expert opinion and LR2 (cut-off value 25) were used to predict malignant nature of the tumors and had sensitivities of 71.9, 90.6, 87.5 and 90.6%, and specificities of 80.3, 84.6, 92.4 and 77.3%, respectively. When the 3D vascularization flow index (VFI) was added to RMI and LR2, the accuracy of the test improved from 77.6 to 81.4% and from 81.6 to 86.5%, respectively, at the expense of sensitivity, while VFI gave no added benefit for simple rules and expert opinion. Agreement between two examiners using expert opinion was good (Cohen’s kappa = 0.89). Conclusions The subjective opinion of an expert seems to be the most reliable method in assessing ovarian tumors, and the 3DPD indices seem to provide no significant added value.
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Affiliation(s)
- Riikka Johanna Niemi
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
| | - Sami Kristian Saarelainen
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Tiina Hannele Luukkaala
- Research and Innovation Center, Tampere University Hospital and Faculty of Social Sciences, University of Tampere, FI-33014, Tampere, Finland
| | - Johanna Unelma Mäenpää
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, FI-33014, Tampere, Finland
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Guerriero S, Saba L, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Sedda F, Peddes C, Fabbri P, Pilla F, Zajicek M, Giuseppina P, Melis GB. Past, present and future ultrasonographic techniques for analyzing ovarian masses. ACTA ACUST UNITED AC 2016; 11:369-83. [PMID: 26102474 DOI: 10.2217/whe.15.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography is today the method of choice for distinguishing between benign and malignant adnexal pathologies. Using pattern recognition several types of tumors can be recognized according to their characteristic appearance on gray-scale imaging. Color Doppler imaging should be used only to perform a semiquantitative color score or evaluate the flow location. International Ovarian Tumor Analysis group had standardized definitions characterizing adnexal masses and suggested the use of 'simple rules' in premenopausal women. Recently, the use of 3D vascular indices has been proposed but its potential use in clinical practice is debated. Also computerized aided diagnosis algorithms showed encouraging results to be confirmed in the future.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics & Gynecology, University of Navarra, Pamplona, Spain
| | | | - Silvia Ajossa
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Maura Perniciano
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Alba Piras
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Cristina Peddes
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Paola Fabbri
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Pilla
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Michal Zajicek
- Department of Obstetrics & Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Parodo Giuseppina
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
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Jiang ZH, Li KT, Tian JW, Ren M. An overview of the development and application of the sonographic scoring system: differentiation of malignant from benign ovarian tumors. Arch Gynecol Obstet 2015; 293:303-10. [DOI: 10.1007/s00404-015-3957-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
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Silvestre L, Martins WP, Candido-Dos-Reis FJ. Limitations of three-dimensional power Doppler angiography in preoperative evaluation of ovarian tumors. J Ovarian Res 2015. [PMID: 26219956 PMCID: PMC4518533 DOI: 10.1186/s13048-015-0174-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background This study describes the accuracy of three-dimensional power Doppler (3D-PD) angiography as secondary method for differential diagnosis of ovarian tumors. Method Seventy-five women scheduled for surgical removal of adnexal masses were assessed by transvaginal ultrasound. Ovarian tumors were classified by IOTA simple rules and two three-dimensional blocks were recorded. In a second step analyses, a 4 cm3 spherical sample was obtained from the highest vascularized solid area of each stored block. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were calculated. The repeatability was assessed by concordance correlation coefficient (CCC) and limits of agreement (LoA), and diagnostic accuracy by area under ROC curve. Results IOTA simple rules classified 26 cases as benign, nine as inconclusive and 40 as malignant. There were eight false positive and no false negative. Among the masses classified as inconclusive or malignant by IOTA simple rules, the CCCs were 0.91 for VI, 0.70 for FI, and 0.86 for VFI. The areas under ROC curve were 0.82 for VI, 0.67 for FI and 0.81 for VFI. Conclusions 3D-PD angiography presented considerable intraobserver variability and low accuracy for identifying false positive results of IOTA simple rules.
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Affiliation(s)
- Liliane Silvestre
- Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, Ribeirao Preto, 14049-900, Brazil.
| | - Wellington P Martins
- Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, Ribeirao Preto, 14049-900, Brazil.
| | - Francisco J Candido-Dos-Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, Ribeirao Preto, 14049-900, Brazil.
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Utrilla-Layna J, Alcázar JL, Aubá M, Laparte C, Olartecoechea B, Errasti T, Juez L, Mínguez JÁ, Guerriero S, Jurado M. Performance of three-dimensional power Doppler angiography as third-step assessment in differential diagnosis of adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:613-617. [PMID: 25270368 DOI: 10.1002/uog.14674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the contribution of three-dimensional (3D) power Doppler angiography (3D-PDA) to the differential diagnosis of adnexal masses. METHODS This was a prospective study in women diagnosed with a persistent adnexal mass and subsequently scheduled for surgery in a tertiary university hospital. All women were evaluated by transvaginal/transrectal ultrasound according to a predetermined three-step protocol, with transabdominal ultrasound being performed in some cases. First, morphological evaluation of the mass was performed using gray-scale 'pattern recognition' (first step). Lesions diagnosed as having a benign pattern were considered as being at low risk of malignancy whereas tumors with solid components, ascites and/or signs of carcinomatosis were considered as being at high risk of malignancy. In both cases no further test was performed and a decision regarding clinical management, either for follow-up or surgery, was taken. Tumors with solid components but without signs of ascites or carcinomatosis were considered as being at intermediate risk of malignancy. These lesions were assessed by two-dimensional (2D) PDA to evaluate tumor vascularity (color score) (second step). Solid tumors with a color score of 1 or 2 were considered as benign and no further test was performed, while tumors with a color score of 2, 3 or 4 within solid components or a color score of 3 or 4 in the case of a solid tumor were considered as malignant. The latter group underwent 3D-PDA assessment (third step). Vascularization index (VI) was calculated in a 1-mL sphere of the most vascularized area of the tumor. When a VI ≥ 24.015% was found, the tumor was considered as malignant. All masses were removed surgically and definitive histological diagnosis was used as the gold standard. Sensitivity and specificity for each strategy were calculated and compared. In the case of bilateral tumors, only the more suspicious one was used for analysis. RESULTS A total of 367 adnexal masses diagnosed in 367 women (mean age, 46.5 (range, 18-80) years) were evaluated during the study period. Of these, 86 masses were malignant and 281 were benign. The sensitivity and specificity for each assessment strategy were as follows: one-step, 97.7% and 78.6%; two-step, 94.2% and 97.9% (P < 0.001 for specificity when compared with that of one-step); three-step, 90.7% and 98.9% (not statistically significant when compared with that of two-step). CONCLUSIONS The addition of 2D-PDA in the differential diagnosis of an adnexal mass significantly increases specificity while sensitivity remains high; however performing subsequent 3D-PDA does not provide additional information or further improve diagnostic performance subsequent to 2D-PDA.
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Affiliation(s)
- J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, Pamplona, Spain
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Alcázar JL, Aubá M, Ruiz-Zambrana Á, Olartecoechea B, Diaz D, Hidalgo JJ, Pineda L, Utrilla-Layna J. Ultrasound assessment in adnexal masses: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Guerriero S, Ajossa S, Gerada M, Virgilio B, Pilloni M, Galvan R, Laparte MC, Alcázar JL, Melis GB. Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.6.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
To discriminate ovarian lesions is of particular importance in gynecological practice. Two main problems need answers: discrimination of benign and malignant adnexal masses and choice of the appropriate surgical treatment if necessary. Nearly 2% of the adnexal masses are ovarian carcinomas or borderline tumors. It is now, well established that ultrasonography is the gold standard for ovarian cyst diagnosis. The purpose of this data was to review the literature and to establish, with the evidence base medicine model, which parameters and existing diagnostic models using ultrasound and Doppler perform best in the evaluation of adnexal masses. Transvaginal sonography has demonstrated considerable advantage over conventional transabdominal sonography. However, transparietal sonography is still useful in large tumors. Definition of the nomenclature and classification was done and should be used. Unilocular ovarian cyst characterization seems easy using sonography and Doppler. In front of complication, discrimination of such functional cyst may be difficult but spontaneous regression confirms usually the expectative management. Dermoid cysts and endometriomas seem to be easier to discriminate from other adnexal masses. Ultrasound and morphologic parameters have a sensitivity of about 90% and a specificity of 80%; that makes this exam the gold standard for ovarian masses diagnosis. Only 50% of ovarian masses are characterized by sonography. Scoring systems help to differentiate benign from malignant masses (sensitivity of about 90%). Logistic regression and models are good methods especially for LR1 and 2 and RMI and may be useful for malignancy prediction but are difficult to use in current practice. Expert diagnosis is a subjective but most important performing parameter. Any suspicious ovarian mass or not easily diagnosed mass requires sonography by an expert, which can first use all the techniques and the different parameters to discriminate benign and malignant tumors. An explicit report will help the physician to define the right attitude for an appropriate management. Six to 16% of adnexial masses are complex or not classified and will result in MRI prescription or surgery.
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Affiliation(s)
- H Marret
- Pôle de gynécologie, obstétrique, médecine fœtale et reproduction humaine, hôpital Bretonneau, 37044 Tours cedex 1, France.
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Hata T, Hata K, Noguchi J, Kanenishi K, Shiota A. Ultrasound for evaluation of adnexal malignancy: From 2D to 3D ultrasound. J Obstet Gynaecol Res 2011; 37:1255-68. [DOI: 10.1111/j.1447-0756.2011.01642.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Alcázar JL, Jurado M. Three-dimensional ultrasound for assessing women with gynecological cancer: A systematic review. Gynecol Oncol 2011; 120:340-6. [DOI: 10.1016/j.ygyno.2010.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/19/2010] [Indexed: 12/26/2022]
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Kudla MJ, Alcázar JL. Does sphere volume affect the performance of three-dimensional power Doppler virtual vascular sampling for predicting malignancy in vascularized solid or cystic-solid adnexal masses? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:602-608. [PMID: 20183808 DOI: 10.1002/uog.7601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess whether, when using spherical sampling with Virtual Organ Computer-Aided Analysis (VOCAL) for calculating three-dimensional (3D) power Doppler angiography (PDA) indices, the sphere volume affects performance in the prediction of malignancy in vascularized cystic-solid or solid adnexal masses. METHODS One hundred and thirty-eight women (mean +/- SD age, 51.8 +/- 14.1 years) diagnosed as having vascularized cystic-solid or solid adnexal masses on B-mode and two-dimensional (2D) power Doppler ultrasound were evaluated by 3D-PDA prior to surgery. Five women had bilateral masses, giving a total number of 143 masses analyzed. Vascularization was assessed using VOCAL software. 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from the most vascularized area within papillary projections and solid areas were calculated automatically using spherical sampling. Five different volumes of sphere were used (1 cm(3), 2 cm(3), 3 cm(3), 4 cm(3) and 5 cm(3)) in each case. A definitive histological diagnosis was obtained in each case after surgical tumor removal. RESULTS One hundred and seventeen (82%) masses were malignant and 26 (18%) were benign. Morphological evaluation revealed 34 (24%) unilocular solid masses, 49 (34%) multilocular solid masses and 60 (42%) mostly solid masses. The 1-cm(3) sphere could be used in 100% of the cases, the 2-cm(3) sphere could be used in 98.2% of the cases and the 3-5-cm(3) spheres could be used in 97.2% of the cases. The median VI, FI and VFI for all sphere volumes were significantly higher in malignant compared with non-malignant tumors. Receiver-operating characteristics curve analysis showed that VI and VFI, independently of sphere volume, were better predictors of malignancy than was FI. The best cut-off values for the 3D-PDA indices differed depending on sphere volume. VI was significantly more specific than were VFI and FI. CONCLUSIONS Sphere volume does not affect the performance of 3D-PDA. We recommend the use of different cut-off values for 3D-PDA indices for discriminating between benign and malignant adnexal masses, depending on the sphere volume used. Use of VI is preferable due to its higher specificity.
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Affiliation(s)
- M J Kudla
- Department of Obstetrics and Gynecology, Medical University of Silesia, Katowice, Poland
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Alcázar JL, Jurado M, López-García G. Tumor Vascularization in Cervical Cancer by 3-Dimensional Power Doppler Angiography. Int J Gynecol Cancer 2010; 20:393-397. [DOI: 10.1111/igc.0b013e3181d159f9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Kudla M, Alcázar JL. Does the size of three-dimensional power Doppler spherical sampling affect the interobserver reproducibility of measurements of vascular indices in adnexal masses? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:732-734. [PMID: 19902476 DOI: 10.1002/uog.7462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Mansour GM, El-Lamie IK, El-Sayed HM, Ibrahim AM, Laban M, Abou-Louz SK, Abd Allah MY, El-Mahallawi MN, El-Lamie KI, Gad-Allah M. Adnexal mass vascularity assessed by 3-dimensional power Doppler: does it add to the risk of malignancy index in prediction of ovarian malignancy?: four hundred-case study. Int J Gynecol Cancer 2009; 19:867-72. [PMID: 19574775 DOI: 10.1111/igc.0b013e3181a8335e] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Risk of Malignancy Index (RMI) is used for the prediction of ovarian malignancy. It includes menopausal status, carbohydrate antigen 125 serum levels, and ultrasound criteria. Three-dimensional power Doppler (3-DPD) is a reproducible investigation for assessment of tumor vascularity, classifying vascularity to avascular, parallel, and chaotic patterns. In this study; 3-DPD was added to RMI for prediction of malignancy in 400 cases of ovarian masses. Sensitivity of RMI for prediction of malignancy was 88%, with a cutoff value of 202.5 at 95% confidence interval. Sensitivity of 3-DPD for prediction of malignancy was 75%, adding 3-DPD to RMI increased its sensitivity to 99%. Considering the pilot nature of the study, further studies are needed to corroborate such findings.
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Affiliation(s)
- Ghada M Mansour
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
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Chase DM, Crade M, Basu T, Saffari B, Berman ML. Preoperative diagnosis of ovarian malignancy: preliminary results of the use of 3-dimensional vascular ultrasound. Int J Gynecol Cancer 2009; 19:354-60. [PMID: 19407559 DOI: 10.1111/igc.0b013e3181a1d73e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To estimate the accuracy of 3-dimensional (3D) vascular ultrasound in the preoperative assessment of pelvic masses for malignancy. METHODS We performed a chart review of 66 patients who underwent 3D ultrasound for pelvic masses. Each mass was preoperatively judged to be benign or malignant based upon a study of vascularity within an ovarian mass using 3D ultrasound. Masses with orderly vascular architecture were categorized as probably benign, and masses with chaotic vascular patterns were categorized as malignant. The predictive value of 3D vascular ultrasound was compared with that of 2-dimensional ultrasound and cancer antigen 125 as a predictor of malignancy. RESULTS Among the 66 patients examined, 34 underwent a documented surgical intervention. Of those 34 patients, 10 had primary malignant neoplasms including 2 with low-malignant potential tumors. Suspicious 3D vascular ultrasound findings predicted malignant neoplasm in 10 patients. Two patients had recurrent cancer; however, only 1 had a suspicious ultrasound finding. There was 1 case of a low-malignant potential tumor without a suspicious ultrasound finding. Excluding the recurrent cancers and the observed patients, the positive predictive value (PPV) and the negative predictive value (NPV) of 3D vascular ultrasound were 100% and 95%, respectively. The PPV and the NPV of 2-dimensional ultrasound in predicting malignancy were 37% and 100%, respectively. An abnormal level of cancer antigen 125 had a PPV and an NPV of 73% and 83%, respectively, in this patient population. CONCLUSIONS In this preliminary and observational study, 3D ultrasound examination of vascular architecture was discriminatory in distinguishing benign ovarian masses from malignancy. Chaotic vascular architecture correlated with malignancy in this group of high-risk patients.
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Affiliation(s)
- Dana M Chase
- Department of Obstetrics, University of California, Irvine Medical Center, Orange, USA
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Alcázar JL, Prka M. Evaluation of two different methods for vascular sampling by three-dimensional power Doppler angiography in solid and cystic-solid adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:349-354. [PMID: 19199281 DOI: 10.1002/uog.6312] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To analyze two different methods for performing three-dimensional power Doppler angiography (3D-PDA) vascular sampling in solid and cystic-solid adnexal masses. METHODS Twenty-one 3D-PDA volumes from 18 consecutive and unselected solid or cystic-solid adnexal masses (13 malignant and five benign) were analyzed. A single examiner (J. L. A.) acquired all the volumes according to a predetermined scanning protocol. Two different observers (one inexperienced and the other experienced) calculated 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from solid tumor areas. First, manual sampling (Plane A, 15 degrees rotation-step) was performed, and 1 week later 5-cm(3) sphere sampling from the most vascularized area was carried out. The observers made a record of any difficulty that they encountered in delineating the solid areas of tumors or in distinguishing true tumor vessels from pre-existing vessels, the time spent performing each analysis was recorded and inter- and intraobserver reproducibility was evaluated for each method using intraclass correlation coefficients (ICC). RESULTS In four (19.0%) of the 21 volumes sphere sampling could not be performed because it was not possible to obtain a sphere smaller than 5.5 cm(3). This happened in cases in which image zooming was used when acquiring the 3D volume. The inexperienced observer encountered more difficulty, but not significantly more, than the experienced observer when analyzing 3D-PDA volumes both by manual sampling (29% vs. 14% of cases) and 5-cm(3) sphere sampling (35% vs. 18% of cases). The mean time spent by the inexperienced observer was significantly greater (P < 0.001) than that spent by the experienced observer both for manual sampling (6.11 min vs. 1.85 min) and 5-cm(3) sphere sampling (2.93 min vs. 2.15 min). Contrary to the findings for the experienced observer, the inexperienced observer required less time to perform sphere sampling than they did manual sampling. Interobserver agreement was high for both methods: ICC for manual volume, 0.993; manual VI, 0.908; manual FI, 0.913; manual VFI, 0.914; sphere volume, 0.949; sphere VI, 0.954; sphere FI 0.850; and sphere VFI, 0.953. Intraobserver reproducibility was also high, with all ICCs above 0.99. CONCLUSIONS Manual and 5-cm(3) sphere sampling are reproducible methods for 3D-PDA vascular sampling. Caution is required when image zoom is used at the time of acquiring the volume because this may prevent sphere sampling. Difficulties found in performing both manual and sphere sampling do not seem to significantly affect the reproducibility of Doppler index calculations.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, University of Navarra School of Medicine, Pamplona, Spain.
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Alcázar JL, Rodriguez D. Three-dimensional power Doppler vascular sonographic sampling for predicting ovarian cancer in cystic-solid and solid vascularized masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:275-281. [PMID: 19244062 DOI: 10.7863/jum.2009.28.3.275] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the role of 3-dimensional (3D) power Doppler (PD) sonography to discriminate between benign and malignant cystic-solid and solid vascularized adnexal masses and to define cutoff values for 3D PD indices to be used in a clinical setting. METHODS A total of 143 consecutive women (mean age, 50.4 years; range, 17-82 years) with diagnoses of cystic-solid or solid vascularized adnexal masses on B-mode and 2-dimensional PD sonography were evaluated by 3D PD sonography before surgery. Three-dimensional PD sonography was used to assess vascularization within papillary projections and solid areas with a virtual organ computer-aided analysis program. Three-dimensional PD vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) were automatically calculated. A definitive histologic diagnosis was obtained in each case. RESULTS A total of 113 masses (74%) were malignant, and 39 (26%) were benign. Morphologic evaluation revealed 30 unilocular solid masses (19.7%), 43 multilocular solid masses (28.3%), and 79 mostly solid masses (52%). The mean VI (9.365% versus 3.3%; P< .001), FI (34.318 versus 28.794; P< .001), and VFI (3.233 versus 1.15; P<0.01) were significantly higher in malignant tumors. No differences were found in the resistive index, pulsatility index, and peak systolic velocity. Receiver operating characteristic analysis revealed an area under the curve of 0.77 (95% confidence interval, 0.69-0.85), 0.71 (0.60-0.81), and 0.75 (0.66-0.83) for the VI, FI and VFI, respectively. For reducing the false-positive rate by almost one-third, sensitivity values for the VI (cutoff, 1.556%), FI (25.212), and VFI (0.323) were 92%, 95%, and 93%, respectively. CONCLUSIONS Three-dimensional PD vascular indices could be helpful for reducing the false-positive rate in cystic-solid and solid vascularized adnexal masses.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
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Chiou SC, Hsieh MH, Chen HY, Lin JD, Chen CC, Hsu WH, Jeng LB, Chang CT, Chen RH, Wang TY, Haung WL. The reproducibility of the virtual organ computer-aided analysis program for evaluating 3-dimensional power Doppler ultrasonography of diffuse thyroid disorders. J Endocrinol Invest 2009; 32:139-46. [PMID: 19411812 DOI: 10.1007/bf03345703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to evaluate the intra- observer and inter-observer reproducibility of 3-dimensional (3D) power Doppler ultrasonography with the virtual organ computer-aided analysis (VOCAL) program for measuring thyroid volume and vascular indices in patients with diffuse thyroid disorders. MATERIALS AND METHODS Patients with diffuse goiters were examined by 3D ultrasonography from August 2005 to July 2006. The parameters for vascular assessment included the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and thyroid size, and were obtained using the VOCAL program. This program used plane A and a 30 degrees rotational step. Intra-observer and inter-observer repeatability are presented as intra-class correlation coefficient (intra-CC) and inter-class correlation coefficient (inter-CC), with values >0.70 being acceptable. RESULTS Sixty-three patients in total were enrolled for this study, including 19 patients with simple goiter and 44 patients with autoimmune thyroid disease (AITD) (23 Graves' disease, 21 Hashimoto's thyroiditis). Thyroid volume and 3 vascular indices showed excellent reproducibility in the AITD group (intra- CC>0.9373 and inter-CC>0.8763) and its subgroups. The VI had excellent consistent reproducibility in the simple goiter group (intra-CC>0.8987 and inter-CC>0.8881), but the other parameters did not. CONCLUSIONS Based on this study, 3D power Doppler ultrasonography with the VOCAL program is a reliable tool for evaluating diffuse thyroid disorders due to an autoimmune process. The VI is the most reliable parameter.
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Affiliation(s)
- S-C Chiou
- Division of Endocrinology and Metabolism, China Medical University Hospital, Taichung, Taiwan.
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Lieng M, Qvigstad E, Dahl GF, Istre O. Flow differences between endometrial polyps and cancer: a prospective study using intravenous contrast-enhanced transvaginal color flow Doppler and three-dimensional power Doppler ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:935-940. [PMID: 19035544 DOI: 10.1002/uog.6267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate whether assessment of blood flow by transvaginal color Doppler and three-dimensional power Doppler imaging, enhanced by intravenous contrast, may be useful in the differentiation between benign endometrial polyps and endometrial cancer. METHODS A prospective study was performed comparing 17 women with benign endometrial polyps and 17 women with endometrial cancer. Transvaginal color Doppler and three-dimensional power Doppler angiography were performed before and after injection of intravenous contrast. The pulsatility index (PI) and the resistance index (RI) of the polyp feeding vessel or central vessel in malignant lesions, as well as the power Doppler endometrial flow indices vascularization index (VI), flow index (FI) and vascularization flow index (VFI), were calculated before and after enhancement by contrast, and compared between the two groups of women. RESULTS PI (mean difference +/- SD, 0.68 +/- 0.22; 95% CI, 0.23-1.13; P = 0.004) and RI (mean difference +/- SD, 0.16 +/- 0.08; 95% CI, 0.00-0.32; P = 0.045) were significantly lower in vessels of malignant tumors than in those of benign endometrial polyps after enhancement by intravenous contrast. No significant differences in PI, RI, VI, FI or VFI before enhancement by contrast, or in VI, FI or VFI after enhancement by contrast, were detected between women with endometrial polyps and those with endometrial cancer. CONCLUSIONS Transvaginal color Doppler examination enhanced by intravenous contrast may help to discriminate between benign endometrial polyps and cancer. Larger studies are required to confirm these findings.
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Affiliation(s)
- M Lieng
- Department of Gynecology and Obstetrics, Ullevål University Hospital, Oslo, Norway.
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Alcázar JL. Three-dimensional power Doppler derived vascular indices: what are we measuring and how are we doing it? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:485-487. [PMID: 18726929 DOI: 10.1002/uog.6144] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
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Cotte B, Gallot D, Ledoux-Pilon A, Dechelotte P, Rivoire C, Canis M, Mage G. [The use of ultrasonographic 3D power Doppler to describe an ovarian Sertoli-Leydig cell tumor]. ACTA ACUST UNITED AC 2008; 36:532-5. [PMID: 18462975 DOI: 10.1016/j.gyobfe.2008.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 01/27/2008] [Indexed: 10/22/2022]
Abstract
We report one case of unilateral ovarian Sertoli-Leydig tumor with intermediate grade and heterologous element, in a young woman with clinical and biological typical presentation. We discuss 2D and 3D ultrasonographic and doppler features.
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Affiliation(s)
- B Cotte
- Service de gynécologie-obstétrique, polyclinique Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex, France.
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Kudla MJ, Timor-Tritsch IE, Hope JM, Monteagudo A, Popiolek D, Monda S, Lee CJ, Arslan AA. Spherical tissue sampling in 3-dimensional power Doppler angiography: a new approach for evaluation of ovarian tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:425-433. [PMID: 18314521 DOI: 10.7863/jum.2008.27.3.425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of virtual spherical tissue sampling using 3-dimensional (3D) ultrasound power Doppler angiography to enhance differentiation between normal and pathologic ovaries. METHODS Twenty-seven cases with ovarian tumors were analyzed: 14 with invasive cancers and 13 with borderline tumors confirmed by surgery. The control subjects consisted of 53 healthy ovulating women. Ultrasound scans were done, and 3D volumes were analyzed with 3-/4-dimensional software for personal computers based on 3D vascularity indices: the vascularization index, flow index, and vascularization-flow index. A virtual spherical tissue sample of 1 cm3 was taken from the place of the highest vessel density contained completely within the contours of the ovary. Calculations for the whole solid volume were done for comparison. RESULTS Vascularity indices for both 1-cm3 spherical samples and whole dense parts of the ovaries were compared in the following groups: (1) ovarian tumors versus controls, (2) normal ovaries in the proliferative versus secretory phase, (3) invasive cancers versus borderline tumors, (4) invasive cancers versus normal ovaries, and (5) borderline tumors versus normal ovaries. Spherical 1-cm3 sampling achieved a higher degree of discrimination between the groups compared with the whole solid-part approach. CONCLUSIONS Spherical 1-cm3 sampling of ovarian tissue with 3D ultrasound power Doppler angiography is a sensitive and promising approach to differentiate between ovarian tumors and normal ovaries. It opens the possibility to implement objective computerized positioning, standardized comparison, and analysis of ovarian tumors.
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Affiliation(s)
- Marek J Kudla
- Department of Obstetrics and Gynecology, Medical University of Silesia, Medykow 14, 40-780 Katowice, Poland.
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Alcázar JL, Rodriguez D, Royo P, Galván R, Ajossa S, Guerriero S. Intraobserver and interobserver reproducibility of 3-dimensional power Doppler vascular indices in assessment of solid and cystic-solid adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1-6. [PMID: 18096724 DOI: 10.7863/jum.2008.27.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the intraobserver and interobserver reproducibility of 3-dimensional (3D) power Doppler angiography-derived vascular indices in evaluation of vascularized solid and cystic-solid adnexal masses. METHODS Stored 3D power Doppler angiographic volume data from 12 consecutive women with a diagnosis of a complex adnexal mass (6 cystic-solid and 6 solid) evaluated and treated at our institution were retrieved from our database for analysis. Two examiners performed the calculations blinded to each other. Calculations were performed offline in a computer using Virtual Organ Computer-Aided Analysis software (plane A, 9 degrees rotation step) to assess volume and vascularization (vascularization index, flow index, and vascularization-flow index) from solid areas within the tumor. In all cases, a definitive histologic diagnosis was obtained. Intraobserver and interobserver reproducibility was assessed by calculating the intraclass and interclass correlation coefficients for each index. RESULTS All tumors proved to be malignant after surgical removal. Intraobserver reproducibility for both examiners and interobserver reproducibility were high for all indices (interclass correlation coefficient > 0.95). CONCLUSIONS Three-dimensional power Doppler angiography is a reproducible technique for offline assessment of stored 3D volume data of vascularized adnexal masses.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, Avenida Pio XII 36, 31008, Pamplona, Spain.
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Transvaginal ultrasound assessment of the premenopausal ovarian mass. J Assist Reprod Genet 2007; 24:507-12. [PMID: 18008159 DOI: 10.1007/s10815-007-9128-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 03/13/2007] [Indexed: 10/22/2022] Open
Abstract
The evaluation of the premenopausal ovarian mass with transvaginal ultrasound and color Doppler is reviewed.
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Sladkevicius P, Jokubkiene L, Valentin L. Contribution of morphological assessment of the vessel tree by three-dimensional ultrasound to a correct diagnosis of malignancy in ovarian masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:874-882. [PMID: 17943717 DOI: 10.1002/uog.5150] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine whether subjective evaluation of the morphology of the vessel tree of ovarian tumors, as depicted by three-dimensional (3D) power Doppler ultrasound, can discriminate between benign and malignant ovarian tumors, and whether it improves characterization compared with using gray-scale ultrasound imaging alone. METHODS A consecutive series of 104 women scheduled for surgical removal of an ovarian mass were examined with transvaginal two-dimensional (2D) gray-scale and 3D power Doppler ultrasound. Predetermined vessel characteristics, e.g. density of vessels, branching, caliber changes and tortuosity, were evaluated in 360 degrees rotating 3D images of the vessel tree of the tumor. Ultrasound results were compared with those of the histology of the surgical specimens. Univariate and multivariate logistic regression were used. RESULTS There were 77 benign tumors, six borderline tumors and 21 invasive malignancies. All vascular features differed significantly between benign and malignant tumors. The areas under their receiver-operating characteristics (ROC) curves (AUCs) were in the range 0.61-0.83. The AUC of a logistic regression model containing three gray-scale ultrasound variables was 0.98. This model correctly classified all malignancies, with a false-positive rate of 10% (8/77). Adding branching of vessels in the whole tumor to the gray-scale model yielded an AUC of 0.99 and resulted in all malignancies and an additional four benign tumors being correctly classified. CONCLUSIONS Subjective evaluation of the morphology of the vessel tree, as depicted by 3D power Doppler ultrasound, can be used to discriminate between benign and malignant ovarian tumors, but adds little to gray-scale ultrasound imaging in an ordinary population of tumors.
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Affiliation(s)
- P Sladkevicius
- Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Malmö, Sweden.
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Guerriero S, Ajossa S, Piras S, Gerada M, Floris S, Garau N, Minerba L, Paoletti AM, Melis GB. Three-dimensional quantification of tumor vascularity as a tertiary test after B-mode and power Doppler evaluation for detection of ovarian cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1271-8. [PMID: 17901131 DOI: 10.7863/jum.2007.26.10.1271] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the role of 3-dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2-dimensional power Doppler sonography. METHODS One hundred fifty-seven consecutive pelvic masses in 153 patients were included in this study and underwent sonography before surgery. Masses that showed a typical benign pattern on B-mode sonography (n = 112) and indeterminate masses with peripheral or absent flow on power Doppler sonography (n = 10) were not evaluated by 3D sonography. Only masses with central vascularization were submitted to 3D power Doppler imaging (n = 35). The following 3D vascular parameters were calculated: relative color and flow measure (similar to the vascularization flow index obtained with other systems). RESULTS With receiver operating characteristic curve analysis, the best cutoff values for relative color and flow measure were 4.4 and 2.7, respectively. Flow measure had sensitivity of 68% and specificity of 40% in the overall population submitted to 3D power Doppler sonography. Accuracy slightly increased when masses with small papillary projections (<10 mL) were excluded. In this group (n = 22), sensitivity was 83%, and specificity was 50%. CONCLUSIONS In masses with central vascularization on 2-dimensional power Doppler sonography, the use of 3D quantification of tumor vascularity had low diagnostic accuracy in the detection of adnexal malignancies, although an increase in accuracy in masses with a solid portion of greater than 10 mL was reported.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy.
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Alcázar JL, Guerriero S. Three-dimensional power Doppler in ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:718-9. [PMID: 17487943 DOI: 10.1002/uog.4041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Marret H, Vinatier L, Sauget S, Giraudeau B, Body G, Tranquart F. Valeur de l'index de vascularisation (Power Doppler Index) pour la discrimination des masses ovariennes en préopératoire. ACTA ACUST UNITED AC 2007; 35:541-7. [DOI: 10.1016/j.gyobfe.2007.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/13/2007] [Indexed: 10/23/2022]
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Redondo MT, Orensanz I, Salazar FJ, Iniesta S, Bueno B, Perez-Medina T, Bajo JM. The Role of 3D Ultrasound and 3D Power Doppler Imaging in the Diagnosis and Evaluation of Ovarian Cancer: New Perspectives. ACTA ACUST UNITED AC 2007. [DOI: 10.5005/jp-journals-10009-1097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Alcázar JL. Tumor angiogenesis assessed by three-dimensional power Doppler ultrasound in early, advanced and metastatic ovarian cancer: A preliminary study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:325-9. [PMID: 16906635 DOI: 10.1002/uog.3804] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To evaluate tumor vascularity by three-dimensional power Doppler ultrasound (3D-PDU) in early and advanced stage primary ovarian cancers and in metastatic tumors to the ovary. PATIENTS AND METHODS This was a retrospective analysis of clinical and sonographic data from 49 women with primary ovarian cancers or metastatic tumors to the ovary. All women underwent 3D-PDU prior to surgery. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) from solid portions or papillary projections in the tumors were calculated using the Virtual Organ Computer-aided AnaLysis (VOCAL(trade mark)) program. Definitive histological diagnosis was obtained in each case. RESULTS Among the 49 women, 10 had stage I primary cancers (five low-malignant potential tumors and five invasive tumors), 26 had advanced stage primary ovarian cancers and 13 had metastatic tumors to the ovary. Mean VI and VFI were significantly higher in advanced stage tumors and metastatic tumors as compared with early stage tumors. No differences in 3D-PDU indices were found between advanced stage and metastatic cancers. CONCLUSIONS Vascular indices derived from 3D-PDU tend to be higher in advanced stage and metastatic ovarian cancers as compared with early stage ovarian tumors.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
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Ángela Pascual M, Hereter L, Graupera B, Fernández Cid M, Dexeus S. Ecografía 3D/4D en ginecología: técnica y metodología. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0304-5013(06)72605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tempe A, Singh S, Wadhwa L, Garg A. Conventional and color Doppler sonography in preoperative assessment of ovarian tumors. Int J Gynaecol Obstet 2005; 92:64-8. [PMID: 16303129 DOI: 10.1016/j.ijgo.2005.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 09/14/2005] [Accepted: 09/22/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the vascular patterns of ovarian tumors by color Doppler imaging (CDI) and compare the findings of conventional sonographic studies and CDI with histopathologic findings for the same tumors. METHODS Fifty nonpregnant women scheduled for elective surgery for ovarian tumors were examined by sonographic scanning and CDI by the same physician. Sonographic morphology scores [SMSs] were used, and the pulsatility index (PI) and resistance index (RI) were calculated after locating vessels in and around the tumors by CDI. RESULTS It was possible to obtain CDI results in 26 of the 50 women. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 71.43%, 73.33%, and 100%, respectively, for SMS. With CDI, the sensitivity, specificity, PPV, and NPV were 100%, 85.72%, 95%, and 100% for PI and 100%, 71.43%, 90.48%, and 100% for RI. RI sensitivity and specificity were identical to those of SMS, i.e., 100% and 71.43%, respectively, but PI specificity was better (85.72%). CONCLUSION In this study, CDI was definitely better than SMS when color flow could be obtained through the tumors. The overall efficiency in diagnosing the nature of tumors is very high if SMS and CDI are both used in patients having ovarian tumors.
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Affiliation(s)
- A Tempe
- Department of Obstetrics and Gynecology, Maulana Azad Medical College, Associated Lok Nayak Hospital, New Delhi, India
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