Ovarian cancer screening by transvaginal color Doppler ultrasonography

The need for the early detection of ovarian cancer continues to be one of the most important issue in women's health care. The ovarian neoplasia characteristically have a scarce symptomatology for which it tries to create a sensitive and specific screening test so that the diagnosis could precociously be made and, consequently, improve the prognosis with a timely therapy. Our purpose was to assess the performance of transvaginal color Doppler ultrasonography in ovarian cancer screening.

In the Institute of Obstetrics and Gynaecology of Second University of Studies of Naples, in the period between January 1997 and December 1998, 60 women, divided into two groups (the 1st group included 30 women in fertile age with standard uterine dimensions, the 2nd group included 30 menopausal women), were submitted to transvaginal color Doppler ultrasonography. Color Doppler ultrasonography was performed with an ESAOTE ANSALDO AU5 HARMONIC ultrasound machine provided with a 6.5 MHz real-time sector electronic array endovaginal probe with a 5 MHz pulsed Doppler system and equipped with the color velocity imaging system for the color blood flow codification. The score used in the evaluation of the ovary are us follows: volume of the adnexa (from 1 to 5); presence of papillas and septa (from 1 to 5); wall thickness (from 1 to 5). An high score (> 12) corresponds to probability of presence of neoplasia. For the flow modifications the following parameters were considered: RI (Index of resistance); PI (Pulse Index); Vmax (Maximum Speed). CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45, PI < or = 0.58 Vmax < or = 60.

Sonographic morphology evaluation and CD were suspicious in 11 cases and 9 of these were positive on histopathological analysis (true positive = 15%, false positive = 5%). All the women that had morphologically normal ovaries observed on ultrasound examination and were not suspicious on CD analysis, were also negative on histopathological analysis (true negative = 80%).

The color Doppler ultrasonography revealed a decidedly valid method of screening of the first level, being non-invasive examination, painless, therefore well accepted by the patients, even if in some women, especially if in fertile age, the physiological modifications calls for repeated investigations and compare its parameters.