Characterization of Adnexal Masses by Transvaginal Sonography and Color Flow Doppler

We assessed the accuracy of transvaginal sonography and color flow Doppler to distinguish benign from malignant adnexal masses and to select patients for laparoscopy. Before surgery, 225 women with adnexal masses were examined by transvaginal sonography and color flow Doppler. Size and morphologic criteria of each mass were determined, and color flow Doppler characteristics were evaluated. Of the 225 patients, 166 were premenopausal (mean age 34.6 ± 9.2 yrs) and 59 had been postmenopausal for at least 1 year (mean age 61.9 ± 7.5 yrs). Operative laparoscopy was performed in 22% of postmenopausal and 50% of premenopausal women, for a total of 96 laparoscopies. We observed 32 malignant tumors, 16 in premenopausal (10%) and 17 in postmenopausal women (29%). Analysis of gray scale morphologic findings revealed solid tissue in 77.8% of malignant and 16.1% of benign tumors (p <0.05). The presence of septa within the cysts was not significantly different in malignant and benign tumors. No sonographically simple adnexal cyst was malignant. Color flow Doppler alone seems to be less predictive of malignancy, but if combined with gray scale, is able to improve the diagnosis.