A combined Doppler and morphopathological study of ovarian tumors

To evaluate intratumoral blood flow in 46 patients with ovarian masses.

Transvaginal color Doppler was carried out in each patient prior to the laparoscopy or laparotomy. Tumors were analyzed according to the size, morphology, presence of the neovascularization, configuration and distribution of the tumoral blood vessels and pattern of the intratumoral blood flow. Vascular patterns of surgically removed tumors were studied microscopically. Three types of vasculature were analyzed: neovascular capillaries without media, sinusoidal thin walled spaces and normal vessels' morphology. The RI (resistance index) values were analyzed in relation to gross appearance, histological type of the tumor, existence of inflammation/necrosis area and vascularization pattern of the tumor.

Neovascularization was found in all the malignant tumors with low RI (less than 0.42) and solid or solid cystic gross morphology. Neovascular signals were obtained in only one patient with ovarian endometrioma. Sinusoidal spaces were identified in all the malignant ovarian tumors, but also in most of the benign lesions. Normal vessel morphology was identified in 60% of malignant ovarian tumors and in all the patients with benign ovarian lesions.

There is a significant correlation between Doppler and histopathological studies in terms of vascularization pattern analysis (detection of neovascular capillaries, sinusoidal spaces and normal vessels morphology). In most of the malignant ovarian tumors there were few areas of vascularization which can be analyzed non-invasively by transvaginal color and pulsed Doppler ultrasound.