Premium
Transvaginal color Doppler ultrasonic characterization of benign and malignant ovarian cystic teratomas and comparison with serum squamous cell carcinoma antigen
Author(s) -
Emoto Makoto,
Obama Hirotsugu,
Horiuchi Shinji,
Miyakawa Takashi,
Kawarabayashi Tatsuhiko
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(20000515)88:10<2298::aid-cncr14>3.0.co;2-s
Subject(s) - medicine , pathology , ovary , teratoma , carcinoma , blood flow , radiology
BACKGROUND The preoperative diagnosis of squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary remains difficult. The purpose of this study is to examine the usefulness of transvaginal color Doppler ultrasound (TV‐CDU) in differentiating malignant (SCC) from benign cystic teratoma of the ovary. METHODS Eighty‐eight patients with an ovarian tumor showing gray scale sonographic appearances of mature cystic teratoma were preoperatively evaluated for the presence or absence of intratumoral blood flow by TV‐CDU. The blood flow characteristics of the tumor vessels were analyzed using the resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). The serum levels of SCC antigen were also randomly examined preoperatively in 50 patients. RESULTS Intratumoral blood flow was significantly detected in malignant teratomas (SCCs) (80.0%; 4 of 5) compared with benign teratomas (20.5%; 17 of 83) (P < 0.01). All malignant teratomas with intratumoral blood flow showed both RI less than 0.4 and PI less than 0.6, whereas no benign teratomas showed any such value except for 1 case with struma ovarii. In addition, both the mean RI and the mean PI values in the tumor vessels were significantly lower in the malignant teratomas (RI: 0.31 ± 0.07; PI: 0.40 ± 0.16) than in the benign teratomas (RI: 0.62 ± 0.13; PI: 1.06 ± 0.44) ( P < 0.001). However, the mean PSV value of the malignant teratomas (PSV: 20.6 ± 8.33) was not significantly different from the benign teratomas (PSV: 18.1 ± 9.9). Elevation of serum SCC was found in 4 of 5 patients (80%) with malignant teratomas, whereas the elevation was found in 11 of 45 patients (24.4%) with benign teratomas ( P < 0.05). The diagnostic accuracy using the RI (cutoff value 0.4) as well as the PI (cutoff value 0.6) was thus 95.2%, which was significantly superior to that obtained by using the serum SCC (76%) (cutoff value, 1.5 ng/mL). CONCLUSIONS Evaluating the presence or absence of intratumoral blood flow, together with blood flow resistance, in tumor vessels using TV‐CDU thus may be more useful to differentiate malignant (SCC) from benign cystic teratomas of the ovary than by measuring serum SCC levels. Cancer 2000;88:2298–304. © 2000 American Cancer Society.