WS09‐02Ultrasound diagnosis of adnexal masses

The basis of ultrasound diagnosis of adnexal masses is the gray scale ultrasound image. In our prospective study of 173 patients scheduled for laparotomy because of an adnexal mass, an experienced examiner correctly discriminated between benign and malignant masses in 95% of cases on the basis of subjective evaluation of the gray scale ultrasound image (sensitivity 92%, i.e. 22/24, specificity 96%, i.e. 143/149). A correct specific diagnosis (e.g. dermoid cyst, endometrioma, etc.) was made in 72 of the 173 women, i.e. in 42%. Adding Doppler ultrasound examination to gray scale imaging did not change the diagnostic accuracy, but it increased the confidence (as rated on a visual analogue scale) with which a correct diagnosis was made in 14% of cases. Increased diagnostic confidence was observed most often in stage I ovarian malignancies (83%, i.e. 5/6). Doppler ultrasound examination was not helpfull in the diagnosis of borderline tumors. For less experienced ultrasound examiners the use of mathematical models to calculate an individual risk of malignancy might be an alternative to subjective evaluation of the the gray scale ultrasound image. In a study of 136 consecutive women scheduled for laparotomy because of an adnexal mass, two mathematical formulas were cross‐validated prospectively: that of Tailor et al . ( Ultrasound in Obstetrics and Gynecology 1997; 10 : 41–7) and that of Timmermann et al . ( Am J Obstet Gynecol 1999; 181: 157–65). Both models performed less well than in the studies where they were created, the sensitivity and specificity of the first model being 71% and 82%, respectively, and the sensitivity and specificity of the second model 72% and 68%, respectively. Conclusion Subjective evaluation of the gray scale ultrasound image is an excellent method for discrimination between benign and malignant adnexal masses. Mathematical models hold promise but must be fine tuned on the basis of information from a very large number of tumors.