ROLE OF COLOUR DOPPLER

IN THE EVALUATION OF
OVARIAN MASSES

Dr Jasmine Bakshi
DNB Trainee, JMMCH
Trichur
Guide: Dr Sareena Gilvaz
HOD, Dept of OBG
JMMCH, Trichur
 WHY EVALUATE OVARIAN
MASSES?

• Ovarian malignancy is the leading cause of

death among gynecological malignancies
• Life time risk without a family history -
1:70
• Usually asymptomatic until metastasis
• No effective screening available

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 DIAGNOSIS

• History
• Clinical Examination
• USG  TVS
TAS
• Colour Flow Doppler
• Tumor markers

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 AIM

To note the efficacy of

Colour Doppler in the
evaluation of ovarian masses

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 INCLUSION CRITERIA

Any patient with an ovarian mass in the

 Pubertal
 Reproductive
 Menopausal age group

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 STUDY DETAILS

• TYPE: Prospective Study

• NUMBER OF PATIENTS : 50

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HPE (GOLD STANDARD)
HPE

38%

62%

Malignant(19) Benign(31)

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 SYMPTOMS
Symptoms Related to B & M Cases

19
20
17

15
No of Patients

10 Benign(31)
10
6 Malignant(19)
5 5 5 5
5
2 2

0
Mas s P/A Pain P/A Cons t B&B Mens trual
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 Clinical Examination Vs HPE

29
40 31
19
30 11
No of HPE
20
Patie nts C/E
10

0
Benign Malignant

Sensitivity - 58% False Negative - 42%

Specificity - 94% False Positive - 6%
(
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p=0.2917(>0.05)9
 USG Vs HPE

15
(
Malignant
19
USG
HPE
25
Benign
31

0 5 10 15 20 25 30 35
No of Patie nts

Sensitivity - 79% False Negative - 21%

Specificity - 81% False Positive - 19%
PPV - 48% NPV - 86%
www.similima.com p=0.2917
10
 SASSONE et al SCORE
VARIABLES INNER WALL WALL(mm)
STRUCTURE THICKNESS SEPTA(mm) ECHOGENICITY
SCORE

1 SMOOTH THIN<3 MM NO SEPTA SONOLUCENT

2 IRREGULARITIES THICK>3 MM THIN<3 MM LOW

<3MM
LOW WITH
3 PAPILLARITIES>3 MOSTLY THICK>3 MM ECHOGENIC
MM SOLID CORE

4 MOSTLY SOLID MIXED

5 HIGH
SCORE =/>9  MALIGNANT SCORE < 9  BENIGN
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 Sassone Vs HPE

31
35
30 24
25 19
16 HPE
No of 20
Sassone
Patie nts 15
10
5
0
Benign Malignant

Sensitivity - 84% False Negative - 16%

Specificity - 77% False Positive - 23%
PPV - 70% NPV - 89%
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p=0.0936 12
 DOPPLER PARAMETERS

S — D
PULSATILITY INDEX(PI)=
-------------------------------
MEAN VELOCITY

S — D
• RESISTANCE INDEX(RI) = -------------------------------
S

PI > 1 & RI > 0.4  BENIGN

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 Doppler Vs HPE

35
31
30 26
25
20 19 13 HPE
No of Patients
15 Doppler
10
5 Doppler
0 HPE
Benign
Malignant

Sensitivity - 68% False Negative - 32%

Specificity - 84% False Positive - 16%
PPV - 72% NPV - 81%
www.similima.com p=0.9174
14
 CA-125 Vs HPE

35 31 30
30
25 19
20 12 HPE
No of Patients
15 CA-125
10
5
0
Benign m alignant

Sensitivity - 63% False Negative - 37%

Specificity - 97% False Positive - 3%
PPV - 92% NPV - 81% p=0.6703
U/mL  MALIGNANT
CA-125 > 35 www.similima.com 15
RISK OF MALIGNANCY INDEX

RMI = M × U × CA-125

M = Menopausal Status
U = Transabdominal USG Findings

RMI > 200  Suspicious For Malignancy

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 RMI Vs HPE

31 31
35
30
19
25 15
20 HPE
No of Patients
15 RMI
10
5
0
Benign Malignant

Sensitivity - 79% False Negative - 21%

Specificity - 100% False Positive - 0%
PPV - 100% NPV - 89%
www.similima.com p=0.8898
17
 CONCLUSION

HPE C/E USG DOPPLER SASSONE CA-125 RMI

% % % % % % %

M 38 20 20 30 20 20 30

B 62 60 60 50 60 60 60

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 CONCLUSION
METHODS Sensitivity Specificity(%)
(%)
USG 79 82

USG+C/E 69 87

USG+ C/E +DOPPLER 69 87

USG+C/E+DOPPLER+CA-125 67 89

USG+C/E+DOPPLER+CA-125+ 70 91
RMI
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 Thank
You
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