Diagnostic value of endosonography scoring systems in the detection of ovarian and endometrial carcinoma.

Purpose: To evaluate the diagnostic significance of sonographic scoring systems in the diagnosis of ovarian and endometrial carcinoma.

Patients And Methods: 357 women with different malignant and benign diseases of the ovary and uterus were divided into 4 groups according to histopathological findings: group A: ovarian carcinoma (n=71); group B: benign ovarian tumors (n=106); group C: endometrial carcinoma (n=60); and group D: benign endometrial diseases in menopause (hyperplasia, polyps, submucosal myoma; n=120). Women were examined using 7 MHz endovaginal probe and were evaluated using 2 different sonographic scoring systems, separately for ovarian and for endometrial carcinoma. Particular morphological characteristics of ovarian carcinoma (tumor size, echo-characterization: solid-cystic, presence of septum, characteristics of tumor capsule and presence of ascites) were evaluated with points 0-2 (total score: 0-10). For endometrial carcinoma we used a clinico-sonographic scoring system, which included evaluation of the endometrial thickness, isthmus-fundus diameter of uterus, number of years in menopause and the presence of risk factors, using scores 0-2 (total score: 0-8).

Results: The average age in group A was 48.1 years, and the arithmetic mean of total score 7.25 points. In group C the average age was 64.1 years, and the arithmetic mean of total score 6.38 points. Using both scoring systems, a total score of 6 points had the highest diagnostic reliability in both ovarian (sensitivity 87.3%, specificity 97.5%, test accuracy 91.6%) and endometrial carcinoma (sensitivity 80%, specificity 91.5%, test accuracy 90.9%).

Conclusion: A total score of 6 and more points presents the gold standard according to which it is possible to diagnose with high accuracy the existence of ovarian and endometrial carcinoma. Shifting towards higher criteria, specificity and positive predictive value rise, but sensitivity, negative predictive value and test accuracy decrease. Shifting towards lower values of total score increases sensitivity and positive predictive value, but decreases specificity, negative predictive value and test accuracy.