Preoperative diagnosis of ovarian malignancy: preliminary results of the use of 3-dimensional vascular ultrasound.

Objective: To estimate the accuracy of 3-dimensional (3D) vascular ultrasound in the preoperative assessment of pelvic masses for malignancy.

Methods: We performed a chart review of 66 patients who underwent 3D ultrasound for pelvic masses. Each mass was preoperatively judged to be benign or malignant based upon a study of vascularity within an ovarian mass using 3D ultrasound. Masses with orderly vascular architecture were categorized as probably benign, and masses with chaotic vascular patterns were categorized as malignant. The predictive value of 3D vascular ultrasound was compared with that of 2-dimensional ultrasound and cancer antigen 125 as a predictor of malignancy.

Results: Among the 66 patients examined, 34 underwent a documented surgical intervention. Of those 34 patients, 10 had primary malignant neoplasms including 2 with low-malignant potential tumors. Suspicious 3D vascular ultrasound findings predicted malignant neoplasm in 10 patients. Two patients had recurrent cancer; however, only 1 had a suspicious ultrasound finding. There was 1 case of a low-malignant potential tumor without a suspicious ultrasound finding. Excluding the recurrent cancers and the observed patients, the positive predictive value (PPV) and the negative predictive value (NPV) of 3D vascular ultrasound were 100% and 95%, respectively. The PPV and the NPV of 2-dimensional ultrasound in predicting malignancy were 37% and 100%, respectively. An abnormal level of cancer antigen 125 had a PPV and an NPV of 73% and 83%, respectively, in this patient population.

Conclusions: In this preliminary and observational study, 3D ultrasound examination of vascular architecture was discriminatory in distinguishing benign ovarian masses from malignancy. Chaotic vascular architecture correlated with malignancy in this group of high-risk patients.