Simple ultrasound-based rules for the diagnosis of ovarian cancer

D. Timmerman, A. C. Testa, T. Bourne, L. Ameye, D. Jurkovic, C. Van Holsbeke, D. Paladini, B. Van Calster, I. Vergote, S. Van Huffel, L. Valentin

Research output: Contribution to journalArticle


Objective: To derive simple and clinically useful ultrasound-based rules for discriminating between benign and malignant adnexal masses. Methods: In a multicenter study involving nine centers consecutive patients with persistent adnexal tumors underwent transvaginal gray-scale and Doppler ultrasound examination using a standardized examination technique and standardized terms and definitions. Information on 42 gray-scale ultrasound variables and six Doppler variables was collected and entered into a research protocol. When developing simple ultrasound-based rules to predict malignancy (M-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the highest positive predictive value (PPV) with regard to malignancy; when developing simple rules to predict a benign tumor (B-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the lowest PPV with regard to malignancy. We selected ten rules that were in agreement with our clinical experience and were applicable to at least 30 tumors and then tested them prospectively on 507 tumors examined in three of the nine centers. Results: 1066 patients with 1233 adnexal tumors were included. There were 903 benign tumors (73%) and 330 malignant tumors (27%). In 167 patients the tumors were bilateral. We selected five simple rules to predict malignancy (M-rules): (1) irregular solid tumor; (2) ascites; (3) at least four papillary structures; (4) irregular multilocular-solid tumor with a largest diameter of at least 100 mm; and (5) very high color content on color Doppler examination. We chose five simple rules to suggest a benign tumor (B-rules): (1) unilocular cyst; (2) presence of solid components where the largest solid component is

Original languageEnglish
Pages (from-to)681-690
Number of pages10
JournalUltrasound in Obstetrics and Gynecology
Issue number6
Publication statusPublished - Jun 2008


  • Color Doppler imaging
  • Ovarian neoplasms
  • Ultrasonography

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

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    Timmerman, D., Testa, A. C., Bourne, T., Ameye, L., Jurkovic, D., Van Holsbeke, C., Paladini, D., Van Calster, B., Vergote, I., Van Huffel, S., & Valentin, L. (2008). Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound in Obstetrics and Gynecology, 31(6), 681-690.