Transvaginal ultrasonographic characterization of ovarian masses: Integration of a morphological scoring system with color-guided pulsed-wave

R. Mezzopane, N. Berlanda, M. Ferrari, E. Zannoni, E. Ferrazzi

Research output: Contribution to journalArticlepeer-review


Objective: The aim of this work was to compare the accuracy of a morphologic scoring system, to that of color-Doppler and to the integration of the two systems, to identify malignant ovarian masses by transvaginal ultrasound examination. Methods: One hundred and twelve adnexal masses were examined by transvaginal sonography within 48 hrs before surgery. The sonographic characteristics of the lesions were evaluated according to a morphological score. Color guided spectral Doppler was used to determine Pulsatility Index (PI) and Resistance Index (RI). Receiver Operating Characteristic (ROC) curves were calculated to define accuracy and best cut-off values of morphological score, PI, and and RI. The Resistance Index (RI) was then added to the morphological score in an integrated score. The area under ROC curve achieved by morphological score was compared to that achieved by best Doppler index RI and best integrated score. Results: Ninety masses proved to be benign and 22 malignant. The mean diameter of benign masses was 62 ± 33 mm, while the mean diameter of malignant masses was 94 ± 34 mm. Benign lesions had a score value of 8 (interquartile range 5-10) compared to malignant lesions (p <0.0001) which had a median score value of 11 (interquartile range 10-12). The ROC curves of RI was better than that of PI. The area under the ROC curve for the morphological score was significantly better than that achieved by RI alone (p <0.0001) while was not significantly different from that achieved by the integrated score. The sensitivity and negative predictive value of the integrated score was 100%. Specificity decreased from 59% to 51%, positive predictive value from 36% to 31%. Conclusion: The integration of information conveyed by color Doppler imaging with a descriptive morphological scoring system can help to improve the sensitivity of transvaginal sonography to detect malignant ovarian masses, with a minor worsening of specificity.

Original languageEnglish
Pages (from-to)97-101
Number of pages5
JournalItalian Journal of Gynaecology and Obstetrics
Issue number3
Publication statusPublished - 1998


  • Morphological scoring system
  • Ovrarian masses
  • Transvaginal ultrasonography

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


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