Objectives: To determine the diagnostic performance of subjective
evaluation of ultrasound findings (pattern recognition) with regard
to making a specific diagnosis in adnexal masses.
Methods: Some 1066 patients in the International Ovarian
Tumor Analysis study were included. They underwent transvaginal
gray-scale and color Doppler ultrasound examination by an
experienced examiner. Using pattern recognition each mass
was classified as benign or malignant, and if possible a
specific diagnosis was suggested endometrioma, dermoid cyst,
hydrosalpinx, functional cyst, paraovarian cyst, tubo-ovarian
abscess, serous or mucinous cyst, adenofibroma, torsion, simple
cyst, peritoneal cyst, fibroma/thecoma, rare benign tumor, borderline
tumor, primary invasive cancer, metastatic cancer or rare malignant
tumor. The suggested diagnosis was compared with the histological
diagnosis of the surgical specimen.
Results: There were 800 benign and 266 malignant tumors. A
specific diagnosis was suggested in 900 (84%) of 1066 tumors.
Pattern recognition diagnosed dermoid cyst with sensitivity 86%
(100/116), specificity 99% (938/950), positive likelihood ratio
(LR+) 86, and negative likelihood ratio (LR−) 0.1; endometrioma
with sensitivity 77% (153/199), specificity 98% (847/867), LR+ 36
and LR− 0.2; hydrosalpinx with sensitivity 86% (18/21), specificity
98% (1022/1045), LR+ 43 and LR− 0.1. Pattern recognition was
associated with high LR+ (8 56) and high LR− (0.3 0.9) for
all other diagnoses except peritoneal inclusion cyst (excluding rare
benign tumors and simple cysts which were associated with very low
LR+ and high LR−). LR+ and LR− for peritoneal inclusion cyst
(n = 5) were 80 and 0.2.
Conclusions: Using pattern recognition it is possible to make a
virtually conclusive diagnosis of dermoid cyst, endometrioma and
hydrosalpinx. Many other adnexal pathologies can be recognized,
but not confidently excluded, using pattern recognition.
- adnexal masses.
- transvaginal ultrasound