| PrefaceThe mortality rate of ovarian malignant neoplasms is the topmost in the gynecologic deceases. Therefore it is important to diagnose in the earle stage. Based on the ovarian size, morphology, blood vessel distribution and blood flow parameter, pelvic ultrasond can detect the ovarian tumor and determinant whether it is malignant. Transvaginal sonography combined with color doppler ultrasound improved the diagnosis accuracy. The serum tumor maker CA125 have been assessed as the potential screening tool. But it cant be adopted alone because of its undependable. The US and CA125 level of 109 patients were observed , the result were correlated with surgery and with histo - patholigical finding, aimed at detecting the different value, also at finding the US characteristics. The blood flow parameter of benign and malignant tumor were analyzed and disscussed the application merit. The Dynamic Flow technique was assessde concisely in this study.Materials and Methods1. ObjectivesOne hundred and nine patients with ovarian tumor who underwent opration served as subjects during June,2003 to February,2005. Twenty -nine patients were bilateral tumor. Patients ranged in age from 11 to 80 years with a mean age of 47.53y. They were examined by US and serum CA125 before operation.2. EquipmentsAll patient had underwent Color Doppler ultrasonography using TOSHIBA Aplio 80 with 2 -5MHz convex or 5 -9MHz transvaginal probes.3. MethodsTransvaginal ultrasonography observed tumor size, number, echo characteristics, septa, papilla and ascites. CDFI and D -flow observed blood flow distribution , the morphology of tumor angiogenesis and grade it. Pulse Doppler sonography evaluated the hemodynamic festures of tumor angiogenesis. All patients'CA125 were observed.4. Statistical analysisThe sensibility, specificity, accuracy, positive predictive value and negative predictive value of US and CA125 were compared by chi - square test in two groups. The blood flow parameters of malignant and benign tumor were compared by un - paired t — test. The above statistical analysis were conducted with the statistical software package SPSS for Window , version 11.0.Results1. Commonly things and histo - pathological diagnosis typesFifty — four ovarian malignant tumors include 28 serous cystadenocsrcino-mas, 9 adenocarcinomas, 4 granulosas cell tumors, 4 matastatic carcinomas, 9 other styles. Fifty - five ovarian benign tumor include 20endometriomas , 18 matuere cystic teratomas, 4 follicular ovarian cysts, 4 cystadenofibromas and 9 other styles.2. Ovarian malignant tumor US features 2.1 Planar sonography characteristics:Among fifty - four malignant ovarian tumor patients ,7/74(9.5% ) showed cystic tumor with papilla or solid projection ,multicolular, thickened cystic wall and septa, along with 1-2 grade blood flow distribution. 53/74 (64. 6% ) showed solid tumor with cystic component inside, with septa , papilla or solid projection, along with 2-3 grade blood flow distribution. 14/74 (17. 4% ) showed solid tumor with atactic modality and small hemorrhage necrotic focus, along with 3 grade blood flow distribution.2.2 Ovarian malignant tumor blood flow grade;2/54(3.7% ) represented 0 grade on ovarian malignant tumor, 1/54 (1. 9% ) represented lgrade, 16/54(29.6% ) was 2 grade, 35/54(64.8% ) was 3 grade. The malignant exhibited central vascularization, excessive blood folw distribution, shaped as dendritic ,netlike blood vessle.We used D - flow at the same time , and found it can display blood flow well and grade true. But it didnt differ significant with CDFI on grading blood flow.2.3 Ovarian malignant tumor blood flow parameter analysisMeasured 46 ovarian malignant tumors and 23 benign tumors blood flow parameter, we got Peak Systolic Velocity 19. 84 ±6. 78cm/s and 12. 91 ±6. 35 cm/s respective on malignancy and benign, Average Maximum Velocity 11.73 ±4.76 cm/s and 7. 86 ±4.57cm/s respective on malignancy and benign, Pul-satility Index 0. 71 ±0. 22 and 1. 26 ±0. 31 respective on malignancy and benign, Resistance Index 0.46 ±0.10 and 0. 70 ±0. 13 respective on malignancy and benign. They differed stastical significant. Based on RI <0.46 and PI < 1. 0, we got 86.9% sensitivity and 78.3% specificity .3. The diagnosis value of US and CA125The value of US on ovarian malignant was higher than CA 125. The sensibility, specificity, accuracy, positive predictive value and negative predictive value of US were 90. 8% , 96. 4% , 93. 6% , 96. 1% f 91. 3% , and CA125 were respective 75.9% , 65. 6% ,71.6% ,68.3% ,73.5% . Combined two methods can improve the sensibility and negative predictive value.Conclusions1. US can reveal the characteristics of ovarian malignant tumors and differ the malignant from benign.2. US has higher sensibility, specificity, accuracy, positive predictive value and negative predictive value than CA 125. Combined them can improve the diagnosis value.3. CDFI is helpful in differenting the malignancy from benign. The malig-... |
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