| Malignant ovarian neoplasm is a common carcinoma in female genital tract, and its prominent type is epithelial ovarian cancer (EOC). About 2/3 of HOC cases are recognized only in advanced stages with the lowest five- year survival in carcinomas of female genital tract, so it is necessary to find a new technique to diagnose early stage EOC.Transvaginal sonography (TVS) is introduced to be a major technique in diagnosis of EOC in clinical practice with sensitivities ranging from 84 to 100%, specificities from 52 to 87.1%, positive predicting values from 29.4 to 60% and negative predicting values from 96 to 100%. Because of the relatively low sensitivity in low malignant potential (LMP) tumors and early stage cancers, as well as the insufficient specificity to distinguishing benign processes, TVS has not been recommended to be widely used up to now. Nonetheless, further improvement of ultrasonographic validity using additional procedures such as color Doppler ultrasonography is desirable.Angiogenesis is an early critical step in the tumorigensis, invasion and metastasis of EOC. Abnormally active angiogenesis and malformation of vessel structure are main characters in malignant solid tumors. While color Doppler can investigate the dynamics2003characters of blood flow by quantitative analysis of resistance to vessel and blood flow velocity. So theoretically transvaginal color Doppler ultrasonography can reflect the anatomy and function of ovarian lesions, mainly the change of blood flow so as to determine the character of lesions. But there are some unresolved problems about TVCDU: (1) which parameters can effectively reflect the blood flow in ovarian lesions? (2) There are obvious overlaps of parameters between malignant and benign lesions, and what cut-off value should we take? (3) There was no scoring system combining parameters of TVCDU. Can we set up a scoring system combining parameters to improve the sensitivity and specificity of diagnosing HOC? (4) In the previous studies, the samples in malignant tumor groups were relatively small, and the malignant groups were not classified.The aim of this study is to evaluate which parameters of TVCDU can effectively reflect blood flow in tumors by measuring and comparing all kinds of parameters of TVCDU, and to set up a scoring system combining effective parameters of TVCDU, and to evaluate its clinical value on diagnosing EOC.Materials and MethodsAfter TVS examination, TVCDU was preoperatively used to determine all the parameters of blood flow in ovarian masses in 60 women with EOC, 36 with benign ovarian cystadenomas (control 1), 65 with endometriosis cysts (control 2). The parameters included resistance index (RI), pulsed index (PI), systolic peak velocity/diastolic end velocity (S/D), time averaged maximum velocity (TAMXV), number of arterioles, type of vasculature and diastolic notch. All the tissue samples were obtained after operation .Microvessel density ( MVD) was counted in the tissue samples by immunohistochemical method (SP method). And all the clinicopathologic data of cases were obtained. The parameters of TVCDU in EOC were compared with those in control groups .The correlation between MVD and the parameters in EOC group was analyzed. A color Doppler scoring system was set up by multivariate logistic regression analysis, and was evaluated on diagnosing EOC by comparing with morphological scoring system (adopting Depriest scoring system). All the data were statistically managed with SPSS 11.0 for windows. The level of P<0.05 was considered significant.Results1 ,The results by Depriest scoring system on diagnosing EOC: 49 cases positive and 11 negative in EOC group, 31 positive and 70 negative in control groups (including control group 1 and 2).2,Comparison of parameters among EOC and the two control groups: There were statistical differences of arteriole showing rate, the fraction of masses with the number of arterioles more than 3,the type of vasculature, diastolic notch, PI, RI, S/D, TAMXV among EOC group and bo...
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