Clinical and ultrasonographic evaluation of pelvic masses [Pelvik kitlelerin klinik ve ultrasonografik degerlendirmesi]

Objective: Ultrasonographic findings, CA-125 levels, risk of malignity index, resistance index and pathologic results of pelvic masses were examined to determine their efficacy in malignant and benign differentiation. Materials and Methods: One hundred and fourteen patients with a diagnosis of pelvic mass between 2002 and 2004 were evaluated. The menopausal status, ultrasonographic appearance (mass lesion greater than 4 cm, solid, cystic, multiloculated, uniloculated, septated, complicated and existence of papillary structures), serum CA-125 levels (cut-of ?35 U/ml), Doppler sonographic resistance index (cut-off ?0.42) and RMI (risk of malignancy index, cut-off ?200) were recorded. Ovarian carcinomas and borderline tumours were classified in the malignant group in the evaluation of the efficacy of these paramaters in malignant/benign differentiation. Results: Mean age of the patients was 39 years (range 12-75 years). Sixteen patients were postmenopausal. Ninety-one (79%) of 114 patients were operated. Fifty-four patients (59%) were laparoscopically operated (none of them was malignant), whereas explorative laparotomy was performed for 37 (41%) patients (13 of them were malignant). Eighteen (15.8%) of the remaining patients were followed-up by ultrasonography and serum CA-125 determinations, and ultrasonographic cyst aspiration was performed in 5 patients (4-4%). Postoperative histopathology of 13 patients showed malignant characteristics (1 clear cell carcinoma, 1 undifferentiated carcinoma, 1 adenocarcinoma, 1 Brenner tumor, 1 carcinoma metastasis, and 4 borderline tumors) and 78 patients showed benign characteristics (13 endometriomas, 3 mature cystic teratomas, 3 ovarian torsions, 2 tuboovarian abcesses, 1 degenerated myoma, 56 benign cysts). The sensitivity of RMI, CA-125 and RI in the differentiation of malignant/benign tumors ranged between 38% and 69%, the specificity between 71% and 99%, the positive predictive value between 23% and 83% and the negative predictive value between 92% and 94%. Discussion: In the differentiation of malignant/benign lesions Doppler ultrasonography was found to be more effective than only ultrasonography and CA-125 or RMI. The low sensitivity of RMI was attributed to the insufficient number of cases in our study. The combination of these 3 parameters will increase the effectivity of clinical judgement of pelvic masses