OBJECTIVES:

Ultrasonographic findings, Ca125 levels, risk of malignity index, resistance index and pathologic results of pelvic masses were examined to determine their efficiency in malignant and benign differentiation.

MATERIALS-METHODS:

Onehundredfourteen patients with a diagnosis of pelvic mass between the years 2002-2004 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 Ca125 levels (cut-of≥ 35U/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 efficiency of these paramaters in malignant/benign differentiation.

RESULTS:

Patients mean age was 39 (Range 12-75). Sixteen patients were postmenopausal. Ninety one (79 %) of 114 patients were operated. Fifytfour 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 remaing 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, CA125 and RI in the differentiation of malignant/benign tumors ranged between 38-69 %, the specifity between 71-99 %, the positive predictive value between 23-83 % and the negative predictive value between 92-94 %.

DISCUSSION:

In the differentiation of malignant/benign lesions Doppler ultrasonography was found to be more effective than only ultrasonography and Ca125 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.

Keywords: Pelvic Mass, Ca125, Risk of malignity index, Doppler Ultrasonography