الفهرس 
Prediction of ovarian malignancyOnly 14 pages are availabe for public view
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Abstract
Ovarian cancer is the second most common gynecologic
malignancy and the most common cause of gynecologic
cancer death worldwide. The majority of ovarian malignancies
(95 percent) are derived from epithelial cells; the remainder
arise from other ovarian cell types (germ cell tumors, sex cordstromal tumors).
Patients with a known or suspected adnexal mass should
undergo a general evaluation to confirm the presence of a mass
and determine its characteristics and any associated symptoms
or physical findings.
Features that are suggestive of malignancy include a solid
mass that is irregular or fixed or is associated with posterior culde-sac nodularity. On the other hand, endometriomas and tuboovarian abscesses are benign lesions that may be fixed and
irregular.
Ultrasonography is considered the primary imaging
modality for confirmation of the ovarian origin of mass and
characterization of nature of mass as benign or malignant. It
correlates morphologic images with gross macroscopic
pathologic features of ovarian masses.
Color Doppler ultrasound flow imaging can detect the
blood flow resistance index (RI) and the velocity, based on the observation of the distribution characteristics and
morphological features of tumor vessels. RI can directly reflect
the resistance against blood flow, and it is higher in benign
ovarian tumors than in malignant ovarian tumors.
This is a retrospective analysis conducted on 379
patients who underwent surgery for adnexal masses at Ain
Shams University hospital over five years period between May
2015 and May 2020.
During this study, 487 medical records of patients who
underwent surgery for adnexal masses were assessed for the
study and there were 379 patients found to be eligible for the
study based on the selection criteria.
The aim of this study is to determine the predictive value
of pre-operative resistance index (RI) of color Doppler of
ovarian vessels in identifying potential ovarian malignancy.
Regarding the demographic data, the Age and
postmenopausal state were significantly highest in ovarian
malignancy and the majority of malignant cases were
postmenopausal (58%).
All the gray-scale US features in our study showed
significant difference between the benign and malignant
ovarian lesions. from these US features, we found that the
malignant ovarian lesions are mostly unilateral (75.3%), more than 5 cm size (72.2%), thick wall (90.1%), with turbid content
(80.2%), solid components (54.3%), unilocular (87.7%) with
papillary projections (56.8%) and thick internal septa (87.7%).
while endometriosis mostly large size >3cm (72.2%), with
thick wall (81.7%) and turbid content (64.3%).
The solid component, papillary projection and septations were
the most consistent and significant predictors for ovarian cancer
with 0.28, 3.82 and 7.19 odds ratio, respectively.
In correlation between the final histopathology and
doppler resistance index, Resistance index was significantly
lowest in ovarian malignancy, which was a significant predictor
of ovarian cancer.
Spectral Doppler can measure the blood flow indices to
determine the resistance within the vessels using the Resistance
index. The values of RI in our study was significantly lowest in
ovarian malignancy (0.48±0.07) than in benign lesions
(0.68±0.12) with (p value <0.001).
Resistance index at ≤0.54 had high specificity and
negative predictive value but moderate sensitivity and
positive predictive value in diagnosing ovarian cancer.