o_1977r8vv9vk1ts2ms0kd8pksa.pdf

578 I. Zalud
Previous studies have suggested that ovarian ultrasound
morphology is not precise for diagnosing
ovarian neoplasms; sensitivities vary from 70% upward
[25, 26]. Standard ultrasound criteria that suggest
a benign condition are well known: unilocular,
cystic, unilateral, absence of internal echoes. Conversely,
malignant tumors have been characterized as
complex: multilocular, cystic-solid, bilateral, with
positive free fluid in the peritoneal cavity. Using these
criteria both false negatives and false positives are encountered.
In a premenopausal population these morphologic
criteria may be misleading. Certain pathologic
conditions, though benign, appear sonographically
with malignant morphology. Examples are dermoid
cysts, endometriosis, corpus luteum, and hemorrhagic
cysts. Color Doppler waveform analysis provides
additional information (Figs. 39.9±39.11). If a
high-resistance velocity wave pattern is observed, one
may be more confident that the lesion is benign
(Fig. 39.12). In the case where a high-velocity/low-resistance
pattern is seen the examination must be repeated
during the next cycle. Recall that the corpus
luteum or luteal flow may exhibit a low-resistance
waveform pattern (Fig. 39.13).
Several investigators are now applying a scoring
system to both morphologic criteria and color Doppler
waveform analysis [27, 28]. Table 39.3 shows the
scoring system used by the Zagreb group. This study
is the largest series of adnexal tumors analyzed by
color Doppler velocimetry [28]. The data yielded a
Pourcelot RI cutoff of 0.40 as a discriminatory value
for benign versus malignant lesions.
Application of color flow analysis may have important
implications with respect to clinical management.
Traditionally, the standard of care for an adnexal
mass has been laparotomy with surgical excision.
For a lesion where the morphology and Doppler
analysis suggest a benign condition, conservative
therapeutic options may be entertained. Advances in
video-endoscopic laparoscopy offer a conservative
surgical approach to removing an ovarian cyst.
Doppler Ultrasound
and Ectopic Pregnancy
Fig. 39.12. Tumor feeding vessel with typical high-resistance
blood flow in the case of benign multilocular ovarian
enlargement
Ectopic pregnancy is defined as implantation of the
fertilized ovum anywhere outside the normal uterine
cavity. It accounts for 2% of all pregnancies in the
United States, with its incidence is reported to be increasing
over the past two decades [29, 30]. Ectopic
pregnancy is associated with a high maternal mortality
and morbidity, accounting for 9%±13% of all
pregnancy-related deaths [31]. The most common site
Fig. 39.13. Corpus luteum blood flow
may imitate a Doppler pattern that
suggests malignancy