o_1977r8vv9vk1ts2ms0kd8pksa.pdf

602 I. Zalud
masses have a benign appearance, while giving confirmation
of malignancy in adnexal masses with suspicious
morphological features.
It is important to emphasize that the areas of overlap
in benign versus malignant pelvic lesions tend to
involve nonneoplastic masses that contain vasodilated
vessels, owing to local or general hormonal imbalances.
Whereas some malignant tumors elicit sparse
angiogenesis and may appear avascular, and therefore
benign, in terms of color Doppler sonography. Obese
women and women with irregular cycles and hormonal
disturbances may produce ovarian blood flow
patterns with typical low vascular resistance to blood
flow. Therefore, measurements of estradiol and progesterone
serum levels on the day of the transvaginal
color Doppler examination should be performed
when low vascular impedance to blood flow is found.
It is possible that ± with further improvement of color
and pulsed Doppler sensitivity, and in conjunction
with clinical findings, gray-scale ultrasound imaging,
and serum hormonal levels when necessary ± a better
distinction between malignant and benign pelvic tumors
will be made. Contrast agents are another possibility
for enhancing both color and power Doppler
examinations by increasing the detection rate of
small vessels [22].
III or greater). The 5-year survival rates for stage III and
IV carcinoma of the ovary are 13% and less than 5%,
respectively. Morbidity and mortality rates remain high
despite improvements in surgical technologies, chemotherapy,
and imaging techniques. There is presently
no adequate screening tool for this disease.
The Zagrebgroup has studied the largest series of
patients to date. Among approximately 14,000 women,
more than 700 cases of adnexal pathology were
detected [8], 624 were benign masses. Color flow was
typically present in about one-third of the lesions. In
all but one of the cases the RI was greater than 0.40.
Color flow was present in more than 95% of ovarian
malignancies, and the RI ranged from 0.28 to 0.40.
Figures 40.5 and 40.6 show a malignant tumor with a
high-velocity/low-resistance Doppler velocimetry pat-
Ovarian Cancer
Among gynecologic cancer-related deaths, ovarian cancer
heads the list. The mortality due to ovarian cancer
exceeds that of all uterine cancers, endometrial and cervical,
combined. More than 65% of women with cancer
of the ovary present with advanced-stage disease (stage
Fig. 40.5. Complex, dominantly cystic adnexal mass with
blood flow detected by color Doppler in the septal portion
Fig. 40.6. Same patient as in Fig. 40.5.
Pulsed-wave Doppler sonography
showed high-velocity/low-resistance
blood flow. Arrows indicate the peak
systolic and diastolic velocity on the
Doppler waveforms