Real‐time ultrasound vs. evaluation of static images in the preoperative assessment of adnexal masses

• Published in: Ultrasound in obstetrics & gynecology Vol. 32; no. 6; pp. 828 - 831
• Main Authors: Van Holsbeke, C., Yazbek, J., Holland, T. K., Daemen, A., De Moor, B., Testa, A. C., Valentin, L., Jurkovic, D., Timmerman, D.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.11.2008; Wiley
• Subjects: Adnexa Uteri - diagnostic imaging; Adnexal Diseases - diagnostic imaging; adnexal tumors; Biological and medical sciences; Clinical Medicine; Diagnosis, Differential; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Klinisk medicin; malignancy; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; ovarian cancer; Ovarian Neoplasms - diagnostic imaging; pattern recognition; Preoperative Care; Prospective Studies; Radiologi och bildbehandling; Radiology, Nuclear Medicine and Medical Imaging; risk of; risk of malignancy; Sensitivity and Specificity; subjective impression; Tumors; Ultrasonography, Doppler - instrumentation; ultrasound; Sonography; Statics; adnexal tumors; ovarian cancer; Ovary cancer; Gynecology; Adnexa uteri; Malignancy; Malignant tumor; Real time; Obstetrics; Female genital diseases; Mass; Ovarian diseases; risk of malignancy; Echography; Risk factor; Preoperative; subjective impression; Ultrasound; Comparative study; Cancer; pattern recognition
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.6214

Objective To determine if the prediction of the malignancy of an adnexal mass using pattern recognition, i.e. subjective evaluation of gray‐scale and Doppler ultrasound findings, is as accurate when based on static images as it is when based on a real‐time ultrasound examination. Methods The static images of 166 non‐consecutive patients with ‘difficult’ adnexal masses, who all underwent surgery and for whom a histopathological diagnosis was available, were evaluated by three experts in gynecological ultrasound (‘image experts’). All ultrasound examinations had been performed and the static images saved by a fourth expert sonologist (‘real‐time’ sonologist). All four sonologists classified the adnexal masses as benign or malignant based on their subjective impression and stated with what degree of confidence their diagnosis was made. The diagnostic performance of the real‐time sonologist was compared with that of each of the three image experts and with that of the ‘consensus opinion’ of the image experts (i.e. the diagnosis suggested by at least two of the latter). Results The real‐time sonologist correctly predicted the diagnosis with an accuracy of 89% (148/166) vs. 85% (141/166) for the consensus opinion of static images (P = 0.0707). Equivalent values for sensitivity and specificity were 80% (56/70) vs. 83% (58/70) (P = 0.4142) and 96% (92/96) vs. 86% (83/96) (P = 0.0027), respectively. Conclusions The preoperative diagnosis of an adnexal mass made on the basis of a real‐time ultrasound examination is more precise than a diagnosis made on the basis of saved static ultrasound images. Evaluation of static images is associated with lower diagnostic specificity. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.