Color and pulsed Doppler sonography, gray-scale imaging, and serum CA 125 in the assessment of adnexal disease

Objective: To compare color and pulsed Doppler sonography with gray- scale ultrasound imaging and serum CA 125 levels in establishing accurate preoperative diagnoses of adnexal masses. Methods: Medical records of 109 patients referred with preexisting adnexal lesions were reviewed retrospectively by comparing preoperative ultrasonic data (gray-scale imaging and color and pulsed Doppler findings) with serum CA 125 levels. Results: Eighty-three masses were removed surgically, confirming seven malignancies and 76 benign tumors, and 26 masses were followed; 19 regressed and 11 persisted. Color and pulsed Doppler sonography showed the highest sensitivity, followed by gray-scale imaging, whereas serum CA 125 levels revealed the highest specificity in distinguishing malignant from benign adnexal tumors. All three methods had high negative predictive values (96- 100%), whereas only serum CA 125 had a positive predictive value greater than 50%. Conclusion: Color and pulsed Doppler sonography, which demonstrate a tumor angiogenic activity, are as accurate as gray-scale imaging in the assessment of adnexal lesions. Together with serum CA 125 marker levels, they produce high negative predictive values, providing reassurance that an adnexal mass is benign.