Comparison of Lerner score, Doppler ultrasound examination, and their combination for discrimination between benign and malignant adnexal masses

OBJECTIVE: To determine whether the combined use of Lerner's morphologic score and color Doppler ultrasound examination results in better discrimination of benign and malignant adnexal masses than the use of Lerner's score alone or Doppler variables alone. DESIGN: One hundred and seventy-three consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. One hundred and forty-nine tumors were benign and 24 malignant. The sensitivity and false-positive rate with regard to malignancy were calculated for Lerner's score, six Doppler variables and combinations of Lerner's score and Doppler variables. Previously defined gray scale and Doppler criteria of malignancy were used and tested prospectively. The best method was defined as that detecting most malignancies with the lowest false-positive rate. RESULTS: Lerner's score had a sensitivity of 92% and a false-positive rate of 36%. The best Doppler variable--time-averaged maximum velocity--had similar diagnostic properties with a sensitivity of 100% and a false-positive rate of 41%. Combining Lerner's score with Doppler measurement of time-averaged maximum velocity--i.e. requiring both Lerner's score and time-averaged maximum velocity to indicate malignancy for a malignant diagnosis to be made--had a sensitivity of 92% and a false-positive rate of 19%. CONCLUSIONS: The combined use of Lerner's score and measurement of time-averaged maximum velocity is a better method for discrimination of benign and malignant adnexal masses than the use of Lerner's score alone or Doppler ultrasound examination alone. The clinical value of the combined method needs to be cross-validated prospectively in a new series of tumors.