Complex Cyst with Papilary Excrescences (cont'd)

[Cagney2712]

Forgot to mention on my initial post that the Ultrasound showed resistive indices of the vascular flow in the papillary excrescences of 0.46, 0.40, 0.43. PLease include that info in reviewing my previous post, and also could you posibly explain the significance of the resistive indices, and what mine indicate??

[Annekathryn Goodman, M.D.]

Hi There
I have to say, over the years I have seen numerous papers stating that certain measurements of the blood flow in an ovarian cyst are helpful in predicting a malignancy and an equal number saying they are not predictive.  My personal take on this whole body of literature is that if you scan enough ovaries and enough cysts, you will see everything and it is not helpful or predictive but just down right confusing. I have pasted an example of this language in a representative paper below so you can see for yourself. All the papers sound like this. It does not really help clinicians. I base my decision on taking out an ovarian cyst on size, persistence, symptoms, and elevated tumor markers and other risk factors for malignancies such as personal or family history of gyn malignancies.
best wishes

Ultrasound in Obstetrics & Gynecology
Volume 2 Issue 5 Page 338 - September 1992
doi:10.1046/j.1469-0705.1992.02050338.x
Volume 2 Issue 5
  
  
Validity of pulsatility and resistance indices in classification of adnexal tumors with transvaginal color Doppler ultrasound
A. Tekay and P. Jouppila
Transvaginal pulsed color Doppler ultrasound was used to examine 72 patients with a pelvic mass preoperatively. Tumor morphology was assessed, prominent areas of vascularization within the tumor were observed and the pulsatility index and the resistance index of tumor and uterine arteries were measured. Flow velocity waveforms with low pulsatility are considered to reflect neovascularization. The ultrasound diagnoses were compared with histopathological or cytological diagnoses. There were 61 benign, eight malignant and three borderline cases. In 75% of the malignant and 23% of the benign tumors, an intratumoral flow with a low pulsatility was detectable. The mean pulsatility index of tumor blood vessels was 1.2 in benign, 0.7 in malignant and 0.6 in borderline neoplasms. The corresponding mean resistance index values were 0.6, 0.5 and 0.5. The differences were not significant and the overlap between the malignant and benign lesions was large. The pulsatility index and resistance index of uterine arteries were significantly decreased in malignant tumors. The results show that, using a cut-off resistance index value of 0.6, the sensitivity and specificity of color Doppler in the detection of malignant and potentially malignant tumors were 82% and 72%, respectively. However, a practical cut-off level for either pulsatility or resistance indices, that could assist in differentiating between malignant or benign lesions, does not seem to exist.