4th International Medical Congress of Izmir Democracy University (IMCIDU) 2022, İzmir, Türkiye, 9 - 11 Aralık 2022, ss.212-216
Abstract
Introduction and Purpose: Currently, ultrasonography is the most frequently used technique to
diagnose pelvic lesions. More specifically, transvaginal ultrasonography provides further data when
compared to transabdominal ultrasonography because of the shorter distance between the probe and the
target. Transvaginal Doppler ultrasonography enables detailed evaluation of vascularization of pelvic
lesions and arterial flow patterns. This study was conducted to detect various lesions which form mass
in the pelvic area of the female patients and to identify the efficiency of transvaginal Doppler
ultrasonography in determining the benign or malignant nature of lesions.
Materials and Methods: This study was conducted in 128 patients aged between 18 and 83, and the median age of them was 44.8. Also 80 of the patients were premenopausal (62.5%) and 48 were postmenopausal (37.5%). Patients with emptied bladders were examined by transvaginal Doppler USG. Those cases with lesions were further studied in terms of their vascularization. Doppler parameters were optimized to detect low flow. Resistive Index (RI), Pulsatility Index (PI) and acceleration profile were measured when there was arterial flow. Each lesion was measured at least three times and the lowest RI and PI values were taken into consideration in the assessment. The limit value for displaying malignity was accepted to be 0.45 for RI and 0.60 for PI. 27 of the total 128 were taken as control group and they had normal sonographic findings and their ovarian, tubal and uterine arterial measurements were recorded. Out of 101 patients with lesions, 71 were diagnosed with histopathology. 30 Non-operated patients remained on 3 to 6 times monthly interval tracking during when lesions were observed via TV ultrasonography and were found stable or regressed and accepted benign.
Results: 98 (77%) of the total 128 cases were vascular, 30 were avascular. 55 (56%) of the 98 vascular cases had benign values whereas 43 (44%) had malign values. Vascularization was detected in 24 (89%) of the 27 patients of the control group and 23 (96%) of them had benign values whereas 1 (4%) had malign values. Vascularization was detected in 29 (83%) of 35 patients with malign diagnosis and 7 (24%) had benign values and 22 (76%) had malign values. Vascularization was detected in 45 (68%) of 66 benign cases and 25 (56%) had benign values whereas 20 (44%) had malign values. Demographic data and Doppler measurements between malign and benign groups were evaluated via TA and TV Doppler measurements. There was not any statistically difference among the groups in terms of vascularity presence. However, statistically significant differences between the groups in terms of RI and PI values (p-value<0.05) (Kruskal –Wallis test) were observed
Conclusion: Transvaginal Doppler ultrasound is a noninvasive technique which is potentially effective in the diagnosis of pelvic masses. Transvaginal Doppler evaluation of the arterial flow in pelvic masses can be helpful in the distinction of malignancy. RI and PI values can be used to differentiate benign and malign pelvic lesions.