US characterization of ovarian masses: A meta-analysis

PURPOSE: To compare the effectiveness of current ultrasonographic (US) techniques for characterizing ovarian masses. MATERIALS AND METHODS: Through a MEDLINE literature search, articles with imaging-histopathologic correlation and data that allowed calculation of contingency tables were identified. Results of morphologic assessment, Doppler US, color Doppler flow imaging, and combined techniques were compared. RESULTS: Among 89 data sets from 46 included studies (5,159 subjects), 35 sets used morphologic information, 36 measured Doppler US indexes, 10 assessed tumor vascularity with color Doppler flow imaging, and eight used combined techniques. Summary receiver operating characteristic curves revealed significantly higher performance for combined techniques than for morphologic information (P = .003), Doppler US indexes (P = .003), or color Doppler flow imaging alone (P = .001). The Q* point (and 95% Cl) for combined techniques was 0.92 (0.87, 0.96) versus 0.85 (0.83, 0.88) for morphology, 0.82 (0.78, 0.86) for Doppler US, and 0.73 (0.58, 0.87) for color Doppler flow imaging. Morphologic assessment showed a trend toward better performance than color Doppler flow imaging (P = .09) or Doppler US indexes (P = .07). Doppler US index results were better in earlier studies (P = .005). CONCLUSION: Combined US techniques and a diagnostic algorithm perform significantly better than morphologic assessment, color Doppler flow imaging, or Doppler US indexes alone in characterizing ovarian masses.