Controversies in assessment of ovarian tumors with transvaginal color Doppler ultrasound

Background. The observations made in the late 1980s indicated that the transvaginal color Doppler ultrasound can be used in the detection of ovarian cancer. This has generated a stream of clinical trials. The conflicting results of numerous publications, however, have led to a major controversy. The aim of this communication is to review the literature and our own observations in order to provide more insight into the subject. Results. The performance characteristics of the 32 previous transvaginal color Doppler ultra sound studies showed a considerable heterogeneity: the sensitivity was 25%-100%, the specificity was 46%-100%, the positive predictive value was 28.6%-100% and the negative predictive value was 63%-100%. The accuracy varied between 57% and 100%. An indisputable overlap was found between the ranges of pulsatility index (PI) and resistance index (RI) values from the benign and malignant adnexal tumors. The RI was <0.40 in 43% of benign tumors and in 25% of the normal vascular ovaries. Conclusion. The current cut-off levels for PI or RI values should not be used in clinical decision making due to their poor specificity.