Scoring system for prediction of ovarian endometriosis based on transvaginal color and pulsed Doppler sonography

OBJECTIVE: To develop a new noninvasive scoring system using clinical signs and symptoms, CA-125 levels, sonographic findings, and transvaginal color and pulsed Doppler parameters for preoperative recognition of ovarian endometriosis. DESIGN: A 5-year prospective study in patients undergoing laparotomy and laparoscopy. SETTING: Department of Obstetrics and Gynecology, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. PATIENTS: Six hundred fifty-six benign and malignant adnexal masses, among which 103 were surgically proved to be ovarian endometriosis. INTERVENTIONS: All patients undergoing laparotomy and laparoscopy were examined by transvaginal ultrasonography with color Doppler imaging. Serum levels of CA-125 were measured the day before surgery. MAIN OUTCOME MEASURE: The total score was applied in all patients with adnexal masses. RESULTS: The scoring system proved to be very useful in distinguishing ovarian endometriosis from other benign and malignant ovarian lesions, with a sensitivity of 99.02% and a specificity of 99.64%, compared with morphological scoring system's sensitivity of 83.91% and specificity of 97.12%. CONCLUSION: The new noninvasive scoring system improves significantly the ability to discriminate between endometriosis and other benign and malignant ovarian entities.