Premenopausal adnex masses:: Diagnostic accuracy of sonography, magnetic resonance imaging, and positron emission tomography

Objective: We analyzed the diagnostic accuracy of imaging techniques for predicting the benign or malignant status of adnexal masses in premenopausal women. Methods: 64 premenopausal women referred for laparoscopic surgery for asymptomatic and persisting adnexal masses were studied. Preoperatively the patients underwent magnetic resonance imaging (MRI), positron emission tomography (PET) and sonography and Doppler sonography. The sensitivity, specificity, and positive and negative predictive values of the imaging modalities were calculated with contingency tables. Results: At surgery 58 patients had benign and 6 had malignant tumors (2 carcinomas and 4 tumors of low malignant potential [borderline tumors]). Sonographic findings were suspicious for malignancy in 5 of 6 patients (sensitivity: 76%). The combination of sonography and a semiquantitative scoring system or Doppler sonography did not improve the diagnostic accuracy. MRI had the same sensitivity but higher specificity (86%) than sonography. PET detected both carcinomas but only 1 of 4 borderline tumors (specificity: 75%). Conclusion: The sensitivity of PET for the early detection of ovarian cancer is poor. Negative MRI or PET findings do not rule out early ovarian malignancy.