DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY IN THE DIAGNOSIS OF MALIGNANCY IN ADNEXAL MASS AND ITS CORRELATION WITH HISTOPATHOLOGICAL DIAGNOSIS

BACKGROUND: To study the diagnostic accuracy of ultrasonography in the diagnosis of malignancy in adnexal mass and its correlation with histopathological diagnosis. METHODS: This is hospital based observational study for a period of 1 year which included 133 patients of adnexal mass attending the OPD who required admission and operative intervention. All cases underwent clinical examination, ultrasonography and RMI scoring. Following surgery specimens were sent for histopathological examination and the reports were correlated with RMI scoring. RESULT: The sonographic feature which was most prevalent among the malignant group was the presence of ascites (69.6%), closely followed by the presence of multilocularity (66.6%). Solid areas were significantly more common in malignant cases (48.84%) compared to benign cases (24.72%), with a chi-square value of 6.62 and a p-value of 0.010, indicating statistical significance. However, other features like multilocularity, bilateral involvement, ascites, and metastasis did not show statistically significant differences between benign and malignant cases, with p-values of 0.222, 0.430, 0.059, and 0.397 respectively. Evidence of metastasis in sonography of adnexal mass has the highest specificity and positive predictive value (100%) for malignancy. Presence of ascites came out to be next best predictor of malignancy. It had the sensitivity of 69.6% ,specificity of 95%, positive predictive value of 70.6% and negative predictive value of 91.8%.Presence of solid areas and bilaterality had low sensitivity and positive predictive value, but high specificity and negative predictive value for malignancy and hence, they were seen more commonly malignant mass as compared to benign mass. Overall, multilocularity was the sonographic feature which was the not a good predictor for malignancy . It was neither very sensitive ( sensitivity =66%)  nor specific (specificity =48%) and had very low positive predictive value for malignancy. The presence of ascites or metastasis on ultrasound examination were significantly associated with a higher possibility of malignant adnexal mass(p <0.001). CONCLUSION: Ultrasonography has better efficacy in diagnosing malignant from benign adnexal lesions but indeterminate lesions supplemented with advanced imaging modalities like MRI and CT Scan will enhance the diagnostic certainty and help us to plan the course of the treatment and will have better outcome.