The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler Asim Kurjak, M.D., Ph.D.,* Sanja Kupesic, M.D., Ph.D., Vladimir Sparac, M.D., Ph.D., Matija Prka, M.D., and Ivanka Bekavac, M.D. Department of Obstetrics and Gynecology, Zagreb University School of Medicine, Sveti Duh Hospital, Zagreb, Croatia Received 8 July 2002 Abstract Objective. The objective was to determine the diagnostic accuracy of three-dimensional (3D) sonography and 3D power Doppler imaging, used together with standard 2D transvaginal grayscale and color/power Doppler modalities, for preoperative sonographic assessment of suspected ovarian lesions. Methods. Five-year retrospective analysis was performed by our experts on ultrasonography and surgery on the reports from 43 referred patients with suspected stage I ovarian cancer. All patients were evaluated during the week prior to surgery at our department. Preoperative sonographic assessment included careful examination of ovarian volume, morphology, and vascularity by four complementary sonographic methods. Scoring systems combining morphological and Doppler parameters were adopted for 2D and 3D sonographic examinations. Final diagnosis was confirmed by a histopathologist. Results. Out of the 43 stage I ovarian cancers, 42 cases were successfully detected preoperatively by four complementary sonographic methods. Only 30 (69.8%) and 37 (86.1%) cases of stage I ovarian cancer were detected by 2D grayscale and combined 2D grayscale and color Doppler sonography, respectively. Morphological analysis obtained by 3D sonography alone detected 32 of 43 ovarian malignancies, reaching a diagnostic rate of 74.4%. Qualitative analysis of tumor vascularity architecture by 3D power Doppler significantly improved the sonographic management process and successfully detected 41 cases of stage I ovarian cancer (95.4%). When morphological features obtained by 3D sonography were added to 3D power Doppler findings, we achieved an even higher diagnostic accuracy of 97.7%. We found a statistically significant difference (P  0.01) in diagnostic rates of 3D power Doppler, and especially the combined use of 3D sonography and 3D power Doppler in comparison to those obtained with transvaginal 2D grayscale (P  0.002 and P  0.001, respectively) or 3D sonography (P  0.006 and P  0.002, respectively). Conclusions. In comparison to transvaginal 2D grayscale or 3D sonography, 3D power Doppler and especially the combined use of 3D sonography and power Doppler imaging significantly improve diagnostic accuracy in preoperative sonographic assessment of suspected ovarian lesions. © 2003 Elsevier Science (USA). All rights reserved. Keywords: Stage I ovarian cancer; Three-dimensional sonography; Three-dimensional power Doppler; Ovarian cancer screening Introduction Advances in ultrasonography have led to frequent inci- dental detection of an early ovarian cancer at initial scan- ning [1,2]. Several attempts have been made to distinguish accurately an early stage ovarian malignancy from ques- tionable ovarian lesions on the basis of grayscale ultrasound and/or color Doppler features [3,4]. It has been reported that the presence of intratumoral papillae, solid parts, and thick septa suggest ovarian malignancy [5]. The detectability of these morphologic findings varies and their diagnostic value is not yet established. Although previous studies reported that color Doppler ultrasound could provide clinically useful information about ovarian tumor vascularity [6,7], the presence of an overlap * Corresponding author. Department of Obstetrics and Gynecology, Zagreb University School of Medicine, Sveti Duh Hospital, Sveti Duh 64, 10000 Zagreb, Croatia. Fax: +385-1-3745534. E-mail address: asim.kurjak@public.srce.hr (A. Kurjak). R Available online at www.sciencedirect.com Gynecologic Oncology 90 (2003) 258 –264 www.elsevier.com/locate/ygyno 0090-8258/03/$ – see front matter © 2003 Elsevier Science (USA). All rights reserved. doi:10.1016/S0090-8258(03)00205-1