Comparison of Diagnostic Accuracy of Doppler Ultrasound in Differentiating Benign and Malignant Uterine Masses with Histopathology

Abstract

Background: Uterine masses are common gynecological findings and include both benign lesions, such as leiomyomas, and malignant tumors, including endometrial carcinoma and uterine sarcomas. Because benign and malignant uterine masses may present with overlapping clinical and grayscale sonographic features, accurate preoperative differentiation remains challenging. Doppler ultrasound provides additional vascular and hemodynamic information that may improve diagnostic discrimination. Objective: To evaluate the diagnostic accuracy of Doppler ultrasound in differentiating benign and malignant uterine masses using histopathology as the reference standard. Methodology: A cross-sectional analytical study was conducted at Social Security Hospital and Tahir Diagnostic Centre, Okara, over four months. Sixty female patients with clinically suspected or sonographically detected uterine masses were included through convenience sampling. All patients underwent grayscale and Doppler ultrasonography using transabdominal and/or transvaginal probes. Doppler assessment included vascularity pattern, resistance index, pulsatility index, and blood flow characteristics. Final diagnosis was confirmed by biopsy or surgical histopathology. Data were analyzed using SPSS version 25. Sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated.  Conclusion: Doppler ultrasound demonstrated high diagnostic accuracy in differentiating benign from malignant uterine masses and may serve as a valuable non-invasive adjunct in preoperative evaluation. However, due to possible overlap in Doppler features and the presence of false-negative cases, Doppler findings should not be used alone. They should be interpreted alongside grayscale ultrasound, clinical parameters, and histopathological confirmation.