Significance and Diagnostic Accuracy of Resistive Index in Predicting Malignant Ovarian Masses Keeping Histopathology as Gold Standard

Authors

  • Sana Iqbal North West General Hospital and Research Centre, Peshawar
  • Anam Safdar Northwest General Hospital and Research Centre, Peshawar
  • Shandana khan Northwest General Hospital and Research Centre, Peshawar

DOI:

https://doi.org/10.37762/jgmds.13-2.813

Keywords:

Doppler Ultrasound, Resistive Index, Histopathology, Ovarian Carcinoma

Abstract

ABSTRACT
OBJECTIVE

This study aimed to determine the significance and diagnostic accuracy of the resistive index (RI) in predicting malignancy in ovarian masses, using histopathology as the gold standard.

METHODOLOGY

This prospective study was conducted at the Department of Radiology, Northwest General Hospital and Research Centre, Peshawar, from Jan 1 2024, to Jul 31 2025. A sample size of 159 was calculated using the WHO calculator. Patients were selected through convenience sampling. Trans-abdominal Doppler Ultrasound was performed using a 3.5 MHz transducer on a GE Logic 5 Doppler Ultrasound machine. The Resistive Index (RI) was calculated for each case, and a threshold of 0.6 was used to differentiate benign from malignant lesions. Data analysis was done using SPSS version 25. 

RESULTS
The sensitivity of the resistive index in predicting malignancy in ovarian masses was 75.2%, and the specificity was 63.2%. The positive predictive value of the RI was 86.7%, and the negative predictive value was 44.4% when histopathology served as the gold standard. The mean age of patients in our study was 48.3 ± 8.1 years.

CONCLUSION

Doppler ultrasound and the resistive index are pivotal non-invasive tools for predicting malignant risk in ovarian masses, with high diagnostic accuracy. It has not only dramatically improved our ability to differentiate benign from malignant adnexal masses but also helped surgeons with preoperative planning. Effect modifiers like patient body habits and the performing sonologist’s expertise. should be included in further studies to determine their effect on the diagnostic accuracy of RI.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Sana Iqbal, North West General Hospital and Research Centre, Peshawar

Assistant Professor, 
Department of Radiology,
North West General Hospital and Research Centre, Peshawar

Anam Safdar, Northwest General Hospital and Research Centre, Peshawar

Assistant Professor, 
Department of Radiology,
Northwest General Hospital and Research Centre, Peshawar

Shandana khan, Northwest General Hospital and Research Centre, Peshawar

Assistant Professor, HOD,
Department of Radiology,
Northwest General Hospital and Research Centre, Peshawar

References

Khalaf LM, Desoky HH, Seifeldein GS, Salah A, Amine MA, Hussien MT. Sonographic and Doppler predictors of malignancy in ovarian lesions. Egypt J Radiol Nucl Med. 2020;51(1):44.https://doi.org/10.1186/s43055-020-00203-2. PMID: 32190261 DOI: https://doi.org/10.1186/s43055-020-00172-8

Huang J, Chan WC, Ngai CH, Lok V, Zhang L, Lucero-Prisno DE III, et al. Worldwide burden, risk factors, and temporal trends of ovarian cancer: A global study. Cancers (Basel). 2022;14(9):2230. https://doi.org/10.3390/cancers14092230. PMID: 35564645; PMCID: PMC9103243 DOI: https://doi.org/10.3390/cancers14092230

Liberto JM, Chen SY, Shih IM, Wang TH, Wang TL, Pisanic TR. Current and emerging methods for ovarian cancer screening and diagnostics: A comprehensive review. Cancers (Basel). 2022;14(12):2885. https://doi.org/10.3390/cancers14122885. PMID: 35740455; PMCID: PMC9225201 DOI: https://doi.org/10.3390/cancers14122885

Abramowicz JS, Condous G, Timmerman D. Ovarian mass—differentiating benign from malignant: Why the International Ovarian Tumour Analysis rules should be implemented in Australasia. Australas J Ultrasound Med. 2018;21(3):121-125. https://doi.org/10.1002/ajum.12092 PMID: 30459943; PMCID: PMC6223954 DOI: https://doi.org/10.1002/ajum.12108

Yu Z, Sun Y. Evaluating pretreatment serum CA-125 levels as prognostic biomarkers in endometrial cancer: A comprehensive meta-analysis. Front Oncol. 2024;14:1442814. https://doi.org/10.3389/fonc.2024.1442814 DOI: https://doi.org/10.3389/fonc.2024.1442814

Sujata P, Mishra SP, Kurra J, Kar D, Bhuyan R. Preoperative risk assessment of adnexal masses using simple rules from the International Ovarian Tumor Analysis group. Ann Rom Soc Cell Biol. 2021;25(2):1340-1351

Dhir YR, Roy A, Maji S, Karim R. Sonological accuracy in defining benign and malignant ovarian neoplasms with colour Doppler and histopathological correlation. Int J Acad Med Pharm. 2023;5(3):2308-2311

Kodali S, Sundari LD, Shah D. Correlation of clinical, Doppler study and histopathological features of ovarian tumors. J South Asian Feder Obstet Gynaecol. 2022;14:257-260. https://doi.org/10.5005/jp-journals-10006-2057 DOI: https://doi.org/10.5005/jp-journals-10006-2024

Shah D, Shah S, Parikh J, Bhatt CJ, Vaishnav K, Bala DV. Doppler ultrasound: A reliable predictor of ovarian malignancy. J Obstet Gynaecol India. 2013;63(3):186-189. https://doi.org/10.1007/s13224-012-0255-8 PMID: 24426372; PMCID: PMC3893995 DOI: https://doi.org/10.1007/s13224-012-0307-9

Mahale N, Kumar N, Mahale A, Ullal S, Fernandes M, Prabhu S. Validity of ultrasound with color Doppler to differentiate between benign and malignant ovarian tumours. Obstet Gynecol Sci. 2024;67(2):227-234. https://doi.org/10.5468/ogs.23167 PMID: 38395074; PMCID: PMC10901352 DOI: https://doi.org/10.5468/ogs.23072

Hong MK, Ding DC. Early diagnosis of ovarian cancer: Advances, challenges, and future directions. Diagnostics (Basel). 2025;15(4):406. https://doi.org/10.3390/diagnostics15040406 DOI: https://doi.org/10.3390/diagnostics15040406

Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin. 2018;68(4):284-296. https://doi.org/10.3322/caac.21456 PMID: 29809280 DOI: https://doi.org/10.3322/caac.21456

Nighat S, Tariq A, Iqbal N, Nadeem J, Imran H, Ishaque S. Accuracy of ultrasonography and color Doppler in the diagnosis of ovarian masses and correlation with histopathology. Pak J Med Dent. 2025;14(4) DOI: https://doi.org/10.36283/ziun-pjmd14-4/078

Miao K, Zhao N, Lv Q, He X, Xu M, Dong X, et al. Prediction of benign and malignant ovarian tumors using ResNet34 on ultrasound images. J Obstet Gynaecol Res. 2023;49(12):2910-2917. https://doi.org/10.1111/jog.15849PMID: 37754803 DOI: https://doi.org/10.1111/jog.15788

Abd Elrahman EO, Hemida R, Ghanem AA, Shams-Eldin N, Mohamed AA. Doppler ultrasound versus pelvic magnetic resonance imaging in diagnosis of ovarian mass in teenagers: A prospective study. Egypt J Hosp Med. 2023;92(1):5508-5518 DOI: https://doi.org/10.21608/ejhm.2023.305794

Sujana K, Pranathi L, Jyothi S. To evaluate the efficacy of ultrasonography and colour Doppler in the diagnosis and characterization of gynaecological pelvic masses. J Popul Ther Clin Pharmacol. 2024 DOI: https://doi.org/10.53555/gedfqa50

Ahmed HE. The usefulness of ultrasound diagnosis of suspicious ovarian masses based on the O-RADS classification system. Al-Azhar Int Med J. 2021;2(10):1-6 DOI: https://doi.org/10.21608/aimj.2021.90943.1551

Rastogi A, Singh B, Rigveda R. Ultrasound and colour Doppler in ovarian masses and correlation with CA-125. Eur J Cardiovasc Med. 2025;15(7)

Downloads

Published

2026-04-01

How to Cite

Sana Iqbal, Safdar, A., & Shandana khan. (2026). Significance and Diagnostic Accuracy of Resistive Index in Predicting Malignant Ovarian Masses Keeping Histopathology as Gold Standard. Journal of Gandhara Medical and Dental Science, 13(2), 87–91. https://doi.org/10.37762/jgmds.13-2.813