Background: Adnexal masses present a significant diagnostic challenge in gynecological practice, requiring accurate characterization to differentiate benign from malignant lesions. While ultrasonography remains the primary imaging modality, comparative data regarding the diagnostic performance of transvaginal versus transabdominal approaches in Indian populations remain limited.
Methods: A prospective diagnostic accuracy study was conducted at Tertiary care Hospital, Pune, involving 100 women with clinically suspected adnexal masses between March 2022 and August 2024. All patients underwent both TVUS and TAUS followed by surgical intervention and histopathological confirmation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both modalities.
Results: Among 100 patients (mean age: 38.6 ± 11.2 years), histopathology confirmed 72 benign and 28 malignant adnexal masses. TVUS demonstrated significantly higher sensitivity (92.9% vs. 75.0%; p=0.031), specificity (94.4% vs. 83.3%; p=0.024), and overall accuracy (93.0% vs. 81.0%; p=0.012) compared to TAUS for detecting malignancy. Agreement between TVUS findings and histopathology (?=0.86) was superior to TAUS (?=0.58). TVUS showed superior visualization of internal mass characteristics including septations (96.0% vs. 78.0%; p=0.002), papillary projections (94.0% vs. 71.0%; p<0.001), and solid components (95.0% vs. 82.0%; p=0.008).
Conclusion: Transvaginal ultrasonography demonstrates superior diagnostic accuracy compared to transabdominal ultrasonography for characterizing adnexal masses and differentiating benign from malignant lesions. TVUS should be considered the preferred initial imaging modality for adnexal mass evaluation.
International Journal of Clinical Obstetrics and Gynaecology
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