Evaluation of Alcazar Scoring System to Differentiate Between Benign and Malignant Ovarian Masses- A Nepalese Perspective

  • Rupesh Sharma Lumbini Medical College and Teaching Hospital, Pravas, Palpa https://orcid.org/0000-0002-3422-6150
  • Deepak Shrestha Lumbini Medical College and Teaching Hospital https://orcid.org/0000-0002-9006-3640
  • Krishna Thapa Lumbini Medical College and Teaching Hospital
  • Kiran Bhandari Lumbini Medical College and Teaching Hospital
Keywords: Alcazar scoring system, Doppler, Histopathology, Ovarian mass


Introduction: Ovarian cancer is the fifth most common cancer in Nepalese females and the tenth overall, accounting for 5% of the total new cases of cancer in females in 2020. Ultrasonography (USG) remains the primary tool for the diagnosis and characterization of ovarian masses in which many grey-scale and Doppler characteristics are evaluated. Various scoring systems have been described incorporating different USG parameters to differentiate the benign and malignant nature of ovarian masses. Alcazar scoring system includes both grey-scale as well as Doppler characteristics of the ovarian masses and is one of the more widely used systems worldwide. Methods: This was an observational cross-sectional study based on 52 consecutive patients who were clinically suspected to have ovarian mass and referred for USG evaluation and who subsequently underwent surgery.Results:As confirmed by histopathology, 37 cases were benign and 15 were malignant masses. Alcazar system of scoring identified 34 out of 37 benign cases and 15 out of 15 malignant cases with sensitivity and specificity for diagnosing malignant cases of 83.3% and 91.1% respectively. Conclusion: Alcazar system of scoring is a highly effective tool to differentiate between benign and malignant ovarian masses and can be of great help in diagnosis, characterization and effective preoperative planning.


Download data is not yet available.

Author Biographies

Rupesh Sharma, Lumbini Medical College and Teaching Hospital, Pravas, Palpa

Assistant Professor,

Department of Radio-diagnosis and Imaging.

Deepak Shrestha, Lumbini Medical College and Teaching Hospital

Assistant Professor,

Department of Obstetrics and Gynaecology.

Krishna Thapa, Lumbini Medical College and Teaching Hospital


Department of Radiodiagnosis and Imaging.

Kiran Bhandari, Lumbini Medical College and Teaching Hospital


Department of Radiodiagnosis and Imaging.


International Agency for Research on Cancer. Nepal: Globocan 2020 [Internet]. Geneva: WHO; 2021. [cited 4 Nov 2021]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/524-nepal-fact-sheets.pdf

American Cancer Society Medical and Editorial Content Team. About Ovarian Cancer [Internet]. Atlanta, Georgia: American Cancer Society; 2018. [cited 6 Nov 2021]. Available from: https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html

Alcázar JL, Mercé LT, Laparte C, Jurado M, López-García G. A new scoring system to differentiate benign from malignant adnexal masses. Am J Obstet Gynecol. 2003;188(3):685-92.PMID: 12634641 DOI: https://doi.org/10.1067/mob.2003.176

DePriest PD, Shenson D, Fried A, Hunter JE, Andrews SJ, Gallion HH, et al. A morphology index based on sonographic findings in ovarian cancer. Gynecol Oncol. 1993;51(1):7-11.PMID: 8244178 DOI: https://doi.org/10.1006/gyno.1993.1238

Sassone AM, Timor-Tritsch IE, Artner A, Westhoff C, Warren WB. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol. 1991;78(1):70-6.PMID: 2047071

Ferrazzi E, Zanetta G, Dordoni D, Berlanda N, Mezzopane R, Lissoni AA, et al. Transvaginal ultrasonographic characterization of ovarian masses: comparison of five scoring systems in a multicenter study. Ultrasound in Obstetrics & Gynecology. 1997;10(3):192-7. Available from:https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1046/j.1469-0705.1997.10030192.x

Zhang X, Meng X, Dou T, Sun H. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses: A meta-analysis. ExpTher Med. 2020;20(6):265. PMID: 33199990 DOI: https://doi.org/10.3892/etm.2020.9395

Desai D, Desai VA, Verma RN, Shrivastava A. Role of gray scale and color Doppler in differentiating benign from malignant ovarian masses. J Midlife Health. 2010;1(1):23-5.PMID: 21799634 DOI: https://doi.org/10.4103/0976-7800.66991

MahijaS, Hk N. Evaluation of the alcazar scoring system in differentiating benign from malignant ovarian tumors. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;4(4):1004-7. DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20150415

Chaudhari SN, Deshpande PN, Gupta PR, Warty TR, Bhikane DB. Evaluation of the Scoring Systems to Differentiate between Benign and Malignant Adnexal Masses in a Tertiary Care Center, Pune. Journal of South Asian Federation of Obstetrics and Gynaecology. 2013;5(3):135-8. Available from: https://www.jsafog.com/doi/JSAFOG/pdf/10.5005/jp-journals-10006-1246

Hassen K, Ghossain MA, Rousset P, Sciot C, Hugol D, Baddoura R, et al. Characterization of papillary projections in benign versus borderline and malignant ovarian masses on conventional and color Doppler ultrasound. AJR Am J Roentgenol. 2011;196(6):1444-9.PMID: 21606312 DOI: https://doi.org/10.2214/ajr.10.5014

How to Cite
Sharma R, Shrestha D, Thapa K, Bhandari K. Evaluation of Alcazar Scoring System to Differentiate Between Benign and Malignant Ovarian Masses- A Nepalese Perspective. J Lumbini Med Coll [Internet]. 14Jan.2022 [cited 22May2022];9(2):5 pages. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/468
Original Research Article