| 1. |
- Timmerman, Dirk, et al.
(författare)
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Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group
- 2010
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Ingår i: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 341, s. 6839-6839
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To prospectively assess the diagnostic performance of simple ultrasound rules to predict benignity/malignancy in an adnexal mass and to test the performance of the risk of malignancy index, two logistic regression models, and subjective assessment of ultrasonic findings by an experienced ultrasound examiner in adnexal masses for which the simple rules yield an inconclusive result. Design Prospective temporal and external validation of simple ultrasound rules to distinguish benign from malignant adnexal masses. The rules comprised five ultrasonic features (including shape, size, solidity, and results of colour Doppler examination) to predict a malignant tumour (M features) and five to predict a benign tumour (B features). If one or more M features were present in the absence of a B feature, the mass was classified as malignant. If one or more B features were present in the absence of an M feature, it was classified as benign. If both M features and B features were present, or if none of the features was present, the simple rules were inconclusive. Setting 19 ultrasound centres in eight countries. Participants 1938 women with an adnexal mass examined with ultrasound by the principal investigator at each centre with a standardised research protocol. Reference standard Histological classification of the excised adnexal mass as benign or malignant. Main outcome measures Diagnostic sensitivity and specificity. Results Of the 1938 patients with an adnexal mass, 1396 (72%) had benign tumours, 373 (19.2%) had primary invasive tumours, 111 (5.7%) had borderline malignant tumours, and 58 (3%) had metastatic tumours in the ovary. The simple rules yielded a conclusive result in 1501 (77%) masses, for which they resulted in a sensitivity of 92% (95% confidence interval 89% to 94%) and a specificity of 96% (94% to 97%). The corresponding sensitivity and specificity of subjective assessment were 91% (88% to 94%) and 96% (94% to 97%). In the 357 masses for which the simple rules yielded an inconclusive result and with available results of CA-125 measurements, the sensitivities were 89% (83% to 93%) for subjective assessment, 50% (42% to 58%) for the risk of malignancy index, 89% (83% to 93%) for logistic regression model 1, and 82% (75% to 87%) for logistic regression model 2; the corresponding specificities were 78% (72% to 83%), 84% (78% to 88%), 44% (38% to 51%), and 48% (42% to 55%). Use of the simple rules as a triage test and subjective assessment for those masses for which the simple rules yielded an inconclusive result gave a sensitivity of 91% (88% to 93%) and a specificity of 93% (91% to 94%), compared with a sensitivity of 90% (88% to 93%) and a specificity of 93% (91% to 94%) when subjective assessment was used in all masses. Conclusions The use of the simple rules has the potential to improve the management of women with adnexal masses. In adnexal masses for which the rules yielded an inconclusive result, subjective assessment of ultrasonic findings by an experienced ultrasound examiner was the most accurate diagnostic test; the risk of malignancy index and the two regression models were not useful.
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| 2. |
- Valentin, Lil, et al.
(författare)
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The risk of malignancy in unilocular cysts: a study on 1148 adnexal masses classified as unilocular cysts at transvaginal scan with review of the literature.
- 2013
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 41:1, s. 80-89
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination, to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. Methods: 3511 patients with an adnexal mass underwent transvaginal ultrasound examination between 1999 and 2007. The sonologists used the International Ovarian Tumor Analysis terms and definitions to describe their ultrasound findings. Gold standard was the histopathological diagnosis of the mass. Results: Of the 3511 masses, 1148 (33%) were classified as unilocular cysts at scan. Of these, 11 i.e. 0.96 % (95%CI 0.48-1.71) were malignant. The malignancy rate was lower in pre- than post-menopausal women: 0.54% (5/931) (0.17-1.25) versus 2.76% (6/217) (1.02-5.92), P = 0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% versus 2%, P = 0.02) or ovarian cancer (18% versus 0.6%, P = 0.003). Hemorrhagic cyst contents at scan was more common in malignant than benign unilocular cysts (18% versus 2%, P = 0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. Conclusions: The malignancy rate in surgically removed adnexal lesions judged to be unilocular cysts at transvaginal scan is around 1%. Postmenopausal status, personal history of breast or ovarian cancer and hemorrhagic cyst contents at scan increase the risk of malignancy. To avoid misclassifying adnexal lesions as unilocular cysts at scan, it is important to scrutinize unilocular cysts for the presence of solid components. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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| 3. |
- Van Calster, Ben, et al.
(författare)
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Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study.
- 2014
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Ingår i: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 349, s. 5920-5920
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Tidskriftsartikel (refereegranskat)abstract
- To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours.
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| 4. |
- Van Holsbeke, Caroline, et al.
(författare)
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External Validation of Diagnostic Models to Estimate the Risk of Malignancy in Adnexal Masses
- 2012
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Ingår i: Clinical Cancer Research. - 1078-0432. ; 18:3, s. 815-825
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To externally validate and compare the performance of previously published diagnostic models developed to predict malignancy in adnexal masses. Experimental Design: We externally validated the diagnostic performance of 11 models developed by the International Ovarian Tumor Analysis (IOTA) group and 12 other (non-IOTA) models on 997 prospectively collected patients. The non-IOTA models included the original risk of malignancy index (RMI), three modified versions of the RMI, six logistic regression models, and two artificial neural networks. The ability of the models to discriminate between benign and malignant adnexal masses was expressed as the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and likelihood ratios (LR+, LR-). Results: Seven hundred and forty-two (74%) benign and 255 (26%) malignant masses were included. The IOTA models did better than the non-IOTA models (AUCs between 0.941 and 0.956 vs. 0.839 and 0.928). The difference in AUC between the best IOTA and the best non-IOTA model was 0.028 [95% confidence interval (CI), 0.011-0.044]. The AUC of the RMI was 0.911 (difference with the best IOTA model, 0.044; 95% CI, 0.024-0.064). The superior performance of the IOTA models was most pronounced in premenopausal patients but was also observed in postmenopausal patients. IOTA models were better able to detect stage I ovarian cancer. Conclusion: External validation shows that the IOTA models outperform other models, including the current reference test RMI, for discriminating between benign and malignant adnexal masses. Clin Cancer Res; 18(3); 815-25. (C)2011 AACR.
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