Introduction: Distinguishing benign adnexal masses from malignant tumors plays an important role in preoperative planning and improving patients’ survival rates. The International Ovarian Tumor Analysis (IOTA) group developed a model termed the Assessment of Different NEoplasias in the adneXa (ADNEX). Objective: Our objective was to evaluate the performance of the ADNEX model in distinguishing between benign and malignant tumors at a cutoff value of 10%. Methods: This was a prospective diagnostic study. 357 patients with an adnexal mass who were scheduled for surgery at Siriraj Hospital were included from May 1, 2018, to May 30, 2019. All patients were undergoing ultrasonography, and serum CA125 was measured. Data were calculated by the ADNEX model via an IOTA ADNEX calculator. Results: Of the 357 patients, 296 had benign tumors and 61 had malignant tumors. The area under the receiver operating characteristic curve for using the ADNEX model was 0.975 (95% confidence interval, 0.953–0.988). At a 10% cutoff, the sensitivity was 98.4% and specificity was 87.2%. The best cutoff value was at 16.6% in our population. Conclusions: The performance of the ADNEX model in differentiating benign and malignant tumors was excellent.
Introduction Preoperative assessment of ovarian tumors to distinguish between benign and malignant is important. At this time, many diagnostic models were available and the popularity of the risk of malignancy index (RMI) in Thailand is still high. The IOTA Assessment of Different NEoplasias in adneXa (ADNEX) model and the Ovarian‐Adnexal Reporting and Data System (O‐RADS) model were both new models with good performance. Objectives The purpose of this study was to compare O‐RADS, RMI, and ADNEX models. Design This diagnostic study was performed using data from the prospective study. Methods Data from 357 patients from a previous study were included and calculated using the RMI‐2 formula then applied to the O‐RADS system and the IOTA ADNEX model. The diagnostic significance of the results was evaluated by receiver operating characteristic (ROC) analysis and pairwise comparison between models was made. Results The area under the receiver operating characteristic curve (AUC) to distinguish an adnexal mass as a benign or malignant tumor was 0.975 (95% CI, 0.953–0.988) for the IOTA ADNEX model; 0.974 (95% CI, 0.960–0.988) for O‐RADS; 0.909 for RMI‐2 (95% CI, 0.865–0.952). There were no differences in pairwise AUC comparisons between the IOTA ADNEX and O‐RADS models, and both were better than those of RMI‐2. Conclusions The IOTA ADEX and O‐RADS models are excellent tools for distinguishing the adnexal mass in the preoperative assessment and were better than RMI‐2. The use of one of these models is recommended.
Objective: This study aimed to investigate the profile of menopausal symptoms in endometrial cancer survivors and analyze the effects and risks of hormone replacement therapy (HRT). Methods: This was a retrospective study in 33 endometrial cancer survivors who underwent hysterectomy and bilateral oophorectomy (BSO) at Keio University Hospital from January 2013 to June 2019 and received HRT. We administered HRT to patients with postsurgical stage I or II endometrial cancer who complained of menopausal symptoms. Some patients with severe menopausal symptoms diagnosed with stage III disease were also treated after obtaining informed consent after being informed of the risks. Patients filled out a questionnaire on menopausal symptoms before and after HRT. We analyzed patient characteristics, clinicopathological factors, adverse events, and oncologic outcomes, which were extracted from medical records. Results:The median age at surgical menopause was 44 years, and the median body mass index was 21.2 kg/m 2 . Using the The International Federation of Gynaecology and Obstetrics 2008 staging criteria, 30 patients were diagnosed with postsurgical stage I disease, and 3 patients were with diagnosed with stage III disease. The histological grade of endometrial cancer was grade 1 in 22 patients, grade 2 in 8 patients, and grade 3 in 2 patients. The median duration of HRT was 963 days (641-2,681 days). Our results revealed that 31/33 patients (96%) showed improvement of menopausal symptoms. During the entire observation period, there were no cases of endometrial cancer recurrence. Conclusion:This study shows that HRT can be given for menopausal symptoms in endometrial cancer survivors in Japan.
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