Prospective evaluation of three different models for the pre‐operative diagnosis of ovarian cancer

Abstract

Objective To test the accuracy of the risk of malignancy index, the revised risk of malignancy index and Design Prospective collaborative study.Setting Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, London.Sample Sixty-one women with known adnexal masses were examined pre-operatively. Women were recruited from three South London hospitals.Methods The demographic, biochemical and sonographic data recorded for each patient included: age; menopausal status; CA125 levels; tumour volume; ultrasound characteristics; and Doppler blood flow analysis (peak and mean blood velocities, the pulsatility and resistance indices). The diagnosis of malignancy was made for each woman using all three models and the results compared with the final histopathological diagnosis.Results Thirty-eight women had benign tumours and 23 had ovarian cancer. Women with malignant tumours were significantly older than those with benign masses. There were also significant differences in CA125 levels, locularity, presence of papillary proliferations and ascites between the two groups. Tailor's regression model achieved a 43% sensitivity and 92% specificity in the diagnosis of malignancy. This compared with a 74% sensitivity and 92% specificity with the risk of malignancy model, and a 74% sensitivity and 89% specificity with the revised risk of malignancy model.When applied prospectively all three diagnostic models performed less accurately than originally reported, despite clinical signs of malignancy being present in many cases. It is likely that their accuracy would be even less in a population of women in whom there was a substantial clinical uncertainty. Intra-tumoral blood velocity and CA125 levels were the best individual parameters for discrimination between benign and malignant tumours.Tailor's regression model to diagnose malignancy in women with known adnexal masses. Conclusion INTRODUCTIONAccurate pre-operative discrimination between benign and malignant adnexal masses would help to optimise surgical management of women with pelvic tumours. Thus, women with malignancies could be referred to tertiary oncology centres, while those with benign tumours could be offered more conservative surgical management'. In order to achieve this aim various methods have been investigated to assess adnexal masses. Over the past years these have included tumour markers, grey-scale and Doppler ultrasound with varying degrees of success.Correspondence: Dr D. Jurkovic, Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London SE5 8RX, UK.Grey-scale morphological ultrasound features suggestive of malignancy include the presence of papillary proliferations, septae and solid areas within the cyst2V3. None of these features used in isolation enables an accurate diagnosis of malignancy, and therefore they have been combined into various morphological scoring systern~~.~. However, these scoring systems failed to achieve the level of sensit...

Differential diagnosis of adnexal masses: sequential use of the risk of malignancy index and HistoScanning, a novel computer‐aided diagnostic tool

“…In this study there was no significant difference in the performance characteristics of RMI 1 , RMI 2 and RMI 3 , which is consistent with earlier reports 25,26 . Only one study has reported improved accuracy of RMI 2 over RMI 1 20 .…”

Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers

“…The validity of the RMI 1 and the RMI 2 scores was similar. 28 – 30 Another algorithm was developed and validated in co-operation with a number of European centers specialized in ultrasound of the pelvis (International Ovarian Tumor Analysis group). The algorithm challenged the suggestion that the CA125 concentration added to ultrasound in distinguishing nonmalignant from malignant ovarian masses.…”

Ovarian Masses in Women: A Retrospective Analysis in Tertiary Care Center

“…Tumor markers specifically CA-125 was raised in all of malignant masses, while rest of the tumor markers were not always associated with malignant masses unlike another study showed that high CA125 levels were responsible for all the false positive diagnosis occurring with risk management model 17 . CA-125 is not a tumor-specific antigen; it is also elevated in approximately 1% of healthy control subjects as shown in previous studies.…”