Usefulness of Diagnostic Indices Comprising Clinical, Sonographic, and Biomarker Data for Discriminating Benign From Malignant Ovarian Masses

Stukan, Maciej; Dudziak, Mirosław; Ratajczak, Karol; Grabowski, Jacek

doi:10.7863/ultra.34.2.207

Cited by 20 publications

(7 citation statements)

References 72 publications

(202 reference statements)

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“…Our systematic review addresses several issues in existing systematic reviews. As part of a scoping review, 10 original systematic reviews were identified up to 2021, [ 9 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] NICE 2011; 6 of 11 reviews included ROMA, 7 RMI I. The most recent review search date was 2018 [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Models Combining Clinical Information, Ultrasound and Biochemical Markers for Ovarian Cancer: Cochrane Systematic Review and Meta-Analysis

Davenport

Rai

Sharma

et al. 2022

Cancers

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Background: Ovarian cancer (OC) is a diagnostic challenge, with the majority diagnosed at late stages. Existing systematic reviews of diagnostic models either use inappropriate meta-analytic methods or do not conduct statistical comparisons of models or stratify test performance by menopausal status. Methods: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, CDSR, DARE, Health Technology Assessment Database and SCI Science Citation Index, trials registers, conference proceedings from 1991 to June 2019. Cochrane collaboration review methods included QUADAS-2 quality assessment and meta-analysis using hierarchical modelling. RMI, ROMA or ADNEX at any test positivity threshold were investigated. Histology or clinical follow-up was the reference standard. We excluded screening studies, studies restricted to pregnancy, recurrent or metastatic OC. 2 × 2 diagnostic tables were extracted separately for pre- and post-menopausal women. Results: We included 58 studies (30,121 patients, 9061 cases of ovarian cancer). Prevalence of OC ranged from 16 to 55% in studies. For premenopausal women, ROMA at a threshold of 13.1 (+/−2) and ADNEX at a threshold of 10% demonstrated significantly higher sensitivity compared to RMI I at 200 (p < 0.0001) 77.8 (72.5, 82.4), 94.9 (92.5, 96.6), and 57.1% (50.6 to 63.4) but lower specificity (p < 0.002), 92.5 (90.0, 94.4), 84.3 (81.3, 86.8), and 78.2 (75.8, 80.4). For postmenopausal women, ROMA at a threshold of 27.7 (+/−2) and AdNEX at a threshold of 10% demonstrated significantly higher sensitivity compared to RMI I at a threshold of 200 (p < 0.001) 90.4 (87.4, 92.7), 97.6 (96.2, 98.5), and 78.7 (74.3, 82.5), specificity of ROMA was comparable, whilst ADneX was lower, 85.5 (81.3, 88.9), 81.3 (76.9, 85.0) (p = 0.155), compared to RMI 55.2 (51.2, 59.1) (p < 0.001). Conclusions: In pre-menopausal women, ROMA and ADNEX offer significantly higher sensitivity but significantly decreased specificity. In post-menopausal women, ROMA demonstrates significantly higher sensitivity and comparable specificity to RMI I, ADNEX has the highest sensitivity of all models, but with significantly reduced specificity. RMI I has poor sensitivity compared to ROMA or ADNEX. Choice between ROMA and ADNEX as a replacement test will depend on cost effectiveness and resource implications.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Models Combining Clinical Information, Ultrasound and Biochemical Markers for Ovarian Cancer: Cochrane Systematic Review and Meta-Analysis

Davenport

Rai

Sharma

et al. 2022

Cancers

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“…Typical appearing simple cysts have a 0%-1% risk of cancer, and typical hemorrhagic cysts, endometriomas, and dermoids have a 1%-2% risk of cancer (7)(8)(9)(10)(11)(12)(13)(14). Conversely, adnexal cysts with a vascularized soft-tissue component are considered to have a high probability of ovarian cancer (5,7,(15)(16)(17)(18)(19)(20)(21). In between the two ends of the spectrum are cysts that cannot be definitively characterized as probably benign or possibly malignant, and they are considered indeterminate at US.…”

Section: Subjects and Inclusionmentioning

confidence: 99%

Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer

Sadowski¹,

Paroder

Patel-Lippmann

et al. 2018

Radiology

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Purpose To assess the prevalence of indeterminate adnexal cysts in women presenting to academic medical centers for pelvic ultrasonography (US), determine the incidence of malignancy, and identify cyst and patient characteristics that are predictive of malignancy. Materials and Methods A multicenter study of US-detected adnexal cysts with appropriate follow-up (surgical pathologic examination, imaging and/or clinical examination) was conducted from January 2008 to June 2012. Indeterminate cysts were classified as category 1 (typical benign appearing cysts >5 cm) or category 2 (cysts with avascular solid components) on the basis of a combination of definitions in the existing literature. The incidence of neoplasms and malignant tumors was calculated. Patient and cyst characteristics associated with neoplasm and malignant tumors were evaluated with the χ test or Fisher exact test for categorical variables and the t test for continuous variables. A backward stepwise logistic regression model was performed for two outcomes: (a) the presence of any neoplasm (benign or malignant) and (b) the presence of a malignant tumor. Results There were 1637 women with an adnexal cyst at US; 391 (mean age = 41.8 years ± 13.5.1; range = 17-91 years) had an indeterminate adnexal cyst at US. The prevalence of indeterminate adnexal cysts was 23.9% (391 of 1637; 95% confidence interval [CI]: 0.22, 0.26). Three hundred three indeterminate cysts in 280 women (mean age = 42.9 years ± 14.1; range = 17-88 years) had adequate follow-up. The incidence of ovarian neoplasms (benign and malignant) was 24.8% (75 of 303 cysts; 95% CI: 0.20, 0.30), and the incidence of malignant tumors was 3.6% (11 of 303 cysts; 95% CI: 0.02, 0.06). The proportion of ovarian neoplasms differed between category 1 and category 2 cysts (17.5% [25 of 143 cysts; 95% CI: 0.12, 0.25] vs 31.3% [50 of 160 cysts; 95% CI: 0.24, 0.39], respectively; P = .001). The proportion of malignant tumors differed between categories 1 and 2 cysts (0% [0 of 143 cysts] vs 6.9% [11 of 160 cysts; 95% CI: 0.03, 0.12]; P < .001). The presence of an avascular nodular component was a significant predictor of malignancy at stepwise logistic regression analysis (odds ratio = 2.83; P ≤ .0001; 95% CI: 1.69, 4.70). Conclusion The presence of an avascular nodular component was the most significant predictor of the presence of malignancy in indeterminate adnexal cysts. The risk of malignancy is higher with category 2 cysts than with category 1 cysts. RSNA, 2018.

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“…As a result, combining color Doppler imaging with pulsed Doppler spectrum analysis improves ovarian mass characterization by obtaining quantitative measurement of blood flow from tumor vessels, increasing the specificity & sensitivity of ovarian mass characterization 8 . The rationale of the study, to find the frequency of ovarian cyst observed in Doppler ultrasound.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Ovarian Cysts Observed in Doppler Ultrasound

Akram¹,

Ashraf²,

Zahur³

et al. 2021

PJMHS

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Background: Ovarian cysts known as ovarian masses, are commonly found incidentally in asymptomatic women. Ovarian cancer is the 7th most frequent cancer in women worldwide, as well as the eighth leading cause of cancer death. Ultrasonography is the principal imaging technique for confirming the mass ovarian origin and determining whether the mass is benign or malignant. Method: This descriptive cross sectional study was conducted from 15 June to December 2019 in the Radiology Department of Avicenna Medical College. A total of 90 ultrasounds undertaken at the Gynecological Ultrasound Unit. A total of 32 patients with functioning ovarian cysts were included. A total of 46 individuals with benign tumors and 9 patients with malignant cysts were included in the control group. The remaining patients were not followed up on and were treated at a different center. The majority of the patients had issues with their menstrual cycle and pain. Results: The mean age of the patients was 35.6+9.16. In functioning ovarian cysts, benign tumors & ovarian tumors. The functioning ovarian cysts had a mean size of 40.8 mm +16.35 mm. Differences were significant found between1this group & other1two groups: A mean size of 61.75 +65.5; P, 0.001 was seen for non-functional benign ovarian disease; and the average size of malignant cysts was 85.9 +50.6; P = 0.001. Out of 32 functional1ovarian cysts, 22 were found by ultrasonography, 8.0 were not identified and 2.0 cases were1diagnosed ultra-sonographically as functional ovarian cysts but histologically revealed to be benign ovarian cysts (non-functional). The sensitivity of color Doppler ultrasound was determined to be 82.0%. Conclusion: The study's findings revealed that ultrasound had an 82 percent sensitivity in diagnosing ovarian masses, increasing its accuracy. As a result, ultrasonography appears to be the first modality of choice in the examination of any woman suspected of having an ovarian tumor. Also, to rule out the need for unnecessarily surgical procedures in benign lesions. Keywords: Ovarian Cysts, cancer, ultrasound

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Usefulness of Diagnostic Indices Comprising Clinical, Sonographic, and Biomarker Data for Discriminating Benign From Malignant Ovarian Masses

Cited by 20 publications

References 72 publications

Diagnostic Models Combining Clinical Information, Ultrasound and Biochemical Markers for Ovarian Cancer: Cochrane Systematic Review and Meta-Analysis

Diagnostic Models Combining Clinical Information, Ultrasound and Biochemical Markers for Ovarian Cancer: Cochrane Systematic Review and Meta-Analysis

Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer

Characteristics of Ovarian Cysts Observed in Doppler Ultrasound

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