501
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Moszynski R, Szpurek D, Smolen A, Sajdak S. Comparison of diagnostic usefulness of predictive models in preliminary differentiation of adnexal masses. Int J Gynecol Cancer 2006; 16:45-51. [PMID: 16445609 DOI: 10.1111/j.1525-1438.2006.00277.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to compare prognostic models evaluating the probability of an ovarian cancer occurrence based on a number of clinical and ultrasonographic data in women with adnexal masses. A total of 686 women with adnexal masses underwent the examinations between 1994 and 2002. The recorded parameters included: age, menopausal status, body mass index, the grayscale and Doppler ultrasonographic examination, and selected markers concentration levels. In order to find the best combination of features, which significantly influences the probability of malignancy, stepwise logistic regression analysis, as well as artificial neural network, was used. The diagnostic efficiency of received models was estimated and compared using receiver-operating characteristics (ROC) curve. The results indicate that 431 and 255 patients had a benign and malignant ovarian tumor, respectively. Application of stepwise logistic regression analysis revealed statistically significant importance of eight features. The sensitivity and specificity for the received model were 65.71% and 77.59%, respectively. Three-layer perceptron network shows 13 features as significant predictors of malignancy. The network gave a sensitivity of 85.7% and specificity of 93.1%. Comparison of area under ROC curve for received models was 0.9679 vs 0.9716. Prognostic values of the analyzed neural model are not optimal but seem to surpass logistic regression model in terms of the predictive possibilities.
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Affiliation(s)
- R Moszynski
- Division of Gynecological Surgery, Karol Marcinkowski University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
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502
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Al-Khatib K, Sieunarine K, Lindsay I, Smith JR. Metastatic Hurthle cell carcinoma in the abdomen masquerading as a primary ovarian tumor: a case report. Int J Gynecol Cancer 2006; 16:429-32. [PMID: 16445671 DOI: 10.1111/j.1525-1438.2006.00484.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hurthle cell carcinoma, a variant of follicular carcinoma of the thyroid, has been regarded as an aggressive type of differentiated thyroid cancer. It is diagnosed histologically and regarded as a carcinoma by the presence of vascular invasion or capsular invasion. In this case report, a patient with a history of thyroid Hurthle cell carcinoma presented with what seemingly appeared to be a pelvic mass of gynecological origin, with a raised risk-of-malignancy index of 567. She underwent a laparotomy which revealed the presence of multiple masses in the form of nodules and lumps attached to her small bowel, sigmoid colon, omentum, and infracolic region, without the involvement of her pelvic organs or para-aortic lymph nodes. At frozen section, the masses were reported to be high-grade metastatic tumor, possibly a melanoma, unlikely to be a female genital tract tumor. These masses were resected along with a 15-cm section of small bowel and analyzed. They were diagnosed to be secondary lesions of Hurthle cell carcinoma of the thyroid. Hurthle cell carcinoma of the thyroid has not been known to be associated with the elevation of CA125 nor has it been known to metastasize to the small bowel and sigmoid colon.
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Affiliation(s)
- K Al-Khatib
- Department of Gynaecology, Chelsea and Westminster Hospital at Imperial College School of Medicine, London, United Kingdom
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503
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Van Calster B, Timmerman D, Nabney IT, Valentin L, Van Holsbeke C, Van Huffel S. Classifying ovarian tumors using Bayesian Multi-Layer Perceptrons and Automatic Relevance Determination: a multi-center study. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; 2006:5342-5345. [PMID: 17945894 DOI: 10.1109/iembs.2006.260118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ovarian masses are common and a good pre-surgical assessment of their nature is important for adequate treatment. Bayesian Multi-Layer Perceptrons (MLPs) using the evidence procedure were used to predict whether tumors are malignant or not. Automatic Relevance Determination (ARD) is used to select the most relevant of the 40+ available variables. Cross-validation is used to select an optimal combination of input set and number of hidden neurons. The data set consists of 1066 tumors collected at nine centers across Europe. Results indicate good performance of the models with AUC values of 0.93-0.94 on independent data. A comparison with a Bayesian perceptron model shows that the present problem is to a large extent linearly separable. The analyses further show that the number of hidden neurons specified in the ARD analyses for input selection may influence model performance.
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Affiliation(s)
- Ben Van Calster
- Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium.
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504
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Santillan A, Garg R, Zahurak ML, Gardner GJ, Giuntoli RL, Armstrong DK, Bristow RE. Risk of Epithelial Ovarian Cancer Recurrence in Patients With Rising Serum CA-125 Levels Within the Normal Range. J Clin Oncol 2005; 23:9338-43. [PMID: 16361633 DOI: 10.1200/jco.2005.02.2582] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo evaluate the risk of epithelial ovarian cancer (EOC) recurrence in patients with rising serum cancer antigen 125 (CA-125) levels that remain below the upper limit of normal (< 35 U/mL).Patients and MethodsAll patients treated for EOC between September 1997 and March 2003 were identified and screened retrospectively for the following: (1) elevated serum CA-125 at time of diagnosis, (2) complete clinical and radiographic response (CR) to initial treatment with normalization of serum CA-125, (3) at least three serial serum CA-125 determinations that remained within the normal range, and (4) clinical and/or radiographic determination of disease status at the time of last follow-up or recurrence. For statistical analyses, univariate regression models were used to compare absolute and relative changes in CA-125 levels among patients with recurrent disease and those without EOC recurrence.ResultsA total of 39 patients satisfied study inclusion criteria; 22 patients manifested EOC recurrence at a median interval from complete response of 11 months. The median follow-up time from complete response to last contact was 32 months for the 17 patients in the no recurrence group. A relative increase in CA-125 of 100% (odds ratio [OR] = 23.7; 95% CI, 2.9 to 192.5; P = .003) was significantly predictive of recurrence. From baseline CA-125 nadir levels, an absolute increase in CA-125 of 5 U/mL (OR = 8.4; 95% CI, 2.2 to 32.6; P = .002) and 10 U/mL (OR = 71.2; 95% CI, 4.8 to > 999.9; P = .002) were also significantly associated with the likelihood of concurrent disease recurrence.ConclusionAmong patients with EOC in complete clinical remission, a progressive low-level increase in serum CA-125 levels is strongly predictive of disease recurrence.
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Affiliation(s)
- Antonio Santillan
- Kelly Gynecology Oncology Service, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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505
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Guppy AE, Nathan PD, Rustin GJS. Epithelial Ovarian Cancer: A Review of Current Management. Clin Oncol (R Coll Radiol) 2005; 17:399-411. [PMID: 16149282 DOI: 10.1016/j.clon.2005.05.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Epithelial ovarian cancer is the most lethal gynaecological cancer among women worldwide, with 6000 new cases diagnosed in the UK each year. Most women present with advanced disease, but, despite a good initial response to treatment, most relapse. The overall 5-year survival rate is 46%, although this drops to about 13% in women with advanced disease. Transvaginal ultrasound and the tumour marker CA125 are being investigated for screening in ongoing randomised trials. Treatment of ovarian cancer is dependent on clinical stage, and should always be managed within a multidisciplinary team. Most cases will require a pelvic clearance and adjuvant chemotherapy. Current guidelines by the National Institute of Clinical Excellence (NICE) recommend that first-line chemotherapy should include a platinum-based regimen with or without paclitaxel. Relapsed ovarian cancer is incurable; however, chemotherapy can improve quality of life and survival. Gene therapy, immunotherapy and signal transduction inhibitors are all potential future therapies, and are being investigated in ongoing clinical research. In this paper we review the literature on the epidemiology, pathology, clinical features and the current treatment options in epithelial ovarian cancer.
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Affiliation(s)
- A E Guppy
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, Middlesex, UK
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506
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Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate Ovarian Mass at US: Incremental Value of Second Imaging Test for Characterization—Meta-Analysis and Bayesian Analysis. Radiology 2005; 236:85-94. [PMID: 15955864 DOI: 10.1148/radiol.2361041618] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare value of current diagnostic strategies in assessment of changes in posttest probability of ovarian cancer when menopausal status and combination and sequence of diagnostic imaging tests are considered. MATERIALS AND METHODS Prevalence of ovarian cancer according to menopausal status in women with an ovarian mass and performance of combined gray-scale and Doppler ultrasonography (US), computed tomography (CT), and non-enhanced magnetic resonance (MR) imaging and contrast material-enhanced MR imaging after indeterminate results at gray-scale US were derived from meta-analysis by using MEDLINE database and institutional data. Study was approved by the institutional review board of University Hospital Geneva, Geneva, Switzerland; informed consent was waived. Posttest probability values were computed through Bayesian analysis and Monte Carlo simulation after initial gray-scale US and secondary combined gray-scale and Doppler US, CT, or MR imaging, while dependence of test results among imaging modalities was considered. Changes in posttest probability were compared among imaging modalities with summary receiver operating characteristic curves. RESULTS Prevalence of ovarian cancer was 8.75% in premenopausal women and 32.40% in postmenopausal women with an ovarian mass. After characterization with initial gray-scale US, posttest probability in pre- and postmenopausal women changed, respectively, to 25% and 63% for indeterminate results and to 2% and 7% for benign results. Subsequent use of combined gray-scale and Doppler US, CT, or MR imaging had significant higher positive and lower negative posttest probability than did use of gray-scale US alone. In women with an indeterminate initial US result, posttest probability decreased after secondary testing with benign results for all imaging modalities to 2% in premenopausal women and to 8%-10% in postmenopausal women. After secondary testing for suspicious lesions, posttest probability increased more after non-enhanced (premenopausal women, 70%; postmenopausal women, 92%) or contrast-enhanced MR imaging (premenopausal women, 80%; postmenopausal women, 95%) than it did after combined gray-scale and Doppler US (premenopausal women, 30%; postmenopausal women, 69%) or CT (premenopausal women, 38%; postmenopausal women, 76%) (P < .001). CONCLUSION In women with an indeterminate ovarian mass at gray-scale US, MR imaging results contributed to change in probability of ovarian cancer in both pre- and postmenopausal women more than did CT or combined gray-scale and Doppler US results.
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Affiliation(s)
- Karen Kinkel
- Department of Radiology, University Hospital Geneva, Geneva, Switzerland.
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507
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Sohaib SA, Mills TD, Sahdev A, Webb JAW, Vantrappen PO, Jacobs IJ, Reznek RH. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 2005; 60:340-8. [PMID: 15710137 DOI: 10.1016/j.crad.2004.09.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2004] [Revised: 07/29/2004] [Accepted: 09/19/2004] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in characterizing adnexal masses, and to determine which patients may benefit from MRI. METHODS We prospectively studied 72 women (mean age 53 years, range 19 to 86 years) with clinically suspected adnexal masses. A single experienced sonographer performed transabdominal and transvaginal greyscale spectral and colour Doppler examinations. MRI was carried out on a 1.5T system using T1, T2 and fat-suppressed T1-weighted sequences before and after intravenous injection of gadolinium. The adnexal masses were categorized as benign or malignant without knowledge of clinical details, according to the imaging features which were compared with the surgical and pathological findings. RESULTS For characterizing lesions as malignant, the sensitivity, specificity and accuracy of MRI were 96.6%, 83.7% and 88.9%, respectively, and of US were 100%, 39.5% and 63.9%, respectively. MRI was more specific (p<0.05) than US. Both MRI and US correctly diagnosed 17 (24%) cases with benign and 28 (39%) cases with malignant masses. MRI correctly diagnosed 19 (26%) cases with benign lesion(s), which on US were thought to be malignant. The age, menopausal status and CA-125 levels in these women made benign disease likely, but US features were suggestive of malignancy (large masses and solid-cystic lesions with nodules). CONCLUSION MRI is more specific and accurate than US and Doppler assessment for characterizing adnexal masses. Women who clinically have a relatively low risk of malignancy but who have complex sonographic features may benefit from MRI.
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Affiliation(s)
- S A Sohaib
- Department of Diagnostic Imaging, St Bartholomew's Hospital, London, UK.
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508
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Monaghan H, Al-Nafussi A. Targeting the use of ovarian cyst aspirate cytology. J Clin Pathol 2004; 57:1232. [PMID: 15509693 PMCID: PMC1770484 DOI: 10.1136/jcp.2004.018572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- H Monaghan
- Department of Laboratory Medicine (Pathology), Royal Infirmary of Edinburgh, 51 Little France Crescent, Little France, Edinburgh EH16 4SA, UK;
| | - A Al-Nafussi
- Department of Laboratory Medicine (Pathology), Royal Infirmary of Edinburgh, 51 Little France Crescent, Little France, Edinburgh EH16 4SA, UK;
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509
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Knudsen UB, Tabor A, Mosgaard B, Andersen ES, Kjer JJ, Hahn-Pedersen S, Toftager-Larsen K, Mogensen O. Management of ovarian cysts. Acta Obstet Gynecol Scand 2004; 83:1012-21. [PMID: 15488114 DOI: 10.1111/j.0001-6349.2004.00607.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was undertaken to review the literature concerning the preoperative diagnosis and treatment of ovarian cysts. METHODS Articles concerning ovarian cysts from a medline literature search during the period 1985-2003 were included in addition to articles found as references in the initial publications. RESULTS Different methods for discriminating between benign and malignant ovarian cysts are discussed. The diagnosis and the treatment are assessed in relation to age, menopausal status, pregnancy, and whether the cyst is presumed to be benign or malignant. In general, expectant management is the choice in premenopausal and pregnant women with non-suspicious cysts and normal levels of CA-125. In postmenopausal women, unilocular, anechoic cysts less than 5 cm in diameter together with a normal CA-125 may be followed up. Operation is recommended in women with cysts larger than 5 cm and/or elevated levels of CA-125. Women with symptoms should be operated regardless of age, menopausal status, or ultrasound findings. CONCLUSIONS The preoperative discrimination between benign and malignant ovarian cysts is a challenge. Multimodal methods improve the results of single modalities, but we still need improved preoperative diagnostic tools. Furthermore, these methods should be validated in consecutive patient populations large enough to give a reliable estimate of the method's sensitivity and specificity.
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Affiliation(s)
- Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
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510
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Deligeoroglou E, Eleftheriades M, Shiadoes V, Botsis D, Hasiakos D, Kontoravdis A, Creatsas G. Ovarian masses during adolescence: clinical, ultrasonographic and pathologic findings, serum tumor markers and endocrinological profile. Gynecol Endocrinol 2004; 19:1-8. [PMID: 15625766 DOI: 10.1080/09513590410001712895] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This retrospective study was undertaken to assess the epidemiological and clinical features, laboratory findings, preoperative work-up, surgical treatment and pathologic findings in adolescents with ovarian cysts. All adolescents who were referred to our institution and had been operated on because of a diagnosed ovarian mass, from January 1997 to June 2003, were included in this study. Forty-four cases of women with an ovarian mass were retrospectively analyzed. These patients, aged between 12 and 21 years, had 47 ovarian masses (three patients had bilateral lesions), of which 49% were non-neoplastic and 51% were neoplastic. Of the neoplastic lesions, 62.5% were germ cell tumors, 20.8% were epithelial and 16.7% were sex cord-stromal tumors. Of the neoplastic tumors, 95.8% were benign while 4.2% were malignant. Procedures included 30 operative laparoscopies (68.20%) and 14 exploratory laparotomies (31.8%). Simple excision of the ovarian cyst was performed in 39 cases (88.6%). According to our study, most of the adolescents with an ovarian cyst underwent an operation because of a neoplastic lesion. The majority of ovarian tumors occurring in adolescents are non-epithelial in origin, and germ cell tumors are the most common histological type. Ultrasound examination is one of the most important diagnostic tools. Preoperative diagnostic approach of these patients should always include careful history taking, physical examination, imaging and evaluation of serum assays. Gynecologists who care for young girls must be familiar with the differential diagnosis of ovarian masses whose surgical treatment should be conservative when appropriate, so that hormonal status and future fertility are not compromised in this group of patients.
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Affiliation(s)
- E Deligeoroglou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Athens, Greece
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511
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Obeidat BR, Amarin ZO, Latimer JA, Crawford RA. Risk of malignancy index in the preoperative evaluation of pelvic masses. Int J Gynaecol Obstet 2004; 85:255-8. [PMID: 15145261 DOI: 10.1016/j.ijgo.2003.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Revised: 10/23/2003] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the ability of a risk malignancy index (RMI) based on serum levels of CA 125, ultrasound findings, and menopausal status to discriminate between benign and malignant pelvic masses in a particular population. METHODS A retrospective study was conducted of 100 women with pelvic masses admitted for laparotomy. The sensitivity and specificity of serum levels of CA 125, ultrasound findings, and menopausal status were calculated both separately and combined into a RMI to diagnose malignancy. RESULTS The RMI was more accurate than any single criterion in diagnosing malignancy. Using a cut-off level of 200 to indicate malignancy, the RMI gave a sensitivity of 90%, specificity of 89%, positive predictive value of 96%, and negative predictive value of 78%. CONCLUSION The RMI is able to correctly discriminate between malignant and benign pelvic masses. It is a simple scoring system that can be introduced easily into clinical practice to facilitate the selection of patients who would benefit from primary surgery.
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Affiliation(s)
- B R Obeidat
- Department of Obstetrics and Gynecology, Jordan University of Science and Technology, PO Box 2954, Irbid 21110, Jordan.
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512
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El-Shalakany A, Abou-Talib Y, Shalaby HS, Sallam M. Preoperative serum inhibin levels in patients with ovarian tumors. J Obstet Gynaecol Res 2004; 30:155-61. [PMID: 15009621 DOI: 10.1111/j.1447-0756.2003.00176.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the value of preoperative determination of serum inhibin levels in the prediction of malignancy in women with ovarian tumors. The prediction of malignancy not only helps patient counseling regarding prognosis and extent of surgery but also allows for proper specialist referral. METHODS Fifty women with clinically diagnosed ovarian tumors before surgery (patients group) and 32 healthy non-pregnant women in the early follicular phase of their cycle (controls) were studied. Serum inhibin (total) levels and CA125 were determined using immunoenzymometric assay and enzyme immunoassay, respectively. RESULTS In the patients group, 31 women had malignant ovarian tumors and 19 had benign tumors. Mean (SEM) serum inhibin levels were 0.94 (0.13) U/mL in the control group, 0.91 (0.7) U/mL in women with benign tumors and 1.9 (0.12) U/mL in women with malignant tumors; the differences are statistically significant (P < 0.01). Inhibin levels were significantly higher in women with late-stage malignant ovarian tumors (III and IV) than in early stages (I and II) and showed no significant difference in relation to menopausal status or the presence of ascites. Taking the 95th centile inhibin level in the control group (1.155 U/mL) as a discriminator level, all women with benign tumors were negative while 67.7% of women with malignant tumors were positive. The inhibin level testing predicted malignancy with a sensitivity of 67.7%, 100% specificity, 100% positive predictive value and 65.52% negative predictive value. Combining CA125 levels (>35 U/mL) with serum inhibin levels (> 1.155 U/mL) improves sensitivity of predicting malignancy to 83.87% and negative predictive value to 75% while maintaining a specificity of 100% and a positive predictive value of 100%. Combining serum inhibin with sonography achieves 96.77% sensitivity and 73.68% specificity for detecting malignancy. CONCLUSION Preoperative serum inhibin levels in women with ovarian tumors are useful in the prediction of malignancy especially when combined with sonography.
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Affiliation(s)
- Amr El-Shalakany
- Department of Obstetrics & Gynecology, Ain Shams University, Cairo, Egypt.
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513
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Timmerman D. The use of mathematical models to evaluate pelvic masses; can they beat an expert operator? Best Pract Res Clin Obstet Gynaecol 2004; 18:91-104. [PMID: 15123060 DOI: 10.1016/j.bpobgyn.2003.09.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The pre-operative characterization of ovarian cysts remains a major challenge. Functional cysts and some other benign cysts should be managed conservatively, whereas persistent tumours may need removal. It is crucial to distinguish between malignant tumours, which are better treated by a gynaecological oncologist, and benign tumours, which may be suitable for minimal-access surgery. Over the past decade several ultrasound-based morphological scoring systems, colour Doppler parameters, logistic regression models and artificial neural networks have been proposed and tested in order to try to predict the histology of ovarian tumours. On prospective testing none of the current models can beat an expert sonologist. Signs of malignancy include the presence of papillary structures, irregular solid areas, septa and a strong vascularization at colour Doppler imaging. Further refinement of mathematical models and the results of multicentre trials need to be reviewed before the clinical use of mathematical models can be advocated.
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Affiliation(s)
- Dirk Timmerman
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, K.U.Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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514
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Hillaby K, Aslam N, Salim R, Lawrence A, Raju KS, Jurkovic D. The value of detection of normal ovarian tissue (the 'ovarian crescent sign') in the differential diagnosis of adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:63-67. [PMID: 14971002 DOI: 10.1002/uog.946] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate whether the presence of normal ovarian tissue adjacent to an adnexal tumor (the 'ovarian crescent sign') could assist in the preoperative differential diagnosis of adnexal lesions. METHODS This was a prospective observational study including 100 women with a preoperative diagnosis of an adnexal mass. Demographic and biochemical data were collected and all women underwent a detailed transvaginal ultrasound scan. Tumor volume, morphological characteristics and Doppler features were recorded in each case. In addition, the tissue adjacent to the cyst was systematically examined for the presence of normal ovarian tissue. All the findings were compared to the final histological diagnosis. RESULTS Sixty-seven (67%) of the cysts removed were benign, nine (9%) were borderline and 24 (24%) women had invasive malignant lesions. Normal ovarian tissue was seen in 58/76 (76%) women with non-invasive lesions, and in one woman (4%) with an invasive malignancy. In the absence of normal ovarian tissue, ovarian cancer was diagnosed with a sensitivity of 96% and specificity of 76%. CONCLUSION The presence of normal ovarian tissue adjacent to an ovarian cyst is a useful morphological feature that may be used to help exclude an invasive ovarian malignancy in women with adnexal masses detected on ultrasound scan.
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Affiliation(s)
- K Hillaby
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK
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515
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516
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Lu C, Van Gestel T, Suykens JAK, Van Huffel S, Vergote I, Timmerman D. Preoperative prediction of malignancy of ovarian tumors using least squares support vector machines. Artif Intell Med 2003; 28:281-306. [PMID: 12927337 DOI: 10.1016/s0933-3657(03)00051-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this work, we develop and evaluate several least squares support vector machine (LS-SVM) classifiers within the Bayesian evidence framework, in order to preoperatively predict malignancy of ovarian tumors. The analysis includes exploratory data analysis, optimal input variable selection, parameter estimation, and performance evaluation via receiver operating characteristic (ROC) curve analysis. LS-SVM models with linear and radial basis function (RBF) kernels, and logistic regression models have been built on 265 training data, and tested on 160 newly collected patient data. The LS-SVM model with nonlinear RBF kernel achieves the best performance, on the test set with the area under the ROC curve (AUC), sensitivity and specificity equal to 0.92, 81.5% and 84.0%, respectively. The best averaged performance over 30 runs of randomized cross-validation is also obtained by an LS-SVM RBF model, with AUC, sensitivity and specificity equal to 0.94, 90.0% and 80.6%, respectively. These results show that the LS-SVM models have the potential to obtain a reliable preoperative distinction between benign and malignant ovarian tumors, and to assist the clinicians for making a correct diagnosis.
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Affiliation(s)
- C Lu
- Department of Electrical Engineering, ESAT-SCD, Katholieke Universiteit Leuven, Kasteelpark Arenberg 10, B-3001 Leuven, Belgium.
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517
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Andersen ES, Knudsen A, Rix P, Johansen B. Risk of malignancy index in the preoperative evaluation of patients with adnexal masses. Gynecol Oncol 2003; 90:109-12. [PMID: 12821350 DOI: 10.1016/s0090-8258(03)00192-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of a Risk of Malignancy Index (RMI) in primary evaluation of patients with adnexal masses. METHODS The RMI is based on menopausal status, ultrasonographic findings, and serum CA 125 level. A cutoff level of 200 was chosen as the threshold for referral for centralized primary surgery. This setup was evaluated by sensitivity, specificity, and positive predictive (PPV) and negative predictive (NPV) values with respect to the ability to distinguish malignant from benign pelvic masses. RESULTS The sensitivity was 70.6%, specificity 89.3%, PPV 66.1%, and NPV 91.1% for the total material. For the patients undergoing surgery the sensitivity was 70.6%, specificity 87.7%, PPV 66.1%, and NPV 89.8%. If stage I disease is considered "benign" disease, the sensitivity is 95.5%, specificity 87.9%, PPV 57.8%, and NPV 99.1%. CONCLUSIONS RMI is a simple, easily applicable method in the primary evaluation of patients with adnexal masses. It is usable as a method for selective referral of relevant patients for centralized primary surgery. The method has significant limitations in borderline ovarian tumors, stage I invasive cancers, and nonepithelial tumors. Other methods should be evaluated to increase diagnostic accuracy in these cases.
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518
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Ali N, Jan H, Trappen P, Nasreen F, Canizales A, Carroll M, Granowska M, Jacobs I, Britton K. Radioimmunoscintigraphy with Tc-99m-labelled SM3 in differentiating malignant from benign adnexal masses. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.02186.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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519
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Diamandis EP, Scorilas A, Fracchioli S, Van Gramberen M, De Bruijn H, Henrik A, Soosaipillai A, Grass L, Yousef GM, Stenman UH, Massobrio M, Van Der Zee AGJ, Vergote I, Katsaros D. Human kallikrein 6 (hK6): a new potential serum biomarker for diagnosis and prognosis of ovarian carcinoma. J Clin Oncol 2003; 21:1035-43. [PMID: 12637468 DOI: 10.1200/jco.2003.02.022] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The discovery of new ovarian cancer biomarkers that are suitable for early disease diagnosis and prognosis may ultimately lead to improved patient management and outcomes. PATIENTS AND METHODS We measured, by immunoassay, human kallikrein 6 (hK6) concentration in serum of 97 apparently healthy women, 141 women with benign abdominal diseases, and 146 women with histologically proven primary ovarian carcinoma. We then calculated the diagnostic sensitivity and specificity of this test and examined the association of serum hK6 concentration with various clinicopathologic variables and patient survival. RESULTS Serum hK6 concentration between normal and benign disease patients was not different (mean, 2.9 and 3.1 micro g/L, respectively). However, hK6 in presurgical serum of ovarian cancer patients was highly elevated (mean, 6.8 micro g/L; P <.001). Serum hK6 decreased after surgery (to a mean of 3.9 micro g/L) in 68% of patients. The diagnostic sensitivity of serum hK6 at 90% and 95% specificity is 52% and 47%, respectively, in the whole patient population. For early stage disease (stage I or II), sensitivity is approximately 21% to 26%. When combined with CA-125, at 90% specificity, sensitivity increases to 72% (for all patients) and to 42% in stage I or II disease. Serum hK6 concentration correlates moderately with CA-125 and is higher in patients with late-stage, higher-grade disease and in patients with serous histotype. Preoperative serum hK6 concentration is a powerful predictor of disease-free and overall survival in both univariate and multivariate analyses. CONCLUSIONS Serum hK6 concentration seems to be a new biomarker for ovarian carcinoma and may have value for disease diagnosis and prognosis.
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Affiliation(s)
- Eleftherios P Diamandis
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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520
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Abstract
Malignant pelvic tumours in adolescents are rare. Cancers most commonly associated with adolescent women are ovarian germ-cell tumours, ovarian stromal tumours, genital rhabdomyosarcomas and cervico-vaginal clear-cell adenocarcinomas. The incidence of the last of these has reduced with the abandonment of diethylstilbestrol (stilboestrol) therapy in pregnancy. With sexual activity among adolescent women increasing, the incidence of cervical cancer and gestational trophoblastic tumours is rising. Treatment for pelvic cancers in adolescence should be in a multidisciplinary setting and in most cases surgery should be conservative with the aim of preserving sexual and reproductive function. With a few notable exceptions, the prognosis for most malignant pelvic tumours that occur in adolescence is good and treatment is with curative intent.
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Affiliation(s)
- Thomas Ind
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
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521
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Marret H, Ecochard R, Giraudeau B, Golfier F, Raudrant D, Lansac J. Color Doppler energy prediction of malignancy in adnexal masses using logistic regression models. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:597-604. [PMID: 12493050 DOI: 10.1046/j.1469-0705.2002.00853.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of this study was to assess the usefulness of color Doppler energy in the preoperative diagnosis of ovarian malignancy using multivariate logistic regression analysis. METHODS One hundred and thirty adnexal masses were studied with transvaginal B-mode, color energy, and pulsed Doppler ultrasonography before surgery in order to develop a model that could be used to determine malignancy. Each ultrasonographic variable (tumor size, wall thickness, septal structure, echogenicity, papillary projection, density (solid or not)) was included individually or combined together as part of the Sassone ultrasound score. Intratumoral blood flow velocity waveforms were obtained to determine pulsatility index and resistance index and a more subjective parameter, location of tumor vascularity, was also assessed. Menopausal status and serum CA 125 levels were also entered as categorical variables. Sonographic parameters were entered alone, then associated with menopausal status and CA 125 serum levels, and finally with Doppler energy measurements. Our model was then validated in a group of 68 adnexal masses and compared to the model of Alcazar. RESULTS Eighteen adnexal masses (13.8%) were malignant or of low malignant potential. Multivariate analysis showed that papillary projection of the tumor wall, cyst with solid parts, resistance index with a cut-off value of 0.53, CA 125, and central blood flow location, were the only factors to be independent predictors of malignancy. Menopausal status was not an independent factor. For the final model including the Doppler energy parameter the best sensitivity and specificity were 83% and 93%, respectively, at a cut-off value of 10% probability of malignancy compared to 83% and 87% for the morphological variables alone. Validation of the model showed its diagnostic performance to be as good as that reported in the original population and better than the model of Alcazar. CONCLUSION Sonographic analysis of adnexal masses including color Doppler energy shows the best predictive properties according to histological diagnosis, and improves preoperative diagnosis of malignancy.
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Affiliation(s)
- H Marret
- Department of Gynecology, Obstetrics, Fetal Medicine and Human Reproduction, Bretonneau University Hospital, Tours, France.
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522
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Schutter EMJ, Davelaar EM, van Kamp GJ, Verstraeten RA, Kenemans P, Verheijen RHM. The differential diagnostic potential of a panel of tumor markers (CA 125, CA 15-3, and CA 72-4 antigens) in patients with a pelvic mass. Am J Obstet Gynecol 2002; 187:385-92. [PMID: 12193930 DOI: 10.1067/mob.2002.123768] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the differential diagnostic potential of a combination of CA 125, CA 15-3, and CA 72-4 antigens in the definition of malignant disease, especially ovarian carcinoma in patients with a pelvic mass. STUDY DESIGN A total of 412 patients were evaluated in a multicenter, retrospective study. RESULTS Two hundred twenty-six malignant, 171 benign pelvic tumors (of which 129 were benign ovarian tumors), and 15 borderline tumors were evaluated. One hundred thirty-three patients had ovarian carcinoma. In 76 cases (55%), the International Federation of Gynecology and Obstetrics stage was III or IV. Borderline tumors (n = 15) were excluded from the statistical calculations. CA 125 antigen was the most sensitive marker for ovarian carcinoma (81%). The highest specificity and positive predictive value was obtained with CA 15-3 antigen (95% and 92%, respectively). Considering a concomitant elevation of all 3 markers as positive, a positive predictive value of 97% was found. However, only 28% of the patients in the total group and 41% of the patients with ovarian carcinoma had a concomitant elevation of all 3 markers. The combination of all 3 markers with levels below the cut-off resulted in a (false-positive) positive predictive value for malignancy between 12% and 36%. With the use of logistic regression analysis, we found a correct prediction in 73% of the cases. CA 15-3 antigen makes the most significant (P <.0001) contribution to the logistic model in the prediction of malignancy in the total group, with all pelvic masses with an odds ratio of 3.86. CONCLUSION The combination of a simultaneous elevated level of CA 125, CA 15-3, and CA 72-4 antigens was predictive for malignant disease in almost all cases. However, such concomitant elevation was found in few of the malignant masses. Logistic regression analysis revealed that CA 15-3 antigen makes the most significant contribution to a model for the prediction of malignancy in the total group. The logistic model gave a correct prediction in 73% to 83%. The present tumor marker panel seems inferior to combinations with other test modalities, which include ultrasonography and/or physical examination and/or menopausal status or age.
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Affiliation(s)
- Eltjo M J Schutter
- Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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523
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Grossi M, Quinn MA, Thursfield VJ, Francis PA, Rome RM, Planner RS, Giles GG. Ovarian cancer: patterns of care in Victoria during 1993-1995. Med J Aust 2002; 177:11-6. [PMID: 12088472 DOI: 10.5694/j.1326-5377.2002.tb04616.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2001] [Accepted: 03/20/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the management of and outcomes in patients with newly diagnosed ovarian cancer during 1993, 1994 and 1995 in Victoria. DESIGN AND SETTING Retrospective cohort study conducted by surveying doctors involved in managing incident ovarian cancer cases identified from the population-based Victorian Cancer Registry. The survey was conducted in 1997 and the cohort was followed up until the end of 1999 to obtain at least four years of follow-up data on all patients. PATIENTS All women with invasive epithelial ovarian cancer diagnosed during 1993, 1994 and 1995. MAIN OUTCOME MEASURES Reported management in terms of staging, treatment and survival. RESULTS Management details were obtained for 84.5% (562/665) of eligible patients. Median age at diagnosis was 66 years (range, 22-98 years). Surgery was the primary therapy in 77.2% of women (434/562). Only one in three women had adequate surgery, which was less likely to be performed by general gynaecologists and general surgeons than gynaecological oncologists (21.3% [35/164] v 13.3% [8/60] v 52% [105/202]). After surgery 78.6% of women (341/434) received chemotherapy, usually with platinum-based regimens. The overall five-year relative survival was 46% for women treated surgically; poor survival was related to increasing age, later tumour stage, presence of ascites, residual disease > 2 cm and poorer histological differentiation of the tumour. CONCLUSIONS For optimal care a preoperative carcinoma antigen (CA)-125 assay, chest x-ray and pelvic ultrasound should be performed, and early referral to a multi-disciplinary unit for definitive surgery is advised. Every effort should be made to adequately stage or debulk the tumour. Women with high-risk early-stage and advanced disease should be considered for platinum-based chemotherapy.
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Affiliation(s)
- Marisa Grossi
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
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524
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Torres JCC, Derchain SFM, Faundes A, Gontijo RC, Martinez EZ, Andrade LALA. Risk-of-malignancy index in preoperative evaluation of clinically restricted ovarian cancer. SAO PAULO MED J 2002; 120:72-6. [PMID: 12163896 DOI: 10.1590/s1516-31802002000300003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN Cross-sectional study. SETTING Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS The best individual performance was found in CA 125 levels (sensitivity of 78%, specificity of 75%), followed by ultrasound score (sensitivity of 75%, specificity of 73%) and menopausal status (sensitivity of 73%, specificity of 69%). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79%. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas.
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Affiliation(s)
- José Carlos Campos Torres
- Department of Obstetrics and Gynecology, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.
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525
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Byrom J, Widjaja E, Redman CWE, Jones PW, Tebby S. Can pre-operative computed tomography predict resectability of ovarian carcinoma at primary laparotomy? BJOG 2002; 109:369-75. [PMID: 12013156 DOI: 10.1111/j.1471-0528.2002.01216.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the ability of computed tomography in predicting whether suspected ovarian cancer could be fully excised at primary laparotomy. DESIGN Retrospective analysis of patient notes and pre-operative computed tomography scans. Setting A UK NHS cancer centre. POPULATION Seventy-seven women who underwent laparotomy for an ovarian tumour and who had had a pre-operative computed tomography scan. METHODS Women who had a computed tomography scan before laparotomy for an ovarian tumour were identified. Analysis was undertaken to determine the accuracy of computed tomography in predicting malignancy, stage and residual disease. The computed tomography parameters significantly associated with residual disease were determined by a chi2 analysis. These parameters, in addition to age and CA125, were used to generate a predictive model. This model was further refined by stepwise logistic regression and a clinical scoring index was generated. MAIN OUTCOME MEASURES To identify those computed tomography parameters significantly associated with residual disease and to use these with CA125 and age to generate a useful clinical scoring index to predict residual disease in suspected ovarian cancer. RESULTS Seventy-seven women underwent a laparotomy for an ovarian tumour and had a pre-operative computed tomography scan. Fifty-one of these women had malignant disease and twenty-five of these women had residual disease remaining. The sensitivity of computed tomography in predicting malignancy was 90% with a specificity of 85% and the overall accuracy of computed tomography for predicting stage of disease was 73% (37/51). The overall sensitivity of computed tomography in predicting residual disease was 88%, the specificity was 92% and the positive predictive value was 85%. The parameters on computed tomography that were significantly (P < 0.05) associated with residual disease were ascites, omental cake, mesenteric disease, paracolic gutter deposits, diaphragmatic deposits and pleural effusion. The predictive model generated was more accurate than computed tomography alone (sensitivity 88%, specificity 98%, positive predictive value 95%). Using stepwise logistic regression enabled the predictive model to be simplified to include mesenteric disease, omental cake, age and CA125 without any change in sensitivity or specificity and this model was used to generate a scoring index. CONCLUSION This study shows that prediction of resectability by computed tomography is excellent and is further improved by the generation of a predictive model, which can be used to generate a simple scoring index. This scoring system now needs to be tested prospectively to ensure that its performance remains as good in an independent sample population.
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Affiliation(s)
- J Byrom
- Academic Department of Obstetrics and Gynaecology, City General Hospital, Stoke-on-Trent, UK
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526
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Pascual MA, Tresserra F, Grases PJ, Labastida R, Dexeus S. Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2002; 30:76-82. [PMID: 11857512 DOI: 10.1002/jcu.10028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. METHODS The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. RESULTS The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). CONCLUSIONS When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected.
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Affiliation(s)
- M Angela Pascual
- Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Universitat Autónoma de Barcelona, Paseo Bonanova, 89-91, 08017 Barcelona, Spain
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527
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Silberstein LB, Rosenthal AN, Coppack SW, Noonan K, Jacobs IJ. Ascites and a raised serum Ca 125--confusing combination. J R Soc Med 2001; 94:581-2. [PMID: 11691896 PMCID: PMC1282244 DOI: 10.1177/014107680109401107] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- L B Silberstein
- Medical Unit, St Bartholomew's and the Royal London Medical College, London EC1A 7BE, UK
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528
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Manolitsas TP, Fowler JM. Role of laparoscopy in the management of the adnexal mass and staging of gynecologic cancers. Clin Obstet Gynecol 2001; 44:495-521. [PMID: 11685875 DOI: 10.1097/00003081-200109000-00006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- T P Manolitsas
- James Cancer Hospital, Solove Research Institute, Ohio State University College Of Medicine, Columbus, Ohio, USA
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529
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Manjunath AP, Sujatha K, Vani R. Comparison of three risk of malignancy indices in evaluation of pelvic masses. Gynecol Oncol 2001; 81:225-9. [PMID: 11330953 DOI: 10.1006/gyno.2001.6122] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aims of this study were to validate the risk of malignancy index (RMI) incorporating menopausal status, serum CA 125 levels, and ultrasound features for discriminating benign from malignant pelvic masses and to evaluate the performance of the three different risk of malignancy indices (RMI 1, RMI 2, and RMI 3). METHODS This is a retrospective study of 152 women admitted at Kasturba Hospital, Manipal, between January 1997 and August 1999 for surgical exploration of pelvic masses. The sensitivity, specificity, and positive predictive value of serum CA 125 levels, ultrasound findings, and menopausal status were taken separately and combined into the RMI 1, RMI 2, and RMI 3 to diagnose ovarian cancer. The risk of malignancy index is the product of menopausal score, ultrasound score, and serum CA 125 levels. RESULTS The study confirms that the malignancy risk index is more accurate than the menopausal status, serum CA 125 levels, and ultrasound features separately in diagnosing malignancy. There was no statistically significant difference in the performance of these three different malignancy risk indices in identifying malignancy. CONCLUSIONS The risk of malignancy index is able to identify malignant and benign pelvic masses efficiently to optimize therapy. The risk of malignancy index is a simple scoring system which can be used in less specialized gynecology centers. We recommend the use of any of these risk of malignancy indices to facilitate the selection of cases for referral to an oncological unit for adequate staging and optimal debulking.
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Affiliation(s)
- A P Manjunath
- Kasturba Medical College and Hospital, Manipal, Karnataka State, PIN-576 119, India
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530
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Mol BW, Boll D, De Kanter M, Heintz AP, Sijmons EA, Oei SG, Bal H, Brölmann HA. Distinguishing the benign and malignant adnexal mass: an external validation of prognostic models. Gynecol Oncol 2001; 80:162-7. [PMID: 11161854 DOI: 10.1006/gyno.2000.6052] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Because external validation of the present models has not been reported, the purpose of the present study was to assess existing diagnostic models that are used to distinguish malignant from benign masses. METHODS We tested the performance of existing models in a prospectively assembled data set of 170 patients with an adnexal mass. Twenty-one models that have been reported previously were assessed. The models were based on combinations of ultrasound findings, color Doppler tests, CA-125 measurement, age, and/or menopausal status. For each model, we constructed ROC curves and calculated an area under the ROC curve. RESULTS Of the 170 adnexal masses that were operated on, 30 (18%) were malignant. The area under the ROC curve of 21 models that were externally validated varied between 0.69 and 0.90. We found the performance of the existing models to be inferior to the performance reported in the initial studies. Even models that incorporated multiple diagnostic tools and that were developed using logistic regression models or neural networks had an area under the ROC curve of 0.86 at maximum. In the case where we focused on almost perfect sensitivity, the highest specificities varied between 0.45 and 0.60. CONCLUSION Although diagnostic models might be of value in the preoperative assessment of the adnexal mass, their diagnostic performance is not as good as that reported in the original publications.
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Affiliation(s)
- B W Mol
- Department of Obstetrics and Gynecology, University of Utrecht, Utrecht, 3584 CX, The Netherlands.
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531
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Høgdall EV, Høgdall CK, Tingulstad S, Hagen B, Nustad K, Xu F, Bast RC, Jacobs IJ. Predictive values of serum tumour markers tetranectin, OVX1, CASA and CA125 in patients with a pelvic mass. Int J Cancer 2000. [DOI: 10.1002/1097-0215(20001120)89:6<519::aid-ijc9>3.0.co;2-#] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Estrid V.S. Høgdall
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
- Department of Clinical Biochemistry, Laboratory of Molecular Biology, Statens Serum Institut, Copenhagen, Denmark
| | - Claus K. Høgdall
- Department of Clinical Biochemistry, Laboratory of Molecular Biology, Statens Serum Institut, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark
| | - Solveig Tingulstad
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn Hagen
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Trondheim University Hospital, Trondheim, Norway
| | - Kjell Nustad
- Central Laboratory, Norwegian Radium Hospital, Oslo, Norway
| | - Feng‐Ji Xu
- M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Ian J. Jacobs
- Department of Gynaecological Oncology, St. Bartholomew`s Hospital, London, UK
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532
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Aslam N, Tailor A, Lawton F, Carr J, Savvas M, Jurkovic D. Prospective evaluation of three different models for the pre-operative diagnosis of ovarian cancer. BJOG 2000; 107:1347-53. [PMID: 11117760 DOI: 10.1111/j.1471-0528.2000.tb11646.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the accuracy of the risk of malignancy index, the revised risk of malignancy index and Tailor's regression model to diagnose malignancy in women with known adnexal masses. 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. CONCLUSION 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.
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Affiliation(s)
- N Aslam
- Department of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London, UK
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533
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Timmerman D. Lack of standardization in gynecological ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 16:395-398. [PMID: 11169320 DOI: 10.1046/j.1469-0705.2000.00276.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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534
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Abstract
Adnexal masses present a special diagnostic challenge, in part because benign adnexal masses greatly outnumber malignant ones. Determination of a degree of suspicion for malignancy is critical and is based largely on imaging appearance. Endovaginal ultrasonography (US) is the most practical modality for assessment of ovarian tumors because it is readily available and has a high negative predictive value. Morphologic analysis of adnexal masses is accurate for identifying masses as either low risk or high risk. The most important morphologic features are non-fatty solid (vascularized) tissue, thick septations, and papillary projections. Color Doppler US helps identify solid, vascularized components in a mass. Spectral Doppler waveform characteristics (eg, resistive index, pulsatility index) correlate well with malignancy but generally add little information to morphologic considerations. Computed tomography can help assess the extent of disease in patients before and after primary cytoreductive surgery. Magnetic resonance (MR) imaging is better reserved for problem solving when US findings are nondiagnostic or equivocal because, although it is more accurate for diagnosis, it is also more expensive. The signal intensity characteristics of ovarian masses make possible a systematic approach to diagnosis. Mature cystic teratomas, cysts, endometriomas, leiomyomas, fibromas, and other lesions can be accurately diagnosed on the basis of T1-weighted, T2-weighted, and fat-saturated T1-weighted MR imaging findings.
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Affiliation(s)
- Y Y Jeong
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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535
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Abstract
Currently the only tumour marker to have a well-defined and validated role in the management of ovarian cancer is CA125. Changes in the level of CA125 can be used as a reliable indication of response or progression according to various criteria, but it does not yet have a clear place in diagnosis or prognosis. Its value as part of a screening tool and during routine follow-up remain the subject of ongoing trials. Other markers remain experimental and do not have a well-defined contribution to make at present.
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Affiliation(s)
- T Meyer
- Department of Medical Oncology, Mount Vernon Hospital, Northwood, Middlesex, UK
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536
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Melville A, Eastwood A, Kleijnen J, Kitchener H, Martin-Hirsch P, Nelson L. Management of gynaecological cancers. Qual Health Care 1999; 8:270-9. [PMID: 10847890 PMCID: PMC2483671 DOI: 10.1136/qshc.8.4.270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A Melville
- NHS Centre for Reviews and Dissemination, University of York, UK
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537
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Kobal B, Rakar S, Ribic-Pucelj M, Tomazevic T, Zaletel-Kragelj L. Pretreatment evaluation of adnexal tumors predicting ovarian cancer. Int J Gynecol Cancer 1999; 9:481-486. [PMID: 11240815 DOI: 10.1046/j.1525-1438.1999.99057.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Kobal B, Rakar S, Ribic-Pucelj M, Tomazevie T, Zaletel-Kragelj L. Pretreatment evaluation of adnexal tumors predicting ovarian cancer. The objective of this study was to determine the ability of tumor marker assessment, gray-scale transvaginal with color Doppler ultrasonography to predict ovarian malignancy. One hundred thirty-four subjects with ovarian masses who entered the study prospectively underwent pelvic examination, tumor marker assessment and gray-scale transvaginal with color flow Doppler ultrasonography preoperatively. Malignancy predictors were statistically evaluated with stepwise multiple logistic regression, and the scores from the model were transformed to probability for having a malignant disease. The presence of neovascularization, intracystic papillary projections, elevated serum CA 125, and age over 45 years were significant predictors for malignancy. Positive predictive value (PPV) for the regression model was 89.0%, and negative predictive value (NPV) was 96.8%. Probability for malignancy ranged from 0.004 to 0.991 depending on which covariates were included. Logistic regression analysis of pretreatment diagnostic gray-scale and color Doppler ultrasonographic characteristics, together with CA 125 enabled a creation of probability assessment scale for individual estimation of ovarian mass, which may contribute to final clinical decision.
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Affiliation(s)
- B. Kobal
- Medical Center, Department of Obstetrics and Gynecology;University of Ljubljana, Faculty of Medicine, Institute for Biomedical Informatics, Ljubljana, Slovenia
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538
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Menon U, Talaat A, Jeyarajah AR, Rosenthal AN, MacDonald ND, Skates SJ, Sibley K, Oram DH, Jacobs IJ. Ultrasound assessment of ovarian cancer risk in postmenopausal women with CA125 elevation. Br J Cancer 1999; 80:1644-7. [PMID: 10408412 PMCID: PMC2363093 DOI: 10.1038/sj.bjc.6690575] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We have previously shown that, in asymptomatic post-menopausal women, serum CA125 elevation is associated with a 36-fold increase in risk of ovarian cancer. This study was undertaken to assess the value of pelvic ultrasound for further stratification of ovarian cancer risk. Of 22,000 post-menopausal women, aged > or = 45 participating in an Ovarian Cancer Screening Trial, 741 with a CA125 > or = 30 U ml(-1) underwent pelvic ultrasonography. Twenty index cancers (primary invasive epithelial carcinomas of the ovary and fallopian tube) were diagnosed amongst these 741 women during a median follow-up of 6.8 years. Ultrasound results separated the women with CA125 elevation into two groups. Those with normal ovarian morphology had a cumulative risk (CR) of index cancer of 0.15% (95% confidence interval (CI) 0.02-1.12) which is similar to that of the entire population of 22,000 women (0.22%, 95% CI 0.18-0.30). In contrast, women with abnormal ovarian morphology had a CR of 24% (15-37) and a significantly increased relative risk (RR) of 327 (156-683). Ultrasound can effectively separate post-menopausal women with raised CA125 levels into those with normal scan findings who are not at increased risk of index cancer and those with abnormal findings who are at substantially increased risk of index cancer.
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Affiliation(s)
- U Menon
- Gynaecology Cancer Research Unit, St. Bartholomew's and The Royal London School of Medicine and Dentistry, UK
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539
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Timmerman D, Bourne TH, Tailor A, Collins WP, Verrelst H, Vandenberghe K, Vergote I. A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: the development of a new logistic regression model. Am J Obstet Gynecol 1999; 181:57-65. [PMID: 10411796 DOI: 10.1016/s0002-9378(99)70436-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the complementary use of ultrasonographic end points with the level of circulating CA 125 antigen by multivariate logistic regression analysis algorithms to distinguish malignant from benign adnexal masses before operation. STUDY DESIGN One hundred ninety-one patients aged 18 to 93 years with overt adnexal masses were examined by transvaginal ultrasonography with color Doppler imaging and 31 variables were recorded. The end points were the histologic classification of the tumor and the areas under the receiver-operator characteristic curves of alternative algorithms. RESULTS One hundred forty patients had benign tumors and 51 (26.7%) had malignant tumors: 31 primary invasive tumors (37% International Federation of Gynecology and Obstetrics stage I), 5 tumors of borderline malignancy (100% International Federation of Gynecology and Obstetrics stage I), and 15 tumors were metastatic and invasive. The most useful variables for the logistic regression analysis were the menopausal status, the serum CA 125 level, the presence of >/=1 papillary growth (>3 mm in length), and a color score indicative of tumor vascularity and blood flow. The optimized procedure had a sensitivity of 95.9% and a specificity of 87.1%. The area under the receiver-operator characteristic curve was significantly higher (P <.01) than the corresponding values from the independent use of serum CA 125 levels or indexes of tumor form or vascularity. CONCLUSION Regression analysis of a few complementary variables can be used to accurately discriminate between malignant and benign adnexal masses before operation.
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Affiliation(s)
- D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium
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540
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Morgante G, la Marca A, Ditto A, De Leo V. Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:524-7. [PMID: 10426607 DOI: 10.1111/j.1471-0528.1999.tb08318.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the ability of two malignancy risk indices (RMI 1 and RMI 2) incorporating menopausal status, serum CA125 level and ultrasound findings, to discriminate a benign from a malignant pelvic mass. DESIGN A retrospective study. SETTING Department of Obstetrics and Gynaecology, University of Siena, Italy. POPULATION One hundred and twenty-four women over 30 years of age admitted consecutively between January 1995 and December 1997 for surgical excision of ovarian masses. MAIN OUTCOME MEASURES The sensitivity, specificity, and positive predictive value of serum CA125, ultrasound findings and menopausal status, separately and combined into the RMI 1 and RMI 2, to diagnose ovarian cancer. RESULTS The RMI 1 and RMI 2 were more accurate than menopausal status, ultrasound findings, and CA 125 separately in diagnosing cancer. For all cut off values between 80 and 250, RMI 2 performed better than RMI 1. The RMI 2 at a cut off level of 125 gave a sensitivity of 81%, specificity of 90%, and positive predictive value of 74%. CONCLUSIONS We found that RMI 2 was more reliable in discriminating benign and malignant ovarian disease than RMI 1. RMI is a simple method which can be used in gynaecology clinics and less specialised centres.
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Affiliation(s)
- G Morgante
- Department of Obstetrics and Gynaecology, University of Siena, Italy
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541
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Zhang Z, Barnhill SD, Zhang H, Xu F, Yu Y, Jacobs I, Woolas RP, Berchuck A, Madyastha KR, Bast RC. Combination of multiple serum markers using an artificial neural network to improve specificity in discriminating malignant from benign pelvic masses. Gynecol Oncol 1999; 73:56-61. [PMID: 10094881 DOI: 10.1006/gyno.1999.5320] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A panel of four selected tumor markers, CA 125 II, CA 72-4, CA 15-3, and lipid-associated sialic acid, was analyzed collectively using an artificial neural network (ANN) approach to differentiate malignant from benign pelvic masses. A dataset of 429 patients, 192 of whom had malignant histology, was retrospectively used in the study. A prototype ANN classifier was developed using a subset of the data which included 73 patients with malignant conditions and 101 patients with benign conditions. The ANN classifier demonstrated a much improved specificity over that of the assay CA 125 II alone (87.5% vs 68.4%) while maintaining a statistically comparable sensitivity (79.0% vs 82.4%) in discriminating malignant from benign pelvic masses in an independent validation test using data from the remaining 255 patients which had been set aside and kept blind to the developers of the ANN system. A similar improvement in specificity was observed among patients under 50 years of age (82.3% vs 62.0%). The ANN system was further tested using additional serum specimens collected from 196 apparently healthy women. The ANN system had a specificity of 100.0% compared to that of 94.8% with the assay CA 125 II alone.
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Affiliation(s)
- Z Zhang
- Division of Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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542
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543
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Parker J, Proietto AM, Lowe G. Clear-Cell Carcinoma of the Ovary in a 19-year-old Woman. Aust N Z J Obstet Gynaecol 1999. [DOI: 10.1111/j.1479-828x.1999.tb03048.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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544
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Rosen DMB, Lam AM, Carlton MA, Cario GM. The Safety of Laparoscopic Treatment for Ovarian Dermoid Tumours. Aust N Z J Obstet Gynaecol 1999. [DOI: 10.1111/j.1479-828x.1999.tb03034.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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545
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546
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Alcázar JL, Jurado M. Using a logistic model to predict malignancy of adnexal masses based on menopausal status, ultrasound morphology, and color Doppler findings. Gynecol Oncol 1998; 69:146-50. [PMID: 9600822 DOI: 10.1006/gyno.1998.4995] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the present study we aimed to develop a formula for predicting adnexal malignancy based on menopausal status, ultrasound morphology, and color Doppler findings. Logistic regression analysis was performed retrospectively in 79 adnexal masses (59 benign and 20 malignant) in 73 unselected and consecutive patients. All these masses had been preoperatively evaluated using transvaginal color Doppler ultrasonography. In logistic analysis menopausal status (premenopausal vs postmenopausal), color Doppler findings (no flow or lowest resistance index >0.45 vs lowest resistance index </=0.45) and ultrasound morphology (nonsuspicious vs suspicious) were entered as categorical variables. Morphology and color Doppler were found to be independent predictors, whereas menopausal status was not. To assess the validity of the developed mathematical formula, this was applied prospectively in a second series of 58 consecutive and unselected patients diagnosed of adnexal mass and scheduled for surgery. The probability of malignancy was estimated in each case. Overall, 56 of 58 (96.5%) adnexal masses were correctly classified. We conclude that the formula developed in this study is easy to apply and could be useful to predict malignancy or benignity of adnexal masses.
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Affiliation(s)
- J L Alcázar
- Clínica Universitaria de Navarra, University of Navarre, Pamplona, Spain
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547
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Buckshee K, Temsu I, Bhatla N, Deka D. Pelvic examination, transvaginal ultrasound and transvaginal color Doppler sonography as predictors of ovarian cancer. Int J Gynaecol Obstet 1998; 61:51-7. [PMID: 9622173 DOI: 10.1016/s0020-7292(98)00018-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess and compare the efficacy of pelvic examination, transvaginal ultrasound and transvaginal color Doppler imaging in differentiating benign and malignant ovarian tumors. METHODS 34 patients with ovarian tumors scheduled for laparotomy underwent pelvic examination and a diagnosis of benign or malignant tumor was made. Transvaginal ultrasound was carried out to study the ovarian morphology followed by color Doppler imaging. A score of > or = 9 on Sassone scoring system or a pulsatility index < 1 was taken as suspicious for malignancy. RESULTS Of all the three indicators (pelvic examination, transvaginal sonography and Doppler) transvaginal sonography had the highest sensitivity (100%) and Doppler had maximum specificity (96.29%) for predicting malignancy. However, statistical analysis did not show any difference in the predicting ability of these three modalities. CONCLUSION Pelvic examination, transvaginal sonography and Doppler all had similar ability to predict malignancy in an adnexal mass.
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Affiliation(s)
- K Buckshee
- Department of Obstetrics and Gynecology, ALL India Institute of Medical Sciences, New Delhi.
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548
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Abstract
The risk of inadvertently treating an ovarian malignancy is always present regardless of the patient's age, clinical history, ultrasound features, serum tumour markers, menopausal status and intraoperative findings. This risk can be minimized by paying particular attention to high-risk characteristics in any of the above assessment criteria and by obtaining an intraoperative frozen section if there is any suspicion of malignancy. The same approach should be used whether the initial treatment is by laparotomy or laparoscopy. We present a case of clear-cell carcinoma of the ovary in a 19-year-old woman where there was delay in diagnosis and treatment as a result of an incorrect initial histopathology assessment. This appears to be the youngest patient reported in the literature with a clear-cell carcinoma of the ovary.
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Affiliation(s)
- J Parker
- Division of Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, New South Wales
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549
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Gynaecological cancer. Clin Nucl Med 1998. [DOI: 10.1007/978-1-4899-3356-0_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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550
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Binelli C, Chretien MF, Yves G, Kanaya M, Alain D. Inhibin assays of ovarian cyst liquid obtained by needle aspiration may allow differential diagnosis between functional and organic cysts. Eur J Obstet Gynecol Reprod Biol 1997; 73:161-5. [PMID: 9228498 DOI: 10.1016/s0301-2115(97)02739-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Radioimmunoassays of estradiol, CA125 and inhibin were carried out on ovarian cyst fluid samples. The samples were taken from ten women with functional cysts and 15 women with organic cysts. Statistical analysis shows that estradiol and inhibin assays allows satisfactory differential diagnosis between functional and organic cysts. However, the inhibin assay provides more precise results and appears to be a more reliable marker than estradiol. The differential diagnosis between the two types of cyst would indicate the use of coelioscopic surgery especially in the case of organic cysts, avoiding unnecessary risks for patients with functional cysts.
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Affiliation(s)
- C Binelli
- Service de Gynécologie-Obstétrique, Angers, France
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