Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings

Role of osteopontin in differential diagnosis of ovarian tumors

AIM

The aim of this study was to evaluate the role of the serum osteopontin (OPN) level as a biomarker for discriminating between malignant and benign ovarian tumors. Furthermore, comparisons with the diagnostic usefulness of the other tests were performed.

METHODS

The study included 114 consecutive women with ovarian tumors (82 benign and 32 malignant) who were referred to our division.

RESULTS

A cut-off level of 28.0 ng/mL for OPN showed a sensitivity of 71.87% and a specificity of 89.02%. The area under the receiver-operator curve (ROC) was 0.812. There were no differences in diagnostic utility between OPN and the other studied tests. OPN levels were lower in patients with endometriotic ovarian cysts than in those with other benign ovarian tumors (14.00 vs 19.50 ng/mL; P = 0.018). The difference between the median OPN level in patients with endometriotic cysts (14.0 ng/mL) and those with malignant tumors (40.85 ng/mL) was also statistically significant (P < 0.0001). The calculated OPN/CA-125 ratio was significantly different between patients with endometriotic cysts (median, 0.36; range, 0.05-2.89) and those with other benign tumors (median, 1.25; range, 0.05-5.70) (P = 0.0002). There was also a statistically significant difference in the median OPN/CA-125 ratio between patients with endometrial cysts (median, 0.36; range, 0.05-2.89) and those with malignant tumors (median, 0.12; range, 0.01-3.39) (P = 0.004).

CONCLUSION

The diagnostic utility of OPN is similar to that of ultrasonographic evaluation and CA-125 level assessment. Thus, OPN may be useful in differential diagnosis for less experienced ultrasonographers and is especially valuable for differential diagnosis of endometriotic cysts.

GI-RADS reporting system for ultrasound evaluation of adnexal masses in clinical practice: a prospective multicenter study

OBJECTIVE

To assess the clinical usefulness of a structured reporting system based on ultrasound findings for management of adnexal masses.

METHODS

This was a prospective multicenter study comprising 432 adnexal masses in 372 women (mean age, 44.0 (range, 13-78) years) over a 36-month period. Ninety-three (25%) women were postmenopausal and 279 (75%) women were premenopausal. Patients were evaluated with transvaginal ultrasound by one of three examiners expert in gynecological ultrasound. Reporting was provided to referring clinicians according to the Gynecologic Imaging Report and Data System (GI-RADS) classification. A predetermined management protocol was offered to referral clinicians. It was suggested that patients classified as GI-RADS 2 be managed with follow-up scan, patients classified as GI-RADS 3 undergo laparoscopic surgery and patients classified as GI-RADS 4 or 5 be referred to a gynecologic oncologist. Definitive histologic diagnosis was available in 370 cases and 62 additional cases were considered as benign because of spontaneous resolution during follow-up. These outcomes were used as the gold standard for calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of GI-RADS classification for identifying adnexal masses at high risk of malignancy, considering GI-RADS 4 and 5 as being malignant.

RESULTS

Of the 432 tumors, 112 were malignant and 320 benign. The GI-RADS classification rate was as follows: GI-RADS 2, 92 (21%) cases; GI-RADS 3, 184 (43%) cases; GI-RADS 4, 40 (9%) cases; GI-RADS 5, (27%) 116 cases. Sensitivity for this system was 99.1% (95% CI, 95.1-99.8%), specificity was 85.9% (95% CI, 81.7-89.3%), LR+ was 7.05 (95% CI, 5.37-9.45) and LR- was 0.01 (95% CI, 0.001-0.07). PPV and NPV were 71.1% and 99.6%, respectively.

CONCLUSIONS

The GI-RADS reporting system performed well in identifying adnexal masses at high risk of malignancy and seems to be useful for clinical decision-making.