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Barreñada L, Ledger A, Dhiman P, Collins G, Wynants L, Verbakel JY, Timmerman D, Valentin L, Van Calster B. ADNEX risk prediction model for diagnosis of ovarian cancer: systematic review and meta-analysis of external validation studies. BMJ MEDICINE 2024; 3:e000817. [PMID: 38375077 PMCID: PMC10875560 DOI: 10.1136/bmjmed-2023-000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Abstract
Objectives To conduct a systematic review of studies externally validating the ADNEX (Assessment of Different Neoplasias in the adnexa) model for diagnosis of ovarian cancer and to present a meta-analysis of its performance. Design Systematic review and meta-analysis of external validation studies. Data sources Medline, Embase, Web of Science, Scopus, and Europe PMC, from 15 October 2014 to 15 May 2023. Eligibility criteria for selecting studies All external validation studies of the performance of ADNEX, with any study design and any study population of patients with an adnexal mass. Two independent reviewers extracted the data. Disagreements were resolved by discussion. Reporting quality of the studies was scored with the TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) reporting guideline, and methodological conduct and risk of bias with PROBAST (Prediction model Risk Of Bias Assessment Tool). Random effects meta-analysis of the area under the receiver operating characteristic curve (AUC), sensitivity and specificity at the 10% risk of malignancy threshold, and net benefit and relative utility at the 10% risk of malignancy threshold were performed. Results 47 studies (17 007 tumours) were included, with a median study sample size of 261 (range 24-4905). On average, 61% of TRIPOD items were reported. Handling of missing data, justification of sample size, and model calibration were rarely described. 91% of validations were at high risk of bias, mainly because of the unexplained exclusion of incomplete cases, small sample size, or no assessment of calibration. The summary AUC to distinguish benign from malignant tumours in patients who underwent surgery was 0.93 (95% confidence interval 0.92 to 0.94, 95% prediction interval 0.85 to 0.98) for ADNEX with the serum biomarker, cancer antigen 125 (CA125), as a predictor (9202 tumours, 43 centres, 18 countries, and 21 studies) and 0.93 (95% confidence interval 0.91 to 0.94, 95% prediction interval 0.85 to 0.98) for ADNEX without CA125 (6309 tumours, 31 centres, 13 countries, and 12 studies). The estimated probability that the model has use clinically in a new centre was 95% (with CA125) and 91% (without CA125). When restricting analysis to studies with a low risk of bias, summary AUC values were 0.93 (with CA125) and 0.91 (without CA125), and estimated probabilities that the model has use clinically were 89% (with CA125) and 87% (without CA125). Conclusions The results of the meta-analysis indicated that ADNEX performed well in distinguishing between benign and malignant tumours in populations from different countries and settings, regardless of whether the serum biomarker, CA125, was used as a predictor. A key limitation was that calibration was rarely assessed. Systematic review registration PROSPERO CRD42022373182.
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Affiliation(s)
- Lasai Barreñada
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ashleigh Ledger
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Paula Dhiman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford, UK
| | - Gary Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford, UK
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Epidemiology, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Netherlands
| | - Jan Y Verbakel
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Leuven Unit for Health Technology Assessment Research (LUHTAR), KU Leuven, Leuven, Belgium
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, UZ Leuven campus Gasthuisberg Dienst gynaecologie en verloskunde, Leuven, Belgium
| | - Lil Valentin
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmo, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Leuven Unit for Health Technology Assessment Research (LUHTAR), KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
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Chen H, Yang BW, Qian L, Meng YS, Bai XH, Hong XW, He X, Jiang MJ, Yuan F, Du QW, Feng WW. Deep Learning Prediction of Ovarian Malignancy at US Compared with O-RADS and Expert Assessment. Radiology 2022; 304:106-113. [PMID: 35412367 DOI: 10.1148/radiol.211367] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Deep learning (DL) algorithms could improve the classification of ovarian tumors assessed with multimodal US. Purpose To develop DL algorithms for the automated classification of benign versus malignant ovarian tumors assessed with US and to compare algorithm performance to Ovarian-Adnexal Reporting and Data System (O-RADS) and subjective expert assessment for malignancy. Materials and Methods This retrospective study included consecutive women with ovarian tumors undergoing gray scale and color Doppler US from January 2019 to November 2019. Histopathologic analysis was the reference standard. The data set was divided into training (70%), validation (10%), and test (20%) sets. Algorithms modified from residual network (ResNet) with two fusion strategies (feature fusion [hereafter, DLfeature] or decision fusion [hereafter, DLdecision]) were developed. DL prediction of malignancy was compared with O-RADS risk categorization and expert assessment by area under the receiver operating characteristic curve (AUC) analysis in the test set. Results A total of 422 women (mean age, 46.4 years ± 14.8 [SD]) with 304 benign and 118 malignant tumors were included; there were 337 women in the training and validation data set and 85 women in the test data set. DLfeature had an AUC of 0.93 (95% CI: 0.85, 0.97) for classifying malignant from benign ovarian tumors, comparable with O-RADS (AUC, 0.92; 95% CI: 0.85, 0.97; P = .88) and expert assessment (AUC, 0.97; 95% CI: 0.91, 0.99; P = .07), and similar to DLdecision (AUC, 0.90; 95% CI: 0.82, 0.96; P = .29). DLdecision, DLfeature, O-RADS, and expert assessment achieved sensitivities of 92%, 92%, 92%, and 96%, respectively, and specificities of 80%, 85%, 89%, and 87%, respectively, for malignancy. Conclusion Deep learning algorithms developed by using multimodal US images may distinguish malignant from benign ovarian tumors with diagnostic performance comparable to expert subjective and Ovarian-Adnexal Reporting and Data System assessment. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Hui Chen
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Bo-Wen Yang
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Le Qian
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Yi-Shuang Meng
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Xiang-Hui Bai
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Xiao-Wei Hong
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Xin He
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Mei-Jiao Jiang
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Fei Yuan
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Qin-Wen Du
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
| | - Wei-Wei Feng
- From the Department of Obstetrics and Gynecology (H.C., B.W.Y., L.Q., X.H., M.J.J., Q.W.D., W.W.F.) and Department of Pathology (F.Y.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Huangpu District, Shanghai 200025, China; and Philips Research Asia Shanghai, Shanghai, China (Y.S.M., X.H.B., X.W.H.)
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Stachowicz N, Smoleń A, Ciebiera M, Łoziński T, Poziemski P, Borowski D, Czekierdowski A. Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems. Diagnostics (Basel) 2021; 11:diagnostics11030442. [PMID: 33806571 PMCID: PMC8001089 DOI: 10.3390/diagnostics11030442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. AIM The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. MATERIAL AND METHODS It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. RESULTS The median age was 60.3 years (range ± 10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71-0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65-0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70-0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73-0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. CONCLUSIONS New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.
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Affiliation(s)
- Norbert Stachowicz
- Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-080 Lublin, Poland;
- Correspondence:
| | - Agata Smoleń
- Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-080 Lublin, Poland;
| | - Michał Ciebiera
- Center of Postgraduate Medical Education, Second Department of Obstetrics and Gynecology, 01-809 Warsaw, Poland;
| | - Tomasz Łoziński
- Department of Obstetrics and Gynaecology, Pro-Familia Hospital, 35-001 Rzeszów, Poland;
| | - Paweł Poziemski
- Department of Obstetrics and Gynecology, Mińsk Mazowiecki County Hospital, 05-300 Mińsk Mazowiecki, Poland;
| | - Dariusz Borowski
- Clinic of Fetal-Maternal Medicine, Gynecology and Neonatology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, 85-067 Bydgoszcz, Poland;
| | - Artur Czekierdowski
- Department of Gynecological Oncology and Gynecology, Medical University of Lublin, 20-081 Lublin, Poland;
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