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Yörük P, Dündar O, Yildizhan B, Tütüncü L, Pekin T. Comparison of the risk of malignancy index and self-constructed logistic regression models in preoperative evaluation of adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1469-1477. [PMID: 18809957 DOI: 10.7863/jum.2008.27.10.1469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate women with adnexal masses in the preoperative period by creating 2 logistic regression models, 1 including sonographic morphologic characteristics and the other including both morphologic and color Doppler characteristics, to compare the diagnostic accuracy of these 2 models with the risk of malignancy index (RMI). METHODS This prospective study included 38 malignant, 7 borderline, and 244 benign ovarian masses. The menopausal status, presence of septa, presence of papillary projections, location of the tumor, presence of ascites, presence of metastases, cancer antigen 125 level, tumor volume, septa thickness, and percentage of the solid component were included in the initial analysis. A second regression analysis was performed with the addition of Doppler parameters (location of blood flow and lowest resistive index) in the data set. Diagnostic performance of the 2 regression models and RMI were described and compared by generating receiver operating characteristic curves for each model. RESULTS The area under the curve values for the morphologic model (model 1), Doppler model (model 2), and RMI were 0.907, 0.971, and 0.889, respectively. Significance levels of model 1 and the RMI were similar (P = .23), whereas model 2 had a significantly higher area under the curve compared with both model 1 (P = .037) and the RMI (P = .018). CONCLUSIONS The addition of Doppler parameters in the regression model significantly increases the predictive performance. Nevertheless, in low-resource settings, the RMI remains the method of choice for distinguishing adnexal masses and referral to gynecologic oncology clinics.
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Affiliation(s)
- Pynar Yörük
- Department ofObstetrics and Gynecology, Marmara University, Istanbul, Turkey. .
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Levine D, Asch E, Mehta TS, Broder J, O'Donnell C, Hecht JL. Assessment of factors that affect the quality of performance and interpretation of sonography of adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:721-728. [PMID: 18424647 DOI: 10.7863/jum.2008.27.5.721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to assess factors that affect the quality of performance and interpretation of sonography of adnexal masses. METHODS Two gynecologic sonographers performed blinded reviews of up to 3 sonograms within 5 years before surgery in 325 consecutive women who underwent oophorectomy (610 sonograms). Three 5-point quality scores were assigned (with 5 being the best score) on the basis of the technical quality of the images, accurate description of findings, and summary impression in the report. The location of the examination (on-site, remote, or emergency department), type of fellowship, practice experience (<5, 5-10, or >10 years), and specialty (women's imaging, abdominal imaging, or other) of the radiologists were recorded. Analysis of variance was used to assess the impact of these multiple factors on quality. RESULTS No significant differences were found among 31 radiologists on the basis of the type of training, years in practice, or number of examinations read. Average scores among radiologists for technical quality, findings, and impressions were 4.96, 4.88, and 4.83, respectively. Radiologists who specialized in women's imaging performed best in the quality of their impressions (4.86 versus 4.79; P = .029). There were no significant differences in scores with respect to the examination location. CONCLUSIONS Within this sample of radiologists, the technical quality of the examinations was not affected by the type of training or subspecialty practice. Reports of adnexal mass findings were accurately described by all radiologists, although specialization in women's imaging improved the ability to provide an accurate impression.
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Affiliation(s)
- Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Guerriero S, Ajossa S, Lai MP, Alcazar JL, Paoletti AM, Marisa O, Melis GB. The diagnosis of functional ovarian cysts using transvaginal ultrasound combined with clinical parameters, CA125 determinations, and color Doppler. Eur J Obstet Gynecol Reprod Biol 2003; 110:83-8. [PMID: 12932878 DOI: 10.1016/s0301-2115(03)00209-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To investigate the role of transvaginal ultrasound combined with clinical parameters, CA125 determinations, and color Doppler in the differentiation between functional cysts and other adnexal masses. STUDY DESIGN Two hundred and eighty-seven consecutive persistent adnexal masses were submitted to B-mode transvaginal ultrasonography associated with color and power Doppler imaging. Plasma CA125 concentrations were measured before surgery. RESULTS According to the obtained logistic regression equation, the presence of anechoic tumors without echogenic portions or septa and CA125 <25IU/ml was associated with a 75% probability of presence of follicular cysts. The visualization of fine trabecular jelly-like content or of a heterogeneous mass with hypoechoic content, absent or only peripheral arterial flow, and age <40 years was associated with a 56% probability of presence of luteal cysts. CONCLUSIONS Addition of findings to B-mode ultrasonography can help to differentiate functional cysts from other adnexal masses.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, via Ospedale 46, 09124, Cagliari, Italy.
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Nemoto Y, Ishihara K, Sekiya T, Konishi H, Araki T. Ultrasonographic and clinical appearance of hemorrhagic ovarian cyst diagnosed by transvaginal scan. J NIPPON MED SCH 2003; 70:243-9. [PMID: 12928726 DOI: 10.1272/jnms.70.243] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We examined clinical and sonographic findings in 112 patients diagnosed as having hemorrhagic ovarian cyst (HOC) who had clinical and transvaginal sonographic follow up. The patients were classified into group A (n=40) with signs and symptoms of acute abdomen and group B (n=72) with no symptoms or mild abdominal pain, and their ultrasonographic and clinical findings were compared. Significant differences were found in mean age, white blood cell (WBC) count, greatest diameter of the mass, shortest diameter of the mass, and size of cross section of the mass. The internal echograms of HOCs were grouped into 4 types: (1) hyperechoic and hypoechoic solid type; (2) reticular or sponge-like type; (3) mixture type of solid and cystic components; and (4) cystic types. In all image types, septum-like or thread-like echoes were seen. Transvaginal sonography (TVS) of type 1, type 2, and type 3 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. HOCs were found more frequently in nulliparous patients (n=79, 70.5%) than in multiparous (n=33, 29.5%). There were many luteal phase (n=86, 76.8%) in comparison with follicular phase (n=13, 11.6%). Thirteen cases were detected during early gestation (n=13, 11.6%). In group A, severe pain reduced or disappeared within 3 h in 37/40 (92.5%) of the patients. Blood flow inside the masses was analyzed in 14 patients by the color Doppler method and showed no significant change. Taken together, this study elucidated the ultrasonographic and clinical characteristics of HOCs, which provide useful information to differentiate HOCs from organic masses and help to avoid unnecessary laparotomy.
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Affiliation(s)
- Yoshihiro Nemoto
- Department of Obstetrics and Gynecology, Nippon Medical School, Kawasaki, Kanagawa, Japan.
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Schutter EM, Sohn C, Kristen P, Möbus V, Crombach G, Kaufmann M, Caffier H, Kreienberg R, Verstraeten AA, Kenemans P. Estimation of probability of malignancy using a logistic model combining physical examination, ultrasound, serum CA 125, and serum CA 72-4 in postmenopausal women with a pelvic mass: an international multicenter study. Gynecol Oncol 1998; 69:56-63. [PMID: 9570999 DOI: 10.1006/gyno.1998.4942] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND To assess the differential diagnostic potential of physical examination, ultrasound, the serum CA 125 assay, and serum CA 72-4 assay, and the contribution of each parameter to a logistic model predicting the probability of malignancy in postmenopausal patients presenting with a pelvic mass. PATIENTS AND METHODS In a multicenter, prospective study a total of 155 patients were evaluated preoperatively using a standard protocol for pelvic examination, transvaginal (occasionally additional abdominal) ultrasound, and serum CA 72-4 (cutoff level 3 U/ml) and CA 125 (cutoff level 35 U/ml). RESULTS Fifty-nine malignant (39%) and 92 benign (61%) pelvic tumors were found in addition to 4 borderline tumors (3%). Forty-three patients appeared to have ovarian carcinoma, FIGO Stage III or IV in 28 cases. Borderline tumors were excluded from the statistical calculations. The diagnostic accuracy of each single parameter, i.e., pelvic examination, ultrasound, and serum CA 125 and CA 72-4 in discriminating between benign and malignant pelvic masses gave highly similar results (81, 76, 78, and 81% respectively). Best sensitivity was found in pelvic examination (92%); best specificity was found in CA 72-4 (93%). Using logistic regression analysis the power of pelvic examination appeared to be the most relevant (adjusted odds ratio 12.1), followed by ultrasound (odds ratio 9.7), serum CA 125 (odds ratio 5.0), and serum CA 72-4 (odds ratio 4.9). Age appeared to be nonpredictive. The logistic model gives a correct prediction in 87% of all cases. CONCLUSIONS The addition of serum CA 72-4 to the combination of pelvic examination, ultrasound, and serum CA 125 leads to an improved discrimination between malignant and benign pelvic masses.
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Affiliation(s)
- E M Schutter
- Department of Obstetrics and Gynecology, Academic Hospital Free University, Amsterdam, The Netherlands
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Osmers RG, Osmers M, von Maydell B, Wagner B, Kuhn W. Evaluation of ovarian tumors in postmenopausal women by transvaginal sonography. Eur J Obstet Gynecol Reprod Biol 1998; 77:81-8. [PMID: 9550206 DOI: 10.1016/s0301-2115(97)00235-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the present study was the evaluation of simple reproducible sonomorphological criteria for the preoperative evaluation of ovarian tumors in postmenopausal women by use of transvaginal sonography. STUDY DESIGN Postmenopausal women (> or =1 year of secondary amenorrhea) with ovarian tumors (n=378; tumors > or =3 cm and <3 cm but with solid parts) were examined in a prospective study by transvaginal sonography prior to surgery between 1987 and 1993. The sonomorphological criteria were correlated with the histological findings of the tumors. RESULTS Of all ovarian tumors in postmenopausal women, 6.3% were functional cysts (follicular or corpus luteum cysts). Almost all of them were detected within the first 5 years of postmenopause. The other ovarian tumors were diagnosed as retention cysts (17.5%), benign neoplasms (39.4%), and malignant tumors (36.8%). Simple ovarian cysts (monolocular, smooth inner wall) represented sonomorphologically the second most frequent type of ovarian tumors in postmenopausal women (35.7%). Of these tumors, 9.6% were diagnosed as malignant. CONCLUSIONS Simple reproducible sonomorphological criteria proved to be a useful clinical parameter in the preoperative evaluation of ovarian tumors.
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Affiliation(s)
- R G Osmers
- University of Göttingen, Department of Obstetrics and Gynecology, Germany
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Osmers RG, Osmers M, von Maydell B, Wagner B, Kuhn W. Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography. Am J Obstet Gynecol 1996; 175:428-34. [PMID: 8765264 DOI: 10.1016/s0002-9378(96)70157-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to establish reproducible sonomorphologic criteria by use of transvaginosonography in the preoperative evaluation of ovarian tumors in the premenopause. STUDY DESIGN In a prospective study from 1987 to 1993 we investigated 1072 ovarian tumors. All tumors > or = 3 cm were included in the study. To avoid unnecessary operations, all tumors we rescanned after 6 weeks. The sonomorphologic criteria were correlated with the histologic findings. RESULTS A total of 4.3% of ovarian tumors in the premenopause were malignant. In the special group of sonographically simple ovarian cysts we found 0.8% malignancies. The incorporation of a control scan after 6 weeks in the management of ovarian cysts reduces the number of unnecessary operations on functional cysts. Only 5.5% of the functional tumors were operated on. The risk for malignancy in cystic-solid ovarian tumors is 17.0%, the highest of all sonomorphologic tumor types. CONCLUSIONS The use of reproducible sonomorphologic criteria in combination with a control scan in premenopausal women with ovarian cysts proved to be efficient to reduce the number of unnecessary operations and to evaluate the risk for malignancy.
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Affiliation(s)
- R G Osmers
- Department of Obstetrics and Gynecology, University of Göttingen, Germany
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Schutter EM, Kenemans P, Sohn C, Kristen P, Crombach G, Westermann R, Môbus V, Kaufmann M, Caffier H, Schmidt-Rhode P. Diagnostic value of pelvic examination, ultrasound, and serum CA 125 in postmenopausal women with a pelvic mass. An international multicenter study. Cancer 1994; 74:1398-406. [PMID: 8055463 DOI: 10.1002/1097-0142(19940815)74:4<1398::aid-cncr2820740433>3.0.co;2-j] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND In a prospective study, the differential diagnostic potential of pelvic examination, ultrasound, and serum CA 125 assay in postmenopausal patients presenting with a pelvic mass was assessed. METHODS A total of 228 patients were evaluated preoperatively in an international, multicenter, prospective study using a standard protocol for pelvic examination, transvaginal (occasionally additional abdominal) ultrasound, and serum CA 125 determination with a cut-off level of 35 U/ml. RESULTS Ninety-five malignant (41.7%) and 127 benign (55.7%) pelvic tumors were found in addition to 6 borderline ovarian tumors (2.6%) in the 228 patients. Seventy-two patients had ovarian carcinoma, 49 of whom were International Federation of Gynecology and Obstetrics Stage III or IV. Borderline tumors were excluded from the statistical calculations. The individual accuracy of pelvic examination, ultrasound, and serum CA 125 in discriminating between benign and malignant pelvic masses was approximately the same (76, 74, and 77%, respectively). Using logistic regression analysis, the power of pelvic examination appeared to be the most relevant factor (adjusted odds ratio, 9.2), followed by serum CA 125 (odds ratio, 5.6), and ultrasound (odds ratio, 4.9). Age appeared to be nonpredictive. No cancer was found in any patient in whom all three methods scored negative (n = 53; positive predictive value for malignancy = 0 and 95%; confidence interval, 0-7). CONCLUSIONS The combined use of pelvic examination, ultrasound, and serum CA 125 leads to improved discrimination between malignant and benign pelvic masses, because malignancy can be excluded when all three examination methods are negative. A change to a more patient-tailored surgical approach could be considered in those cases.
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Affiliation(s)
- E M Schutter
- Department of Obstetrics and Gynaecology, Academic Hospital Free University, Amsterdam, The Netherlands
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