Adnexal masses difficult to classify as benign or malignant using subjective assessment of gray scale and Doppler ultrasound findings: logistic regression models do not help.
Summary of "Adnexal masses difficult to classify as benign or malignant using subjective assessment of gray scale and Doppler ultrasound findings: logistic regression models do not help."
To develop a logistic regression model that can discriminate between benign and malignant adnexal masses perceived to be difficult to classify by subjective evaluation of gray scale and Doppler ultrasound findings (subjective assessment) and to compare its diagnostic performance with that of subjective assessment, serum CA 125 and the risk of malignancy index (RMI).
We used the 3511 patients with an adnexal mass included in the International Ovarian Tumor Analysis (IOTA) studies. All patients had been examined with transvaginal gray scale and Doppler ultrasound following a standardized research protocol by an experienced ultrasound examiner using a high end ultrasound system. In addition to prospectively collecting information on > 40 clinical and ultrasound variables, the ultrasound examiner classified each mass as certainly or probably benign, unclassifiable, or certainly or probably malignant. A logistic regression model to discriminate between benignity and malignancy was developed for the unclassifiable masses (n = 244, i.e. 7% of all tumors) using a training set (160 tumors, 45 malignancies) and then tested on a test set (84 tumors, 28 malignancies). The gold standard was the histological diagnosis of the surgically removed adnexal mass. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative likelihood ratio (LR+, LR-) were used to describe diagnostic performance and were compared between subjective assessment, CA 125, the RMI and the logistic regression model created.
One variable was retained in the logistic regression model: the largest diameter (in mm) of the largest solid component of the tumor (OR 1.04, 95% CI 1.02 - 1.06). The model had an AUC of 0.68 (95% confidence interval, CI 0.59 to 0.78) on the training set and 0.65 (95%CI 0.53 to 0.78) on the test set. On the test set, a cutoff of 25% probability of malignancy (corresponding to largest diameter of largest solid component 23mm) resulted in sensitivity 64% (18/28), specificity 55% (31/56), LR+ 1.44 and LR- 0.65. The corresponding figures for subjective assessment were 68% (19/28), 59% (33/56), 1.65 and 0.55. On the test set of patients with available CA 125 results, the LR+ and LR- of the logistic regression model (cutoff 25% probability of malignancy) were 1.29 and 0.73, of subjective assessment 1.44 and 0.63, of CA 125 (cutoff 35 U/mL) 1.25 and 0.84 and of RMI (cutoff 200) 1.21 and 0.92.
About 7% of adnexal masses that are considered appropriate to remove surgically cannot be classified as benign or malignant by experienced ultrasound examiners using subjective assessment. Logistic regression models to estimate the risk of malignancy, CA 125 measurements and the RMI are not helpful in these masses. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, SWEDEN. email@example.com.
This article was published in the following journal.
Medical and Biotech [MESH] Definitions
A smooth, solid or cystic fibroepithelial (FIBROEPITHELIAL NEOPLASMS) tumor, usually found in the OVARIES but can also be found in the adnexal region and the KIDNEYS. It consists of a fibrous stroma with nests of epithelial cells that sometimes resemble the transitional cells lining the urinary bladder. Brenner tumors generally are benign and asymptomatic. Malignant Brenner tumors have been reported.
A benign adnexal neoplasm composed of EPITHELIAL CELLS. They typically manifest as solitary papules and occur only in the skin.
A group of disorders having a benign course but exhibiting clinical and histological features suggestive of malignant lymphoma. Pseudolymphoma is characterized by a benign infiltration of lymphoid cells or histiocytes which microscopically resembles a malignant lymphoma. (From Dorland, 28th ed & Stedman, 26th ed)
A tumor composed of spindle cells with a rich vascular network, which apparently arises from pericytes, cells of smooth muscle origin that lie around small vessels. Benign and malignant hemangiopericytomas exist, and the rarity of these lesions has led to considerable confusion in distinguishing between benign and malignant variants. (From Dorland, 27th ed; DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1364)
A condition characterized by poorly-circumscribed gelatinous masses filled with malignant mucin-secreting cells. Forty-five percent of pseudomyxomas arise from the ovary, usually in a mucinous cystadenocarcinoma (CYSTADENOCARCINOMA, MUCINOUS), which has prognostic significance. Pseudomyxoma peritonei must be differentiated from mucinous spillage into the peritoneum by a benign mucocele of the appendix. (Segen, Dictionary of Modern Medicine, 1992)
ABSTRACT: BACKGROUND: Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the use...
OBJECTIVE: The aim of this study was to establish when a second stage diagnostic test may be of value in case a primary diagnostic test has given an uncertain diagnosis of the benign or malignant natu...
ABSTRACT: BACKGROUND: To investigate the 3.0-Tesla (3 T) magnetic resonance imaging (MRI) characteristics of primary adnexal lesions for discriminating benign from malignant lesions. METHODS: One hund...
OBJECTIVE: To evaluate the ability of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate malignant from benign adnexal tumours....
OBJECTIVES: To determine whether threshold criteria using semi-quantitative multiphase-dynamic contrast-enhanced magnetic resonance imaging (DCE- MRI) can improve prediction of m...
This study intends to assess the ability of contrast-enhanced ultrasound in the detection of benign and malignant ovarian masses compared to unenhanced ultrasound. By using an intravascul...
The aim of the study is to assess elastography during EUS examinations of focal pancreatic masses, and to consequently differentiate benign versus malignant pancreatic masses in a prospect...
The purpose of this study is to evaluate the blood flow in kidney masses by using ultrasound microbubble contrast material, and to see if results from ultrasound contrast studies can predi...
Intraductal papillary mucinous neoplasm (IPMN) is a cystic pancreatic lesion that is a precursor to invasive pancreatic cancer. Differentiating whether an IPMN lesion is benign or malignan...
This proposal is designed as a pilot study for the use of laser ablation for local control of symptomatic (e.g compressive) benign thyroid masses in 20 patients.