Sonographic Discrimination Between Benign and Malignant Adnexal Masses in Premenopause

Abstract

Purpose: The aim of this study was to assess the diagnostic value of sonographic pattern recognition by experts, a standardized morphological scoring system, the risk malignancy index (RMI) and CA 125 assay for the preoperative assessment of ovarian lesions in premenopausal patients.

Material and methods: Diagnostic work-up of 1320 patients who underwent surgical exploration due to an adnexal mass at a tertiary referral center were included. We assessed the discriminative value of pattern recognition, a sonographic morphological scoring system, RMI and CA 125 by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen’s kappa for each diagnostic approach while using histopathology as the reference standard.

Results: Pattern recognition showed the highest discriminative power with an observed kappa of 0.53. Sensitivity and specificity yielded 0.76 and 0.97 respectively. Combining pattern recognition with CA 125 serum measurement in the context of a triage system diminished the diagnostic value (kappa: 0.24; sensitivity: 0.29 specificity: 0.97). For the RMI we observed a sensitivity of 0.54 and a specificity of 0.96 and estimated kappa value yielded 0.37. Omitting the CA 125 assay and using a morphological sonographic assessment system increased the kappa value to 0.45 with sensitivity and specificity observed at 0.61 and 0.97 respectively.

Conclusion: Expert pattern recognition was found to be the method with the highest discriminative power in assessing an adnexal mass during premenopause. Additional assessment of serum CA 125 diminished the diagnostic accuracy. Standardized morphological sonographic assessment resulted in a moderate diagnostic accuracy. Supplementing the morphological sonographic assessment with CA 125 by using the RMI algorithm did not improve the diagnostic value.

Zusammenfassung

Ziel: Ziel der Studie war es den diagnostischen Nutzen von Ultraschall und CA 125 Bestimmung bei der präoperativen Beurteilung von Ovarialzysten in der Prämenopause zu evaluieren

Material und Methoden: Die Behandlungsverläufe von 1320 Patientinnen, welche aufgrund einer ovariellen Raumforderung chirurgisch an einem tertiären Zuweisungszentrum behandelt wurden, wurden ausgewertet. Für die Ultraschallauswertung nach pattern recognition, den RMI und einer standardisierten morphologie-basierten Beurteilung erfolgte die Bestimmung des Diskiminationsvermögens mittels Berechnung von Sensitivität, Spezifität sowie Cohens kappa.

Ergebnisse: Für die Pattern recognition wurde das höchste Diskriminitationsvermögen (kappa: 0,53, Sensitivität: 0,76 und Spezifität: 0,97) beobachtet. Die Kombination mit einer CA 125 Bestimmung verminderte das Diskriminationsvermögen (kappa: 0,24, Sensitivität: 0,29, Spezifität: 0,97). Für den RMI betrug die Sensitivität 0,54 und die Spezifität 0,96 mit einem kappa Wert von 0,37. Durch Exklusion des CA 125 und Verwendung einer standardisierten morphologischen Ultraschallauswertung stieg kappa auf 0,45 bei einer Sensitivität von 0,45 und einer Spezifität von 0,97.

Schlussfolgerung: Pattern recognition zeigte in unserer Auswertung die höchste diagnostische Wertigkeit bei der Beurteilung einer ovariellen Raumforderung in der Prämenopause. Eine zusätzliche Bestimmung von CA 125 verminderte hierbei das Diskriminationsvermögen des Ultraschalls.

Key words

ovary - premenopause - adnexal mass

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