Accuracy of Pelvic Mass Score in Pre-operative Determination of Malignancy in Adnexal Masses.

Abstract

Suspicious adnexal masses are common clinical problems in gynaecological practice. A reliable diagnostic tool for the early detection of the ovarian malignancy is essential. To validate a new scoring system -Pelvic Mass Score (PMS) in predicting the nature of the adnexal mass pre-operatively. A prospective observational study was carried out in 100 consenting women with an undiagnosed adnexal mass requiring operative intervention. Among them 62 patients had mass with a feeding vessel in which the Doppler velocimetry study values were available. The PMS was determined in these 62 patients. A score of 29 or more was taken as suggestive of malignancy. The results were compared with the histopathological diagnosis to confirm malignancy. The chi-square test was applied to test the significance. Among the 62 patients with vascular mass, 31 had histopathological diagnosis of malignancy. The statistical analysis of the data with PMS with 29 as cut-off revealed 100% sensitivity and 100% Negative Predictive Value (NPV) as there was no false negative case detected. But the specificity and Positive Predictive Value (PPV) was poor; 45.2% and 64.6% respectively. Based on the Receiver Operating Characteristic (ROC) curve, if we redefine cut-off as 69, specificity increases to 80.6% with a sensitivity of 90.3%, the PPV and NPV being 82.35 and 89.29 respectively. The present study concludes that, in suspicious vascular adnexal masses PMS can be used as a reliable diagnostic score to predict malignancy if we redefine the existing cut-off of 29 to 69.