Abstract
Background: This study aimed to evaluate the diagnostic added-value of serum CA-125 to the International Ovarian Tumor Analysis (IOTA) Simple Rules in order to facilitate differentiation between malignant and benign ovarian tumors before surgery. Methods: A secondary analysis of a cross-sectional cohort of women scheduled for surgery in Maharaj Nakorn Chiang Mai Hospital between April 2010 and March 2018 was carried out. Demographic and clinical data were prospectively collected. Histopathologic diagnosis was used as the reference standard. Logistic regression was used for development of the model. Evaluation of the diagnostic added-value was based on the increment of the area under the receiver operating characteristic curve (AuROC). Results: One hundred and forty-five women (30.3%) out of a total of 479 with adnexal masses had malignant ovarian tumors. The model that included information from the IOTA Simple Rules and serum CA-125 was significantly more superior to the model that used only information from the IOTA Simple Rules (AuROC 0.95 vs. 0.89, p < 0.001 for pre-menopause and AuROC 0.98 vs 0.83, p < 0.001 for post-menopause). Conclusions: The IOTA SR X CA-125 model showed high discriminative ability and is potentially useful as a decision tool for guiding patient referrals to oncologic specialists.
Highlights
General gynecologists are required to provide an accurate differentiation between benign and malignant adnexal pathologies to ensure an optimal starting point in the whole chain of care [1], as this would lead to appropriate decisions regarding the referral of patients to specialized oncologic care
Out of a total of 479 women with adnexal masses included in this secondary analysis, 145 (30.3%) had malignant ovarian tumors and 334 (69.7%) had benign ovarian tumors
In conclusion, this study demonstrated that serum CA-125 significantly adds value to the International Ovarian Tumor Analysis (IOTA) Simple Rules in differentiating malignant adnexal masses from benign
Summary
General gynecologists are required to provide an accurate differentiation between benign and malignant adnexal pathologies to ensure an optimal starting point in the whole chain of care [1], as this would lead to appropriate decisions regarding the referral of patients to specialized oncologic care. Transvaginal ultrasonography is generally the first modality used by gynecologists to characterize these masses in practice It is currently the only imaging modality recommended by the American College of Obstetricians and Gynecologists (ACOG) to evaluate adnexal masses in women [3]. To date, this is widely accepted that the most accurate approach for the preoperative diagnosis of adnexal masses is subjective assessment (SA) by an experienced sonographer [4]. This study aimed to evaluate the diagnostic added-value of serum CA-125 to the International Ovarian Tumor Analysis (IOTA) Simple Rules in order to facilitate differentiation between malignant and benign ovarian tumors before surgery. Conclusions: The IOTA SR X CA-125 model showed high discriminative ability and is potentially useful as a decision tool for guiding patient referrals to oncologic specialists
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