Sonographic Assessment of Complex Ultrasound Morphology Adnexal Tumors in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems

Artur Czekierdowski,Janusz Kraczkowski,Agata Smoleń,Andrzej Miturski,Norbert Stachowicz,Tomasz Łoziński,Tomasz Kluz

doi:10.3390/diagnostics11030414

Artur Czekierdowski, Janusz Kraczkowski + Show 5 more

Open Access

https://doi.org/10.3390/diagnostics11030414

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Journal: Diagnostics	Publication Date: Feb 28, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: Medical University of Lublin, Rzeszów University

Abstract

Background: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. Methods: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20–42 years old) with a mean gestation age of 13.5 (range: 8–31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. Results: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR− = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70–75%) except for SRR (53%). Conclusion: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.

Highlights

The extensive use of ultrasound in early pregnancy has led to an increased detection of ovarian lesions that are diagnosed incidentally in asymptomatic gravid women [1,2]
We have described ultrasound features, management and outcomes in 36 pregnant patients with complex adnexal masses detected at ultrasound examination
We have found that the most difficult for correct classification lesions were unilocular or multilocular cysts presenting with papillary projections and/or solid parts

Summary

Introduction

The extensive use of ultrasound in early pregnancy has led to an increased detection of ovarian lesions that are diagnosed incidentally in asymptomatic gravid women [1,2]. The most common pregnancy-related adnexal masses are simple cysts, the corpus luteum cysts and the theca lutein cysts All of these lesions may resolve late in the second trimester of gestation, in some women they can persist until after delivery. Most adnexal masses detected in early pregnancy are benign, and sonographers do not need complicated scoring systems or predictive models to classify the type of tumor correctly. To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Both the SRR and ADNEX scoring systems may be used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate

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