International Ovarian Tumor Analysis Group Research Articles

Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli–Leydig cell tumors and Leydig cell tumors

To describe the clinical history and ultrasound findings in women with ovarian Sertoli cell, Sertoli-Leydig cell and Leydig cell tumors. Women with a histological diagnosis of Sertoli cell tumor, Sertoli-Leydig cell tumor or Leydig cell tumor who had undergone preoperative ultrasound examination were identified from the databases of each of three participating ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions published by the International Ovarian Tumor Analysis (IOTA) group. In addition, all images were reviewed and described using pattern recognition. Of 22 patients identified, 15 had Sertoli-Leydig cell tumors, two had Sertoli cell tumors and five had Leydig cell tumors. Four patients were postmenopausal, one 48-year-old woman had undergone hysterectomy, 16 were of fertile age and one was a 4-year-old girl. Most patients (82%, 18/22) had endocrine symptoms, the most common being bleeding disturbance (64%, 14/22) and hirsutism (32%, 7/22). Twenty-two (96%) of 23 tumors (one woman had bilateral tumors) contained a solid component; 16 (70%) were purely solid. Pattern recognition showed that the Leydig cell tumors were small solid tumors (four of five had a largest diameter of 1-3 cm) and the two Sertoli cell tumors were somewhat larger solid tumors (4 cm and 7 cm); the Sertoli-Leydig cell tumors were either small (3-4 cm) or medium-sized (6-7 cm) solid tumors, or multilocular solid tumors of any size (3-18 cm) with purely solid areas mixed with areas of innumerable closely packed small cyst locules. On the basis of endocrine symptoms, the woman's age and ultrasound findings, it should be possible to suggest a correct preoperative diagnosis of Sertoli cell, Sertoli-Leydig cell or Leydig cell tumors in many cases.

OC156: External validation of mathematical models to distiguish benign and malignant adnexal tumors: a multicenter study by the international ovarian tumor analysis (IOTA) group

complex based on ultrasound and this, with CA125, generates a risk of malignancy index (RMI). Objective: The purpose of this study was to determine whether RCOG guidelines on complex ovarian cysts are applicable to a subgroup of post-menopausal women with PMB. Methods: Clinical and ultrasound data for consecutive women in our PMB clinic from September 2001 until April 2004 were retrieved from a database. All women found to have an ovarian cyst had serum CA125 measurement and RMI calculated. Those with complex cysts or an increased RMI (> 250) were counselled and offered surgery according to RCOG guidelines. Those with simple cysts and a low RMI (<250) were managed conservatively. Pathology reports were obtained for all resected samples. Results: 753 women underwent TVS. 76 (10.1%) were found to have ovarian cysts. 59 had simple cysts, and all of them had normal CA125 levels and RMIs of less than 250. 17 (2.25%) women had complex cysts: 11 had normal CA125 and thus low RMI scores and 6 had elevated CA125 giving an elevated RMI. All women with complex cysts were offered surgery. 6 of the 11 with low RMI elected to have surgery and all had benign disease. The remaining 5 had follow-up CA125 and TVS and all had ultrasound resolution of their cysts between 6 months and 2 years. All 6 women with increased RMI underwent surgery. 5 had primary ovarian malignancy with one complex benign lesion. Conclusion: RMI calculations are a reliable predictor of ovarian malignancy in women with complex ovarian cysts and PMB. RCOG guidelines for the management of complex ovarian lesions in the post-menopausal population are safely applicable to this important sub-group of women.

Logistic Regression Model to Distinguish Between the Benign and Malignant Adnexal Mass Before Surgery: A Multicenter Study by the International Ovarian Tumor Analysis Group

To collect data for the development of a more universally useful logistic regression model to distinguish between a malignant and benign adnexal tumor before surgery. Patients had at least one persistent mass. More than 50 clinical and sonographic end points were defined and recorded for analysis. The outcome measure was the histologic classification of excised tissues as malignant or benign. Data from 1,066 patients recruited from nine European centers were included in the analysis; 800 patients (75%) had benign tumors and 266 (25%) had malignant tumors. The most useful independent prognostic variables for the logistic regression model were as follows: (1) personal history of ovarian cancer, (2) hormonal therapy, (3) age, (4) maximum diameter of lesion, (5) pain, (6) ascites, (7) blood flow within a solid papillary projection, (8) presence of an entirely solid tumor, (9) maximal diameter of solid component, (10) irregular internal cyst walls, (11) acoustic shadows, and (12) a color score of intratumoral blood flow. The model containing all 12 variables (M1) gave an area under the receiver operating characteristic curve of 0.95 for the development data set (n = 754 patients). The corresponding value for the test data set (n = 312 patients) was 0.94; and a probability cutoff value of .10 gave a sensitivity of 93% and a specificity of 76%. Because the model was constructed from multicenter data, it is more likely to be generally applicable. The effectiveness of the model will be tested prospectively at different centers.