Malignant Adnexal Masses Research Articles

Comparative diagnostic accuracy of the IOTA SRR and LR2 scoring systems for discriminating between malignant and Benign Adnexal masses by junior physicians in Chinese patients: a retrospective observational study

BackgroundThe accuracy of ultrasound in distinguishing benign from malignant adnexal masses is highly correlated with the experience of ultrasound physicians. In China, most of ultrasound differentiation is done by junior physicians.PurposeTo compare the diagnostic performance of the International Ovarian Tumour Analysis (IOTA) Simple Rules Risk (SRR) and IOTA Logistic Regression Model 2 (LR2) scoring systems in Chinese patients with adnexal masses.MethodsRetrospective analysis of ovarian cancer tumor patients who underwent surgery at a hospital in China from January 2016 to December 2021. Screening patients with at least one adnexal mass on inclusion and exclusion criteria. Two trained junior physicians evaluated each mass using the two scoring systems. A receiver operating characteristic curve was used to test the diagnostic performance of each system.ResultsA total of 144 adnexal masses were retrospectively collected. Forty masses were histologically diagnosed as malignant. Compared with premenopausal women, postmenopausal women had a much higher rate of malignant masses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the SRR was 97.5% (95% CI: 86.8 -99.9%), 82.7% (95% CI: 74.0 -89.4%), 68.4% (95% CI: 58.7 -76.8%) and 98.9% (95% CI: 92.5 -99.8%). The sensitivity, specificity, PPV, NPV of the LR2 were 90.0% (95% CI: 76.5 -97.2%), 89.4% (95% CI: 81.9 -94.6%), 76.6% (95% CI: 65.0 -85.2%), and 95.9% (95% CI: 90.2 -98.3%). There was good agreement between two scoring systems, with 84.03% total agreement and a kappa value of 0.783 (95% CI: 0.70-0.864). The areas under the curve for predicting malignant tumours using SRR and LR2 were similar for all patients (P > 0.05 ).ConclusionThe two scoring systems can effectively distinguish benign from malignant adnexal masses. Both scoring systems have high diagnostic efficacy, and diagnostic efficacy is stable, which can provide an important reference for clinical decision making.

Evaluating the risk of malignancy in adnexal masses: validation of O-RADS and comparison with ADNEX model, SA, and RMI.

To evaluate the diagnostic value of Ovarian-adnexal Reporting and Data System (O-RADS), and to compare it with Assessment of Different NEoplasias in the adnexa (ADNEX) model, Subjective Assessment (SA), and Risk of Malignancy Index (RMI) in differentiating benign and malignant adnexal masses (AMs). Ultrasound characteristics of 445 patients included in the study were retrospectively analyzed and evaluated using diagnostic models. The diagnostic performances of ultrasound diagnostic models were measured by assessing, receiver-operating characteristic curves, sensitivities, positive predictive values, positive likelihood ratios, specificities, negative predictive values, and negative likelihood ratios. Kappa values were used to evaluate inter-reviewer agreement (IRA). Of the 445 AMs, 265 were benign and 180 were malignant. The area under the curve (AUC) of O-RADS (0.941), ADNEX model (0.925), and SA (0.931) were higher than RMI (0.815) (all p < 0.05). The sensitivity of O-RADS (93.3%), ADNEX model (94.4%), and SA (96.1%) were higher than RMI (70.6%) (p > 0.05), and there was no statistical significance among them (p > 0.05). The specificity of O-RADS, ADNEX model, SA, and RMI was 90.2%, 90.6%, 90.2%, and 92.5%, respectively, with no statistical significance (p > 0.05). All four ultrasound diagnostic methods showed better IRA. O-RADS, ADNEX model and SA have better diagnostic value in differentiating benign and malignant AMs than RMI.

Prediction of the Risk of Malignancy of Adnexal Masses during Pregnancy Comparing Subjective Assessment and Non-Contrast MRI Score (NCMS) in Radiologists with Different Expertise.

Ovarian cancer represents 7% of all cancers in pregnant women. Characterising an ovarian mass during pregnancy is essential to avoid unnecessary treatment and, if treatment is required, to plan it accordingly. Although ultrasonography (US) is the first-line modality to characterise adnexal masses, MRI is indicated when adnexal masses are indeterminate at the US examination. An MRI risk stratification system has been proposed to assign a malignancy probability based on the adnexal lesion's MRI, but features of the scoring system require the administration of intravenous gadolinium-based contrast agents, a method that might have a limited use in pregnant women. The non-contrast MRI score (NCMS) has been used and evaluated in non-pregnant women to characterise adnexal masses indeterminate at the US examination. Therefore, we evaluated the diagnostic accuracy of the NCMS in pregnant women, analysing 20 cases referred to our specialised institution. We also evaluated the diagnostic agreement between two radiologists with different expertise. The two readers classified ovarian masses as benign or malignant using both subjective assessment (SA), based on the interpretive evaluation of imaging findings derived from personal experience, and the NCMS, which includes five categories where 4 and 5 indicate a high probability of a malignant mass. The expert radiologist correctly classified 90% of the diagnoses, using both SA and the NCMS, relying on a sensitivity of 85.7% and a specificity of 92.3%, with a false positive rate of 7.7% and a false negative rate of 14.3%. The non-expert radiologist correctly identified patients at a lower rate, especially using the SA. The analysis of the inter-observer agreement showed a K = 0.47 (95% CI: 0.48-0.94) for the SA (agreement in 71.4% of cases) and a K = 0.8 (95% CI: 0.77-1.00) for the NCMS (agreement in 90% of cases). Although in pregnant patients, non-contrast MRI is used, our results support the use of a quantitative score, i.e., the NCMS, as an accurate tool. This procedure may help less experienced radiologists to reduce the rate of false negatives or positives, especially in centres not specialised in gynaecological imaging, making the MRI interpretation easier and more accurate for radiologists who are not experts in the field, either.

Accuracy of Multi-Detector Computed Tomography In the Diagnoses of Adnexal Masses

Background: Ovarian cancer is the 5th common cause of death in women. patients older than 30 years are high malignant potential group. The lifetime risk of dying from invasive ovarian cancer is about 1 in 95. Modern imaging techniques have demonstrated significant accuracy in the diagnosis and staging of adnexal masses that help the clinician in surgical and post-surgical treatment planning. Objective: To determine the accuracy of multidetector computed tomography (MDCT) in diagnoses of benign and malignant adnexal masses, compare it with histopathological diagnoses and find out the sensitivity, specificity, positive predictive value, negative predictive value of MDCT in diagnoses of benign and malignant adnexal masses. Materials and Methods: This cross-sectional observational study was carried out between January 2013 to December 2014 with 45 patients referred for an MDCT scan of the pelvic organ with a suspicion of adnexal mass in Dhaka Medical College, Dhaka. All the patients were evaluated by detailed history and clinical examination. CT scan of the pelvic organ was performed in all cases and the report was checked by the radiologists of DMCH. Operated patients were followed up after surgery up to histopathological diagnosis and correlated with CT scan findings. Results: CT diagnosis for evaluation of benign adnexal mass, sensitivity was 90.0%, specificity 92.0%, accuracy 91.1%, PPV was 90.0% and NPV 92.0%. In the case of malignant mass, sensitivity is 92.0%, specificity 90.0%, accuracy 91.1%, PPV 92.0% and NPV 90.0%. Conclusion: MDCT is a valuable modality in the diagnosis of benign and malignant adnexal masses.KYAMC Journal Vol. 14, No. 02, July 2023: 74-78.

Subjective assessment and IOTA ADNEX model in evaluation of adnexal masses in patients with history of breast cancer.

To evaluate the performance of subjective assessment and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating between benign and malignant adnexal tumors and between metastatic and primary adnexal tumors in patients with a personal history of breast cancer. This was a retrospective single-center study including patients with a history of breast cancer who underwent surgery for an adnexal mass between 2013 and 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all ultrasound reports had been stored and were retrieved for the purposes of this study. The specific diagnosis suggested by the original ultrasound examiner in the retrieved report was analyzed. For each mass, the ADNEX model risks were calculated prospectively and the highest relative risk was used to categorize each into one of five categories (benign, borderline, primary Stage I, primary Stages II-IV or metastatic ovarian cancer) for analysis of the ADNEX model in predicting the specific tumor type. The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal tumors and between primary and metastatic adnexal tumors was evaluated, using final histology as the reference standard. Included in the study were 202 women with a history of breast cancer who underwent surgery for an adnexal mass. At histology, 93/202 (46.0%) masses were benign, 76/202 (37.6%) were primary malignancies (four borderline and 72 invasive tumors) and 33/202 (16.3%) were metastases. The original ultrasound examiner classified correctly 79/93 (84.9%) benign adnexal masses, 72/76 (94.7%) primary adnexal malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6%, specificity of 84.9% and accuracy of 89.6%, while the ADNEX model had higher sensitivity (98.2%) but lower specificity (78.5%), with similar accuracy (89.1%), in discriminating between benign and malignant ovarian masses. Subjective evaluation had a sensitivity of 51.5%, specificity of 88.8% and accuracy of 82.7% in distinguishing metastatic and primary tumors (including benign, borderline and invasive tumors), and the ADNEX model had a sensitivity of 63.6%, specificity of 84.6% and similar accuracy (81.2%). The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal masses in this series of patients with history of breast cancer was relatively similar. Both subjective assessment and the ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but the sensitivity was low. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

OP14.01: Evaluating the ADNEX model for differentiating between benign and malignant adnexal masses in Denmark

OP14.01: Evaluating the ADNEX model for differentiating between benign and malignant adnexal masses in Denmark

Improving risk stratification of indeterminate adnexal masses on MRI: What imaging features help predict malignancy in O-RADS MRI 4 lesions?

PurposeOvarian-Adnexal Reporting and Data System (O-RADS) MRI uses a 5-point scale to establish malignancy risk in sonographically-indeterminate adnexal masses. The management of O-RADS MRI score 4 lesions is challenging, as the prevalence of malignancy is widely variable (5–90%). We assessed imaging features that may sub-stratify O-RADS MRI 4 lesions into malignant and benign subgroups. MethodRetrospective single-institution study of women with O-RADS MRI score of 4 adnexal masses between April 2021–August 2022. Imaging findings were assessed independently by 2 radiologists according to the O-RADS lexicon white paper. MRI and clinical findingswere compared between malignant and benign adnexal masses, and inter-reader agreement was calculated. ResultsSeventy-four women (median age 52 years, IQR 36–61) were included. On pathology, 41 (55.4%) adnexal masses were malignant. Patients with malignant masses were younger (p = 0.02) with higher CA-125 levels (p = 0.03). Size of solid tissue was greater in malignant masses (p = 0.01–0.04). Papillary projections and larger solid portion were more common in malignant lesions; irregular septations and predominantly solid composition were more frequent in benign lesions (p < 0.01). Solid tissue of malignant lesions was more often hyperintense on T2-weighted and diffusion-weighted imaging (p ≤ 0.03). Other imaging findings were not significantly different (p = 0.09–0.77). Inter-reader agreement was excellent–good for most features (ICC = 0. 662–0.950; k = 0. 650–0.860). ConclusionVarious MRI and clinical features differed between malignant and benign O-RADS MRI score 4 adnexal masses. O-RADS MRI 4 lesions may be sub-stratified (high vs low risk) based on solid tissue characteristics and CA-125 levels.

Identifying Serum Small Extracellular Vesicle MicroRNA as a Noninvasive Diagnostic and Prognostic Biomarker for Ovarian Cancer.

There remains a lack of effective and noninvasive methods for the diagnosis and prognosis prediction of epithelial ovarian carcinoma (EOC). Here, we investigated the possibility of serum-derived small extracellular vesicle (sEV) microRNAs (miRNAs) as potential biomarkers for distinguishing between benign and malignant adnexal masses and predicting the prognosis of EOC patients. A serum sEV miRNA model for identifying the EOC (sEVmiR-EOC) was successfully established in the training cohort. Furthermore, the sEVmiR-EOC model was confirmed in the testing cohort and validation cohort, demonstrating robust diagnostic accuracy. The sEVmiR-EOC model showed better performance than carbohydrate antigen 125 (CA125) in discriminating patients with stage I EOC from benign patients. Using EOC samples and follow-up data, we identified miR-141-3p and miR-200c-3p as potential prognostic predictors. Finally, we confirmed the change of the sEVmiR-EOC RiskScore between the preoperative and postoperative samples and found that the sEVmiR-EOC model could predict the prognosis of EOC patients.

Evaluation of Human Epididymis Protein 4, Risk of Ovarian Malignancy Algorithm, and Risk of Malignancy Index Efficiency for Ameliorating Sensitivity and Specificity for Differentiating Benign from Malignant Adnexal Masses

Abstract Background Inadequacy of effective sensitive and specific screening modalities results in late-stage diagnosis of ovarian cancer. Cancer Antigen-125 (CA-125) individually possesses limited specificity for differentiating adnexal masses. The present study aimed to evaluate the Human Epididymis Protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA), and Risk of Malignancy Index (RMI) for ameliorating sensitivity and specificity for differentiating benign from malignant adnexal masses. Materials and Methods This study was conducted on 96 preoperative women with suspected adnexal mass (patients) and 48 healthy females without adnexal mass (controls) for the duration of 2 years. Both study participants were divided into two groups, pre- and postmenopausal. CA-125 and HE4 were done using commercially available kits. ROMA% and RMI were calculated. We validated their performances using histopathology as the gold standard. The statistical analysis was done using SPSS 21, Kruskal–Wallis, and Tukey's tests. The best cutoff points to best values of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also evaluated. Results For differentiating benign from malignant masses in the premenopausal group, the sensitivity, specificity, PPV, NPV, and area under the curve (AUC) were 93.7%, 78.3%, 65.2%, 96.6%, 0.892 for CA-125; 87.5%, 83.7%, 70%, 93.9%, 0.926 for HE4; 93.7%, 70.2%, 57.6%, 96.2%, 0.927 for ROMA; and 68.7%, 86.4%, 68.7%, 86.5%, 0.916 for RMI. While in the postmenopausal group, the sensitivity, specificity, PPV, NPV, and AUC were 92.3%, 76.4%, 85.7%, 86.6%, 0.907 for CA-125; 78.5%, 94%, 95.6%, 80%, 0.955 for HE4; 92.3%, 94.1%, 96%, 88.8%, 0.968 for ROMA; and 88.4%, 88.2%, 92%, 83.3%, 0.943 for RMI. Conclusion For differentiating benign from malignant masses more specifically in women with a suspected adnexal mass, ROMA and HE4 appear to be more effective than CA-125.

Seromucinous carcinoma of ovary - A rare entity

Ovarian epithelial tumours are common tumors of female genital tract and they account for vast majority of female ovarian neoplasms. ovarian seromucinous carcinomas (OSMC) are rare ovarian tumours containing serous and endocervical mucinous type cells. In 2020, World Health Organization Classification of Female Genital Tumors recategorized seromucinous ovarian carcinomas as ovarian endometrioid carcinoma with mucinous differentiation. Most OSMC present in stage I or II and have a favourable prognosis.We present the case of a 30-year-old female who presented with complaints of lower abdominal pain and abdominal distension. Contrast enhanced computed tomography of abdomen suggested a left sided malignant adnexal mass following which Left sided salpingo-oophorectomy was performed and histopathological examination and immunohistochemistry of specimen was done and a diagnosis of left ovarian seromucinous carcinoma was rendered.

Simple rules, O-RADS, ADNEX and SRR model: Single oncologic center validation of diagnostic predictive models alone and combined (two-step strategy) to estimate the risk of malignancy in adnexal masses and ovarian tumors

ObjectiveTo compare performance of Assessment of Different NEoplasias in the adneXa (ADNEX model), Ovarian-Adnexal Reporting and Data System (O-RADS), Simple Rules Risk (SRR) assessment and the two-step strategy based on the application of Simple Rules (SR) followed by SRR and SR followed by ADNEX in the pre-operative discrimination between benign and malignant adnexal masses (AMs). MethodsWe conducted a retrospective study from January-2018 to December-2021 in which consecutive patients with at AMs were recruited. Accuracy metrics included sensitivity (SE) and specificity (SP) with their 95% confidence intervals (CI) were calculated for ADNEX, O-RADS and SRR. When SR was inconclusive a “two-step strategy” was adopted applying SR + ADNEX model and SR + SRR assessment. ResultsA total of 514 women were included, 400 (77.8%) had a benign ovarian tumor and 114 (22.2%) had a malignant tumor. At a threshold malignancy risk of >10%, the SE and SP of ADNEX model, O-RADS and SRR were: 0.92 (95% CI, 0.86–0.96) and 0.88 (95% CI, 0.85–0.91); 0.93 (95% CI, 0.87–0.97) and 0.89 (95% CI, 0.96–0.92); 0.88 (95% CI, 0.80–0.93) and 0.84 (95% CI, 0.80–0.87), respectively. When we applied SR, 109 (21.2%) cases resulted inconclusive. The SE and SP of two-step strategy SR + SRR assessment and SR + ADNEX model were 0.88 (95% CI, 0.80–0.93) and 0.92 (95% CI, 0.89–0.94), SR + ADNEX model 0.90 (95% CI, 0.83–0.95) and 0.93 (95% CI, 0.90–0.96), respectively. ConclusionsO-RADS presented the highest SE, similar to ADNEX model and SR + ADNEX model. However, the SR + ADNEX model presented the higher performance accuracy with the higher SP and PPV. This two-step strategy, SR and ADNEX model applicated to inconclusive SR, is convenient for clinical evaluation.

Pre-Operative Evaluation of Color Doppler Ultrasonography to Predict Malignancy in Ovarian Masses at Ain-Shams University

Background Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries. This cancer is characterized by high malignancy, difficult early detection, low survival rate, and high fatality rate. Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass. Aim of the Work The aim of the study is to determine predictive value of pre-operative resistance index (RI) of color Doppler of ovarian vessels in identifying potential ovarian malignancy at Ain Shams maternity hospital between May 2015 and May 2020. Methods this retrospective observational study, was done on total 379 patients who underwent laparotomy for adnexal masses at Ain Shams University hospitals over five years period between May 2015 and May 2020 with inclusion and exclusion criteria. Medical records of the study population were revised to assess demographic data, ultrasound criteria and histopathological result Results Thin wall and clear content are negatively correlated with ovarian malignancy and these correlators statistically significant. While presence of papillae and septation are positively correlated with ovarian malignancy and these findings were statistically highly significant. Masses proved to be ovarian malignancy were mostly unilateral, more than 5 cm size, thick wall, with turbid content, solid consistency, unilocular with papillae and septation. RI in our study was lower in malignant lesions ranging between (0.22–0.60) and the Mean±SD of resistance index values in the ovarian cancer (0.48±0.07). Resistance index at cut off value ≤0.54 had high specificity and negative predictive value but moderate sensitivity and positive predictive value in diagnosing ovarian malignancy. Conclusion As evident from the current study, thick wall, turbid content, solid consistency, papillae and septations were significantly most frequent in ovarian cancer. Resistance index was significantly highest in ovarian malignancy. In current study RI was lower in malignant lesions. From the results of current study we can conclude that the pre-operative resistance index (RI) of color Doppler of ovarian vessels had significant high diagnostic performance in predicting ovarian cancer. Resistance index at cut off value≤0.54 in diagnosis of ovarian cancer has sensitivity (85.2%), specificity (91.6%), accuracy (90.2%), positive predictive value (73.4%) and negative predictive value (95.8%).

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience

ObjectiveThe objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. MethodsA cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. ResultsOut of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%). ConclusionsThe IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.

O-RADS MRI SCORE: An Essential First-Step Tool for the Characterization of Adnexal Masses.

The ovarian-adnexal reporting and data system on magnetic resonance imaging (O-RADS MRI) score is now a well-established tool to characterize pelvic gynecological masses based on their likelihood of malignancy. The main added value of O-RADS MRI over O-RADS US is to correctly reclassify lesions that were considered suspicious on US as benign on MRI. The crucial issue when characterizing an adnexal mass is to determine the presence/absence of solid tissue and thus need to perform gadolinium injection. O-RADS MR score was built on a multivariate analysis and must be applied as a step-by-step analysis: 1) Is the mass an adnexal mass? 2) Is there an associated peritoneal carcinomatosis? 3) Is there any significant amount of fatty content? 4) Is there any wall enhancement? 5) Is there any internal enhancement? 6) When an internal enhancement is detected, does the internal enhancement correspond to solid tissue or not? 7) Is the solid tissue malignant? With its high value to distinguish benign from malignant adnexal masses and its high reproducibility, the O-RADS MRI score could be a valuable tool for timely referral of a patient to an expert center for the treatment of ovarian cancers. Finally, to make a precise diagnosis allowing optimal personalized treatment, the radiologist in gynecological imaging will combine the O-RADS MRI score with many other clinical, biological, and other MR criteria to suggest a pathological hypothesis. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.

Comparison of International Ovarian Tumor Analysis Simple Rules with Risk of Malignancy Index for Preoperative Differentiation of Benign and Malignant Adnexal Masses

Comparison of International Ovarian Tumor Analysis Simple Rules with Risk of Malignancy Index for Preoperative Differentiation of Benign and Malignant Adnexal Masses

Magnetic Resonance Imaging in the Diagnosis of Female Adnexal Masses: Comparison With Histopathological Examination.

Introduction Adnexal masses present a special diagnostic challenge because it is difficult to differentiate between benign and malignant lesions clinically. The diagnosis of malignancy is vital, and imaging is the most important part of the evaluation of adnexal masses. This study was conducted with the goal of comparing the accuracy of magnetic resonance imaging (MRI) in diagnosing female adnexal masses in comparison with histopathology examination (HPE). A total of 70 female patients with suspected adnexal lesions were selected for the study. After obtaining informed consent from the patients, an MRI was performed with a subsequent histopathological examination of the lesion. Results The study revealed that MRI demonstrated 27% non-neoplastic, 47% benign, and 26% malignant lesions. HPE, the gold standard for identifying and classifying pathological masses, positively identified the lesions and classified them as non-neoplastic, surface epithelial-stromal, germ cell, and sex cord-stromal tumors. The present study of 70 cases with adnexal masses showed a strong positive correlation between MRI and HPE findings. Conclusion MRI provides the added advantage of visualization of the tumor matrix with differential identification of the fatty and cystic tissue through heterogeneous signals and enhancement indicating aggressiveness and local spread. MRI has greater diagnostic accuracy when compared to ultrasonography (USG), with HPE as the gold standard for discriminating between benign and malignant adnexal masses.

Ultrasound Features and Ultrasound Scores in the Differentiation between Benign and Malignant Adnexal Masses

Background: Several ultrasound (US) features help ultrasound experts in the classification of benign vs. malignant adnexal masses. US scores serve in this differentiation, but they all have misdiagnoses. The main objective of this study is to evaluate what ultrasound characteristics are associated with malignancy influencing ultrasound scores. Methods: This is a retrospective analysis of ultrasound features of adnexal lesions of women managed surgically. Ultrasound characteristics were analyzed, and masses were classified by subjective assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA Simple Rules Risk Assessment SRRA, ADNEX model, and O-RADS). Results: Of a total of 187 adnexal masses studied, 134 were benign (71.7%) and 53 were malignant (28.3%). SA, IOTA SRRA, ADNEX model with or without CA125 and O-RADS had high levels of sensitivity (93.9%, 81.1%, 94.3%, 88.7%, 98.1%) but lower specificity (80.2%, 82.1%, 82.8%, 77.6%, 73.1%) with similar AUC (0.87, 0.87, 0.92, 0.90, 0.86). Ultrasound features significantly related with malignancy were the presence of irregular contour, absence of acoustic shadowing, vascularized solid areas, ≥1 papillae, vascularized septum, and moderate-severe ascites. Conclusion: IOTA SRRA, ADNEX model, and O-RADS can help in the classification of benign and malignant masses. Certain ultrasound characteristics studied in ultrasound scores are associated with malignancy.

Diagnostic performance of IOTA SR and O-RADS combined with CA125, HE4, and risk of malignancy algorithm to distinguish benign and malignant adnexal masses

PurposeTo compare the diagnostic performance of International Ovarian Tumour Analysis Simple Rules (IOTA SR) and Ovarian-Adnexal Reporting and Data System (O-RADS), and to analyse whether combining IOTA SR and O-RADS with the biomarkers cancer antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of malignancy algorithm (ROMA) further improves diagnostic performance in women with different menopause status. MethodsThis study retrospectively included patients with ovarian adnexal masses confirmed by surgical pathology between September 2021 and February 2022. The area under the curve (AUC), sensitivity, and specificity were calculated to evaluate the diagnostic efficacy of IOTA SR, O-RADS, and their combination with CA125, HE4, and ROMA. ResultsThis study included 1,179 ovarian adnexal masses. In all women, the AUC of IOTA SR was comparable to O-RADS (0.879 vs. 0.889, P = 0.361), and O-RADS had a significantly higher sensitivity than IOTA SR (95.77 % vs. 87.32 %, P < 0.001). In premenopausal women, O-RADS had a significantly higher AUC than other diagnostic strategies (all P < 0.05), and the sensitivity, specificity, and accuracy were 93.33 %, 84.74 %, and 85.59 %, respectively. In postmenopausal women, IOTA SR + ROMA had a significantly higher AUC than other diagnostic strategies (all P < 0.05), and the sensitivity, specificity, and accuracy were 85.37 %, 93.88 %, and 90.00 %, respectively. ConclusionsOur study supports the high diagnostic value of IOTA SR or O-RADS alone in all women, and O-RADS was more sensitive than IOTA SR. In premenopausal women, O-RADS had the highest diagnostic value. In postmenopausal women, IOTA SR outperformed O-RADS, and IOTA SR + ROMA had the highest diagnostic value.

Assessment of risk of malignancy index scoring and histopathological correlation in the diagnosis and management of adnexal mass

: Pathologies of adnexal masses are commonly benign. The malignant lesions of adnexa carries a very low five-year survival rate, and hence the early recognition need to be done. There is no single gold standard investigation for the diagnosis of the malignancy of the adnexa. Risk of Malignancy Index (RMI) scoring system, combines the Serum CA 125(U/ML), Ultrasound score (U) and the menopausal status(M).: To assess the efficiency of Risk of Malignancy Index-3 (RMI-3) scoring system in discriminating benign and malignant adnexal mass, for early detection and management of malignant ovarian mass.: This is a prospective, observational study, among 50 female patients above the age of 25 years, diagnosed with adnexal mass under the Department of obstetrics and gynaecology, Government Rajaji Hospital, affiliated to Madurai Medical College, Madurai.All the study participants were subjected to detailed history taking, thorough clinical examination, ultrasonogram of abdomen and pelvis, and markers such as CA 125. Risk of Malignancy Index was calculated and correlated with the histopathological (HPE) findings of the excised tumours. : When the cut off of RMI score for predicting malignancy is 149.2 which had a sensitivity of 79.2%, specificity of 92.3%, positive predictive value of 90.47%, negative predictive value of 82.78% and a diagnostic accuracy of 86.01%.: Risk of Malignancy Index score is a simple tool, with a good diagnostic accuracy, hence it can be used as good screening tool for identification of the malignant lesions from the adnexal mass.

Comparison of ultrasound-based ADNEX model with magnetic resonance imaging for discriminating adnexal masses: a multi-center study.

The ADNEX model offered a good diagnostic performance for discriminating adnexal tumors, but research comparing the abilities of the ADNEX model and MRI for characterizing adnexal tumors has not been reported to our knowledge. The aim of this study was to evaluate the diagnostic accuracy of the ultrasound-based ADNEX (Assessment of Different NEoplasias in the adneXa) model in comparison with that of magnetic resonance imaging (MRI) for differentiating benign, borderline and malignant adnexal masses. This prospective study included 529 women with adnexal masses who underwent assessment via the ADNEX model and subjective MRI analysis before surgical treatment between October 2019 and April 2022 at two hospitals. Postoperative histological diagnosis was considered the gold standard. Among the 529 women, 92 (17.4%) masses were diagnosed histologically as malignant tumors, 67 (12.7%) as borderline tumors, and 370 (69.9%) as benign tumors. For the diagnosis of malignancy, including borderline tumors, overall agreement between the ADNEX model and MRI pre-operation was 84.9%. The sensitivity of the ADNEX model of 0.91 (95% confidence interval [CI]: 0.85-0.95) was similar to that of MRI (0.89, 95% CI: 0.84-0.94; P=0.717). However, the ADNEX model had a higher specificity (0.90, 95% CI: 0.87-0.93) than MRI (0.81, 95% CI: 0.77-0.85; P=0.001). The greatest sensitivity (0.96, 95% CI: 0.92-0.99) and specificity (0.94, 95% CI: 0.91-0.96) were achieved by combining the ADNEX model and subjective MRI assessment. While the total diagnostic accuracy did not differ significantly between the two methods (P=0.059), the ADNEX model showed greater diagnostic accuracy for borderline tumors (P<0.001). The ultrasound-based ADNEX model demonstrated excellent diagnostic performance for adnexal tumors, especially borderline tumors, compared with MRI. Accordingly, we recommend that the ADNEX model, alone or with subjective MRI assessment, should be used for pre-operative assessment of adnexal masses.