• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Could Existing Ultrasound Predictive Models be Used to Better Predict Ovarian Cancer? 

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Screening for ovarian cancer in asymptomatic, low risk women is not recommended
  • However, research continues on predictive models, particularly how to assess ultrasound images in the presence of an adnexal mass
  • The IOTA group, founded in 1999, is a network of approximately 50 multidisciplinary centers, worldwide with aims that include
    • Standardize terminology, definitions and measurements to describe sonographic features of adnexal masses
    • Research that focus on the development of predictive models to estimate the risk of ovarian malignancy when an adnexal mass is present
  • Abramowicz et al. (AJOG, 2017) reviewed the performance characteristics of two new ultrasound-based scoring systems
    • Simple Rules
    • Assessment of Different NEoplasias in the adnexa (ADNEX)

METHODS:

  • Large patient cohort studies, recruited from multiple participating centers
  • Mathematical modeling, based on logistic regression

Simple Rules

  • Interpretation
    • B= benign, M= Malignant
    • If ≥1 M features present, absence of B features= tumor is malignant
    • If ≥1 B features present, absence of M features= tumor is benign
    • If both B and M features present = inconclusive
  • Benign features
    • Unilocular cyst
    • Solid component <7 mm in diameter
    • Presence of acoustic shadows
    • Smooth multilocular tumor with largest diameter <10cm
    • No detectable color Doppler signal
  • Malignant features
    • Irregular solid tumor
    • Ascites
    • ≥4 papillary structures
    • Irregular multilocular mass >10 cm in diameter
    • Strong color Doppler signal

ADNEX:

  • A model capable of estimating the risk that an adnexal tumor is benign, borderline, early stage malignant (stage 1), late stage malignant (stage II-IV), or metastatic
  • ADNEX model Criteria:
    • Age
    • Serum CA125 (software still calculates risk even if no CA- 125 value is available)
    • Type of center (oncology referral center or general hospital)
    • Maximum diameter of lesion (mm)
    • Proportion of solid tissue (largest solid component diameter divided by maximum lesion diameter)
    • Presence of more than 10 cyst locules (yes/no)
    • Number of intracavitary papillary projections (0,1,2,3,>3)
    • Presence of acoustic shadows (yes/no)
    • Presence of ascites (yes/no)

RESULTS:

  • Simple Rules
    • In meta-analysis, sensitivity and specificity were 93% and 81% respectively when inconclusives were considered malignant
    • Negative predictive value is 94.9% if result followed up with expert opinion
    • Model prospectively validated
    • Simple Rules performance was similar even with different levels of ultrasound experience
  • ADNEX
    • Results based on clinical and ultrasound data from almost 6000 women
    • Model clinically validated
    • Sensitivity and specificity were 96.5% and 71.3% respectively
    • ROC curve AUC was 0.94
  • Simple rules and ADNEX model are validated, good predictive tests for the preoperative classification of adnexal tumors

CONCLUSION:

  • Purpose of Simple Rules and ADNEX is to help improve triage and provide more educated decisions regarding management and referral to gyn oncologists in the presence of an adnexal mass
    • Improved outcomes when malignant tumors are managed by gyn oncologists
  • ACOG/SGO committee opinion states that
    • Sensitivity and specificity of 86% and 99% respectively for malignancy can be expected when the sonographic evaluation of an adnexal mass includes
      • Tumor size
      • Morphology
      • Wall characteristics
      • Presence of septae
    • Referral to a gyn oncology is recommended when one suspects malignancy
      • Postmenopause: Elevated CA125 or presence of ascites, nodular or fixed pelvic mass or evidence of abdominal or distant metastasis
      • Premenopause: Very elevated CA125, ascites or evidence of abdominal or distant metastasis
    • The authors conclude that Simple Rules or ADNEX would yield better results in discriminating benign from malignant adnexal masses
    • Models are simple but not yet used in the US
      • Litigation concerns result in active management of adnexal masses
      • Simple Rules and ADNEX are not yet validated in the USA
    • The study suggests the models should be validated in the US and introduced into medical practice

Learn More – Primary Sources:

Ovarian mass-differentiating benign from malignant. The value of the International Ovarian Tumor Analysis (IOTA) ultrasound rules

Simple Rules model available at: http://www.iotagroup.org/simplerules/

ADNEX software available at: http://www.iotagroup.org/adnexmodel/site%20iota.html

image_pdfFavoriteLoadingFavorite

< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Evaluation of the Adnexal Mass
Screening for Ovarian Cancer – Fantasy or Reality?
Obstetrics Critical Care Course
USPSTF Releases Final Recommendation On Ovarian Cancer Screening
BRCA1 & BRCA2 Mutations: What Are the Risks for Developing Breast and Ovarian Cancer?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site