Top

Archives of Gynecology and Obstetrics

Published in:

01-03-2014 | General Gynecology

Computed tomography adnexal mass score to estimate risk for ovarian cancer

Authors: Joseph T. Santoso, Aimee Robinson, Sri Suganda, Sirinya Praservit, Jim Y. Wan, Fred Ueland

Published in: Archives of Gynecology and Obstetrics | Issue 3/2014

Abstract

Objective

We wish to develop a CT scan-based scoring system which estimates the probability of adnexal mass malignancy.

Methods

Patients (324) undergoing adnexal mass surgery were recruited into the study from June 1, 2002, to January 1, 2009. All study patients had a preoperative CT scan and serum CA-125 test. CT scan abnormalities included any solid tumor components, ascites, and pelvic or abdominal lymphadenopathy and omental caking.

Results

There were 225 (70 %) benign and 99 (30 %) malignant ovarian masses. Using logistic regression with the area under the curve of the receiver operating curve of 82 %, the cancer probability was determined by the equation.

$$ \frac{{{\text{e}}^{{ - 3. 6 3 7 2 { } + \, 0.0 30 6 { }* \, \left( {\text{A}} \right) \, + \, 0.00 1 { }* \, \left( {\text{B}} \right) \, + \, 0.{ 876 }* \, \left( {\text{C}} \right) + 1. 5 5 1 { }* \, \left( {\text{D}} \right) \, + { 1}. 7 3 7 7 { }* \, \left( {\text{E}} \right) \, + { 2}. 7 6 { }* \, \left( {\text{F}} \right)}} }}{{ 1+ {\text{e}}^{{ - 3. 6 3 7 2 { } + \, 0.0 30 6 { }* \, \left( {\text{A}} \right) \, + \, 0.00 1 { }* \, \left( {\text{B}} \right) \, + \, 0. 8 7 6 { }* \, \left( {\text{C}} \right) \, + { 1}. 5 5 1 { }* \, \left( {\text{D}} \right) \, + { 1}. 7 3 7 7 { }* \, \left( {\text{E}} \right) \, + { 2}. 7 6 { }* \, \left( {\text{F}} \right)}} }} $$

where A = age, B = CA-125, C = solid adnexal mass is 1 and cystic is 0, D = ascites is 1, E = omental caking is 1 and absence is 0, F = node size ≥1 cm is 1 and <1 cm is 0 value. The natural logarithm e is a constant [2.718281828]. For example, for a woman of age 60, CA-125 = 50 U/mL, with solid adnexal mass, ascites, omental caking, and lymphadenopathy, the probability is 0.994. Hence, this woman has a 99.4 % probability of having cancer.

Conclusion

The computed tomography adnexal mass score combines CT scan findings, CA-125, and patient age into an equation to predict the malignant probability of an adnexal mass.

Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK [eds]. SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011

Myers ER, Bastian LA, Havrilesky LJ, et al. (2006) Management of adnexal mass. Evidence report/technology assessment no. 130. AHRQ publication 06-E004.2

Ferrazzi E, Zanetta G, Dordoni D, Berlanda N, Mezzopane R, Lissoni AA, Lissoni G (1997) Transvaginal ultrasonographic characterization of ovarian masses. Ultrasound Obstet Gynecol 10(3):192–197PubMedCrossRef

Merz E, Weber G, Bahlmann F, Kiesslich R (1998) A new sonomorphologic scoring system [Mainz Score] for the assessment of ovarian tumors using transvaginal ultrasonography. Part I: a comparison between the scoring-system and the assessment by an experienced sonographer. Ultraschall Med 19(3):99–107PubMedCrossRef

Weber G, Merz E, Bahlmann F, Leber AM (1999) A new sonomorphologic scoring-system [Mainz score] for the assessment of ovarian tumors using transvaginal ultrasonography. Part II: a comparison between the scoring-system and the assessment by an experienced sonographer in postmenopausal women. Ultraschall Med 20(1):2–8PubMedCrossRef

DePriest PD, Shenson D, Fried A, Hunter JE, Andrews SJ, Gallion HH, Pavlik EJ, Kryscio RJ, Jr Van Nagell JR (1993) A morphology index based on sonographic findings in ovarian cancer. Gynecol Oncol 51(1):7–11PubMedCrossRef

Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, Jr Van Nagell JR (2003) Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography. Gynecol Oncol 91(1):46–50PubMedCrossRef

Sawicki W, Spiewankiewicz B, Cendrowski K, Stelmachow J (2001) Preoperative discrimination between malignant and benign adnexal masses with transvaginal ultrasonography and color blood flow imaging. Eur J Gynaecol Oncol 22(2):137–142PubMed

Twickler DM, Forte TB, Santos-Ramos R, McIntire D, Harris P, Scott D (1999) The ovarian tumor index predicts risk for malignancy. Cancer 86(11):2280–2290PubMedCrossRef

10.

Varras M (2004) Benefits and limitations of ultrasonographic evaluation of uterine adnexal lesions in early detection of ovarian cancer. Clin Exp Obstet Gynecol 31(2):85–98PubMed

11.

ACOG practice bulletin no. 83, 2007. Management of adnexal mass

12.

Timmerman D, Ameye L, Fischerova D, Epstein E, Melis GB, Guerriero S, Van Holsbeke C, Savelli L, Fruscio R, Lissoni AA, Testa AC, Veldman J, Vergote I, Van Huffel S, Bourne T, Valentin L (2010) Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery. BMJ 341:c6839PubMedCrossRefPubMedCentral

13.

Buy JN, Ghossain MA, Sciot C, Bazot M, Guinet C, Prévot S, Hugol D, Laromiguiere M, Truc JB, Poitout P (1991) Epithelial tumors of the ovary: CT findings and correlation with US (1991). Radiology 178(3):811–818PubMed

14.

Tempany CM, Zou KH, Ilverman SG, Brown DL, Kurtz AB, McNeil BJ (2000) Staging of advanced ovarian cancer: comparison of imaging modalities–report from the Radiological Diagnostic Oncology Group. Radiology 215(3):761–767PubMedCrossRef

15.

Brooks SE (1994) Preoperative evaluation of patients with suspected ovarian cancer. Gynecol Oncol 55(3 Pt 2):S80–S90PubMedCrossRef

16.

Kawamoto S, Urban BA, Fishman EK (1999) CT scan of epithelial ovarian tumors. Radiographics. 19 Spec No:S85–102; quiz S263–264

17.

Padilla LA, Radosevich DM, Milad MP (2005) Limitation of pelvic exam for evaluation of the female pelvic organs. Int J Gynaecol Obstet 88:84–88PubMedCrossRef

18.

Timmerman D, Van Calster B, Testa AC, Guerriero S, Fischerova D, Lissoni AA, Van Holsbeke C, Fruscio R, Czekierdowski A, Jurkovic D, Savelli L, Vergote I, Bourne T, Van Huffel S, Valentin L (2010) Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol 36(2):226–234PubMedCrossRef

19.

Ware Miller R, Smith A, Desimone CP, Seamon LG, Goodrich S, Podzielinski I, Sokoll L, Jr Van Nagell JR, Ueland FR (2011) Performance of the American College of Obstetrics and Gynecologists’ ovarian tumor referral guidelines with a multivariate index assay. Obstet Gynecol 117(6):1268–1306CrossRef

20.

Ueland FR, Desimone CP, Seamon LG, Miller RA, Goodrich S, Podzielinski I, Sokoll L, Smith A, Jr van Nagell JR (2011) Effectiveness of a multivariate index assay in the preoperative assessment of ovarian tumors. Obstet Gynecol 117(6):1289–1297PubMedCrossRef

21.

Tsili AC, Dalkalitsis N, Paraskevaidis E, Tsampoulas K (2010) Multi-detector CT features of benign adnexal lesions. Acad Radiol 17(1):31–38PubMedCrossRef

22.

Tsili AC, Tsampoulas C, Charisiadi A, Kalef-Ezra J, Dousias V, Paraskevaidis E, Efremidis SC (2008) Adnexal masses: accuracy of detection and differentiation with multidetector computed tomography. Gynecol Oncol 110(1):22–31PubMedCrossRef

23.

Kubik-Huch RA, Dorffler W, von Schulthess GK, Marincek B, Kochli OR, Seifert B, Haller U, Steinert HC (2000) Value of [18F]-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma. Eur Radiol 10(5):761–767PubMedCrossRef

24.

Kormano M, Alanen A, Gronroos M (1984) Predicting malignancy of suspected ovarian tumours by CT. Eur J Radiol 4(1):61–64PubMed

25.

Rohde U, Steinbrich W (1983) Differential diagnosis of ovarian benign and malignant tumors by CT. J Belge Radiol 66(1):9–14PubMed

26.

McDonald JM, Doran S, DeSimone CP, Ueland FR, DePriest PD, Ware RA, Saunders BA, Pavlik E, Goodrich S, Kryscio RJ, van Nagell JR (2000) Predicting risk of malignancy in adnexal masses. Obstet Gynecol 115(4):687–694CrossRef

27.

Im SS, Gordon AN, Buttin BM, Leath CA 3rd, Gostout BS, Shah C, Hatch KD, Wang J, Berman ML (2005) Validation of referral guidelines for women with pelvic masses. Obstet Gynecol 105(1):35–41PubMedCrossRef

Title: Computed tomography adnexal mass score to estimate risk for ovarian cancer
Authors: Joseph T. Santoso
Aimee Robinson
Sri Suganda
Sirinya Praservit
Jim Y. Wan
Fred Ueland
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 3/2014
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-013-3013-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Computed tomography adnexal mass score to estimate risk for ovarian cancer

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2014

Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a randomized controlled trial

Perinatal outcomes of immigrant women of Turkish, Middle Eastern and North African origin in Berlin, Germany: a comparison of two time periods

Triple therapy with Lactobacilli acidophili, estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women

Increased osteopontin expression is associated with progression from vulvar precancerous lesions to vulvar squamous cell carcinoma

Anesthetic considerations for high order cesarean sections: a prospective cohort study

Abdominopelvic tuberculosis mimicking advanced ovarian cancer and pelvic inflammatory disease: a series of 28 female cases