Early-Stage Ovarian Malignancy Score versus Risk of Malignancy Indices: Accuracy and Clinical Utility for Preoperative Diagnosis of Women with Adnexal Masses
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Components | EOM | RMI † | |||
---|---|---|---|---|---|
I | II | III | IV | ||
Menopausal Status | |||||
Pre-menopause | 0 | 1 | 1 | 1 | 1 |
Post-menopause | 7 | 3 | 4 | 3 | 4 |
Ultrasonographic Features | |||||
None | 0 | 0 | 1 | 1 | 1 |
Any 1 feature | 1 | 1 | 1 | 1 | |
Presence of multilocularity | |||||
Presence of solid component | 3 | ||||
Bilateral lesions | |||||
Presence of ascites | 13 | ||||
Presence of intra-abdominal metastases | |||||
≥2 Features | 3 | 4 | 3 | 4 | |
Tumor Size (cm) | |||||
<7 | 1 | ||||
≥7 | 2 | ||||
<9 | 0 | ||||
9–12 | 10 | ||||
>12 | 16 | ||||
Serum CA125 (IU/L) | |||||
<30 | 0 | ||||
30–200 | 1 | ||||
>200 | 12 |
n (%) | |
---|---|
Malignant Tumors (n = 46) | |
Endometrioid carcinoma | 11 (20.4) |
Serous carcinoma | 10 (18.5) |
Mucinous carcinoma | 6 (11.1) |
Adenocarcinoma | 6 (11.1) |
Clear cell carcinoma | 5 (9.3) |
Granulosa cell tumor | 3 (5.6) |
Other rare tumors | 5 (9.3) |
Borderline Tumors (n = 8) | |
Borderline mucinous tumor | 7 (12.9) |
Borderline serous tumor | 1 (1.8) |
Borderline endometrioid tumor | 0 (0) |
Benign Tumors (n = 216) | |
Endometriotic cyst | 77 (35.7) |
Dermoid cyst | 45 (20.8) |
Mucinous cystadenoma | 41 (19.0) |
Serous cystadenoma | 26 (12.0) |
Follicular cyst | 11 (5.1) |
Corpus luteal cyst | 10 (4.6) |
Others rare tumors | 6 (2.8) |
Variables | Early Stage Ovarian Cancer (n = 54) | Benign Ovarian Tumor (n = 216) | p-Value | ||
---|---|---|---|---|---|
n | (%) | n | (%) | ||
Clinical Characteristics | |||||
Age (year) * | 48.7 | ±15.4 | 43.5 | ±12.1 | 0.008 |
Nulliparity | 21 | (38.9) | 69 | (31.9) | 0.337 |
Post-menopause | 28 | (51.9) | 41 | (19.0) | <0.001 |
Ultrasonographic Features | |||||
Maximum tumor diameter (cm) * | 16.4 | ±6.7 | 10.1 | ±5.1 | <0.001 |
Multilocularity | 38 | (70.4) | 145 | (67.1) | 0.745 |
Solid component | 33 | (61.1) | 57 | (26.4) | <0.001 |
Bilateral lesions | 5 | (9.3) | 43 | (19.9) | 0.075 |
Ascites | 11 | (20.4) | 2 | (0.9) | <0.001 |
Intra-abdominal metastases | 2 | (3.7) | 1 | (0.5) | 0.103 |
Tumor Marker | |||||
Serum CA125 (IU/L) ** | 102.8 | 25.0, 314.0 | 30.8 | 14.8, 81.1 | <0.001 |
Scores | Cutoff | Early Stage Ovarian Cancer (n = 54) | Benign Ovarian Tumor (n = 216) | Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | PPV (%) (95% CI) | NPV (%) (95% CI) | LR+ (95% CI) | ||
---|---|---|---|---|---|---|---|---|---|---|
n | (row%) | n | (row%) | |||||||
EOM | ≥15 | 51 | (40.8) | 74 | (59.2) | 94.4 (84.6–98.8) | 65.7 (59.0–72.0) | 40.8 (32.1–49.9) | 97.9 (94.1–99.6) | 2.76 (1.68–4.50) |
<15 | 3 | (2.1) | 142 | (97.9) | ||||||
≥30 | 21 | (95.5) | 1 | (4.6) | 38.9 (25.9–53.1) | 99.5 (97.4–100.0) | 95.5 (77.2–99.9) | 86.7 (81.8–90.7) | 84.0 (12.73, 3488.41) | |
<30 | 33 | (13.3) | 215 | (86.7) | ||||||
RMI I | ≥200 | 31 | (47.0) | 35 | (53.0) | 57.4 (43.2–70.8) | 83.8 (78.2–88.4) | 47.0 (34.6–59.7) | 88.7 (83.6–92.7) | 3.54 (1.92–6.49) |
<200 | 23 | (11.3) | 181 | (88.7) | ||||||
RMI II | ≥200 | 36 | (44.4) | 45 | (55.6) | 66.7 (52.5–78.9) | 79.2 (73.1–84.4) | 44.4 (33.4–55.9) | 90.5 (85.4–94.3) | 3.20 (1.81–5.61) |
<200 | 18 | (9.5) | 171 | (90.5) | ||||||
RMI III | ≥200 | 34 | (47.2) | 38 | (52.8) | 63.0 (48.7–75.7) | 82.4 (76.7–87.2) | 47.2 (35.3–59.3) | 89.9 (84.8–93.7) | 3.58 (1.98–6.43) |
<200 | 20 | (10.1) | 178 | (89.9) | ||||||
RMI IV | ≥450 | 33 | (50.0) | 33 | (50.0) | 61.1 (46.9–74.1) | 84.7 (79.2–89.2) | 50.0 (37.4–62.6) | 89.7 (84.7–93.5) | 4.00 (2.17–7.32) |
<450 | 21 | (10.3) | 183 | (89.7) |
Threshold Probability | Net Benefit (Proportion of Net True Positive) | Reduced Numbers of Inappropriate Referrals per 100 Patients | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Refer all | EOM | RMI I | RMI II | RMI III | RMI IV | EOM | RMI I | RMI II | RMI III | RMI IV | |
5% | 0.157 | 0.174 | 0.108 | 0.125 | 0.119 | 0.116 | 31.482 | −94.815 | −63.333 | −74.815 | −80.000 |
10% | 0.111 | 0.158 | 0.100 | 0.115 | 0.110 | 0.109 | 42.593 | −9.630 | 3.333 | −0.741 | −2.222 |
15% | 0.059 | 0.141 | 0.092 | 0.104 | 0.101 | 0.101 | 46.296 | 18.765 | 25.556 | 23.951 | 23.704 |
20% | 0 | 0.120 | 0.082 | 0.092 | 0.091 | 0.092 | 48.148 | 32.963 | 36.667 | 36.296 | 36.667 |
25% | −0.067 | 0.098 | 0.072 | 0.078 | 0.079 | 0.081 | 49.259 | 41.481 | 43.333 | 43.704 | 44.445 |
30% | −0.143 | 0.071 | 0.059 | 0.062 | 0.066 | 0.070 | 50.000 | 47.160 | 47.778 | 48.642 | 49.630 |
35% | −0.231 | 0.041 | 0.045 | 0.044 | 0.050 | 0.056 | 50.529 | 51.217 | 50.952 | 52.169 | 53.333 |
40% | −0.333 | 0.006 | 0.028 | 0.022 | 0.032 | 0.041 | 50.926 | 54.259 | 53.333 | 54.815 | 56.111 |
45% | −0.455 | −0.035 | 0.009 | −0.003 | 0.011 | 0.022 | 51.235 | 56.626 | 55.185 | 56.872 | 58.272 |
50% | −0.600 | −0.085 | −0.015 | −0.033 | −0.015 | 0 | 51.481 | 58.519 | 56.667 | 58.519 | 60.000 |
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Phinyo, P.; Patumanond, J.; Saenrungmuaeng, P.; Chirdchim, W.; Pipanmekaporn, T.; Tantraworasin, A.; Tongsong, T.; Tantipalakorn, C. Early-Stage Ovarian Malignancy Score versus Risk of Malignancy Indices: Accuracy and Clinical Utility for Preoperative Diagnosis of Women with Adnexal Masses. Medicina 2020, 56, 702. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120702
Phinyo P, Patumanond J, Saenrungmuaeng P, Chirdchim W, Pipanmekaporn T, Tantraworasin A, Tongsong T, Tantipalakorn C. Early-Stage Ovarian Malignancy Score versus Risk of Malignancy Indices: Accuracy and Clinical Utility for Preoperative Diagnosis of Women with Adnexal Masses. Medicina. 2020; 56(12):702. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120702
Chicago/Turabian StylePhinyo, Phichayut, Jayanton Patumanond, Panprapha Saenrungmuaeng, Watcharin Chirdchim, Tanyong Pipanmekaporn, Apichat Tantraworasin, Theera Tongsong, and Charuwan Tantipalakorn. 2020. "Early-Stage Ovarian Malignancy Score versus Risk of Malignancy Indices: Accuracy and Clinical Utility for Preoperative Diagnosis of Women with Adnexal Masses" Medicina 56, no. 12: 702. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120702