Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması

Year 2018, , 0 - 0, 15.12.2018

Kemal Sandal , Mesut Polat , Murat Yassa , Taner Günay , Gamze Erdem Kadir Güzin

https://doi.org/10.16948/zktipb.445755

Cited By: 2

Abstract

ÖZET

Giriş ve Amaç

Adneksiyal kitlelerin preoperatif olarak malignite riskinin değerlendirilmesi,
operasyonun yapılacağı merkeze ve ekibe karar verilmesi açısından önem
arzetmektedir. Bu durum hastanın postoperatif prognozu ile doğrudan
ilişkilidir. Bu çalışmada adneksiyal kitlelerin preoperatif değerlendirmesinde
mevcut olan malignite riski belirleme modellerinden Risk of Malignancy
İndex(RMI) versiyonlarının ve Assessment of Different
Neoplasias in the Adnexa  (ADNEX) modelinin malignite öngörüsündeki başarı oranlarının incelenmesi
amaçlanmıştır.

Materyal ve
Metod

Tersiyer eğitim araştırma hastanesinde Eylül 2014-Haziran
2016 tarihleri arasında adneksiyel kitle nedeniyle opere tüm hastalar
retrospektif olarak değerlendirildi, ultrasonografi, klinik bilgi ve Ca 125
verileri ile RMI I-II-III-IV skorları ve ADNEX model malignite risk yüzdeleri
hesaplandı, sonuçlar patolojik tanılar ile değerlendirildi.

Bulgular

191 vakanın verileri
değerlendirildiğinde RMI I (>200) duyarlılık %66 özgüllük %88.4 PPV %68.6,
NPV %87.1, RMI II (>200) duyarlılık %75.5, özgüllük %78.3, PPV %57.1,
NPV%89.3, RMI III(>200) duyarlılık 
%66, özgüllük %88.4, PPV %68.6, NPV %87.1, RMI IV(>450)
duyarlılık  %67.9, özgüllük %90.6, PPV
%73.5, NPV %88 olarak izlendi. ADNEX
model için çalışmada 3 farklı malignite sınır değeri uygulanmıştır. Malignite
riskinde %5’lik sınır değer kullanıldığında duyarlılık %98.1, özgüllük %46.4,
PPV %41.3, NPV%98.5, %10’luk sınır değer kullanıldığında duyarlılık %94,3,
özgüllük %63, PPV %49,5, NPV%96,7, %15’lik sınır değer kullanıldığında
duyarlılık %94,3, özgüllük %72,5, PPV %56,8 NPV%97,1 olarak saptandı.

Sonuç

ADNEX modeli duyarlılık ve özgüllük sonuçları literatür ile
benzer olarak izlenmiştir. RMI versiyonlarının sonuçları literatürle
karşılaştırıldığında duyarlılık açısından literatüre göre daha düşük, özgüllük
verileri literatür ile benzer izlenmiştir. Duyarlılık sonuçlarında ADNEX
modeli RMI versiyonlarına göre oldukça yüksek değerlere ulaşmakla birlikte
özgüllük açısından daha kısıtlı olduğu izlenmiştir. Sonuçların doğrulanması
için longitudinal çalışmalara ihtiyaç vardır.

Keywords

Adneksiyal Kitle, RMI, ADNEX

Comparision of Risk Of Malignancy Indices and Assesment of Different Neoplasias in the Adnexa ( ADNEX) Model as preoperative malignancy evaluation methods for adnexal masses

Abstract

Aim

 Preoperative
evaluation of adnexial masses is crucial for decision processes of preoperative
preparation. It is also directly related to prognosis. In this study, we
aimed to evaluate the performances of versions of Risk of Malignancy Index
(RMI) and Assesment of Different Neoplasias in the Adnexa (ADNEX) model for
diagnosis of malignancy.

Matherials and Method

We retrospectively
evaluated patients who applied with adnexial mass to our tertiary gynecolocial
center between 1st of September, 2014 and 30th of July, 2016.

Of 206 patients, 15
were excluded due to missing CA 125 and ultrasonograpic measurement and
recurrent ovarian cancer diagnoses.

191 patients were
included into the study. Demographic, ultrasonographic data and CA-125 values
were all recorded and RMI I to IV scores and malignancy risk percents for ADNEX
model were calculated. Three cut-off values for malignancy probabilites (5%,
10%, and 15%) were applied for ADNEX model. Results
were compared to postoperative pathological diagnoses.

FINDINGS. Sensitivity (SEN), specifity (SPE), positive
predictive value (PPV), and negative predictive value (NPV) were 66%, 88.4%,
68.6%, and 87.1% for RMI I, 75.5%, 78.3%, 57.1%, and 89.3% for RMI II, 66%,
88.4%, 68.6%, and 87.1% for RMI III, and 67.9%, 90.6%, 73.5 and 88% for RMI IV.
For ADNEX model, SEN, SPE, PPV, and NPV values were 98.1%, 46.4%, 41.3%, and
98.5% for cut-off value of 5%, 94.3%, 63%, 49,5%, and 96.7% for cut-off value
of 10%, and 94.3%, 72.5%, 56.8%, and 97.1% for cut-off value of 15%.

CONCLUSION. Results of versions of RMI
were similar to those in the literature in terms of specifity, but lower in
terms of sensitivity. Sensitivity and specifity values for ADNEX model were
similar to those of the literature. Although sensitivity of ADNEX model were
higher than those of versions of RMI, specifity values were lower. Future
prospective studies could be performed to evaluate diagnostic perfomances of
those indices and to develop newer indices in terms of better SEN and SPE. 

Keywords

Adnexal mass, RMI, ADNEX

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