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

Year 2018, Volume: 49 Issue: 4, 0 - 0, 15.12.2018
https://doi.org/10.16948/zktipb.445755

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.



References

  • 1. National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol, 1994. 55(3 Pt 2): p. S4-14.
  • 2. Jacobs, I., et al., A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. BJOG: An International Journal of Obstetrics & Gynaecology, 1990. 97(10): p. 922-929.
  • 3. Tingulstad, S., et al., Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre‐operative diagnosis of pelvic masses. BJOG: An International Journal of Obstetrics & Gynaecology, 1996. 103(8): p. 826-831.
  • 4. Tingulstad, S., et al., THE RISK‐OF‐MALIGNANCY INDEX TO EVALUATE POTENTIAL OVARIAN CANCERS IN LOCAL HOSPITALS. Obstetrics & Gynecology, 1999. 93(3): p. 448-452
  • 5. Yamamoto, Y., et al., Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2009. 144(2): p. 163-167.
  • 6. Van Calster, B., et al., Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ, 2014. 349: p. g5920.
  • 7. Morgan, R.J., et al., Ovarian cancer, version 1.2016, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 2016. 14(9): p. 1134-1163.
  • 8. Bristow, R.E., et al., Adherence to treatment guidelines for ovarian cancer as a measure of quality care. Obstetrics & Gynecology, 2013. 121(6): p. 1226-1234.
  • 9. Obstetricians, A.C.o. and Gynecologists, Committee Opinion No. 477. The role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol, 2011. 117: p. 742-746.
  • 10. Manjunath, A., K. Sujatha, and R. Vani, Comparison of three risk of malignancy indices in evaluation of pelvic masses. Gynecologic oncology, 2001. 81(2): p. 225-229.
  • 11. Ma, S., K. Shen, and J. Lang, A risk of malignancy index in preoperative diagnosis of ovarian cancer. Chinese medical journal, 2003. 116(3): p. 396-399.
  • 12. Geomini, P., et al., The accuracy of risk scores in predicting ovarian malignancy: a systematic review. Obstetrics & Gynecology, 2009. 113(2, Part 1): p. 384-394.
  • 13. Van den Akker, P.A., et al., External validation of the adapted Risk of Malignancy Index incorporating tumor size in the preoperative evaluation of adnexal masses. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011. 159(2): p. 422-425.
  • 14. Yamamoto, Y., et al., Comparison of 4 Risk-of-Malignancy Indexes in the Preoperative Evaluation of Patients With Pelvic Masses: A Prospective Study. Clinical Ovarian and Other Gynecologic Cancer, 2014. 7(1): p. 8-12.
  • 15. Timmerman, D., et al., Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. American journal of obstetrics and gynecology, 2016. 214(4): p. 424-437.
  • 16. Szubert, S., et al., External validation of the IOTA ADNEX model performed by two independent gynecologic centers. Gynecologic Oncology, 2016. 142(3): p. 490-495.
  • 17. Sayasneh, A., et al., Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study. British Journal of Cancer, 2016. 115(5): p. 542-548.
  • 18. Simsek, H.S., et al., Role of a risk of malignancy index in clinical approaches to adnexal masses. Asian Pac J Cancer Prev, 2014. 15(18): p. 7793-7797.
  • 19. Arun-Muthuvel, V. and V. Jaya, Pre-operative evaluation of ovarian tumors by risk of malignancy index, CA125 and ultrasound. Asian Pac J Cancer Prev, 2014. 15(6): p. 2929-2932.
  • 20. Terzic, M., et al., Risk of malignancy index validity assessment in premenopausal and postmenopausal women with adnexal tumors. Taiwanese Journal of Obstetrics and Gynecology, 2013. 52(2): p. 253-257.
  • 21. Van Gorp, T., et al., Subjective assessment by ultrasound is superior to the risk of malignancy index (RMI) or the risk of ovarian malignancy algorithm (ROMA) in discriminating benign from malignant adnexal masses. European Journal of Cancer, 2012. 48(11): p. 1649-1656.
  • 22. Ashrafgangooei, T. and M. Rezaeezadeh, Risk of malignancy index in preoperative evaluation of pelvic masses. Asian Pac J Cancer Prev, 2011. 12(7): p. 172.
  • 23. van den Akker, P.A., et al., Evaluation of the Risk of Malignancy Index in daily clinical management of adnexal masses. Gynecologic oncology, 2010. 116(3): p. 384-388.
  • 24. Obeidat, B., et al., Risk of malignancy index in the preoperative evaluation of pelvic masses. International Journal of Gynecology & Obstetrics, 2004. 85(3): p. 255-258.
  • 25. Andersen, E.S., et al., Risk of malignancy index in the preoperative evaluation of patients with adnexal masses. Gynecologic oncology, 2003. 90(1): p. 109-112.
  • 26. Davies, A.P., et al., The adnexal mass: benign or malignant? Evaluation of a risk of malignancy index. BJOG: An International Journal of Obstetrics & Gynaecology, 1993. 100(10): p. 927-931.

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

Year 2018, Volume: 49 Issue: 4, 0 - 0, 15.12.2018
https://doi.org/10.16948/zktipb.445755

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.
 

References

  • 1. National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol, 1994. 55(3 Pt 2): p. S4-14.
  • 2. Jacobs, I., et al., A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. BJOG: An International Journal of Obstetrics & Gynaecology, 1990. 97(10): p. 922-929.
  • 3. Tingulstad, S., et al., Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre‐operative diagnosis of pelvic masses. BJOG: An International Journal of Obstetrics & Gynaecology, 1996. 103(8): p. 826-831.
  • 4. Tingulstad, S., et al., THE RISK‐OF‐MALIGNANCY INDEX TO EVALUATE POTENTIAL OVARIAN CANCERS IN LOCAL HOSPITALS. Obstetrics & Gynecology, 1999. 93(3): p. 448-452
  • 5. Yamamoto, Y., et al., Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2009. 144(2): p. 163-167.
  • 6. Van Calster, B., et al., Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ, 2014. 349: p. g5920.
  • 7. Morgan, R.J., et al., Ovarian cancer, version 1.2016, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 2016. 14(9): p. 1134-1163.
  • 8. Bristow, R.E., et al., Adherence to treatment guidelines for ovarian cancer as a measure of quality care. Obstetrics & Gynecology, 2013. 121(6): p. 1226-1234.
  • 9. Obstetricians, A.C.o. and Gynecologists, Committee Opinion No. 477. The role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol, 2011. 117: p. 742-746.
  • 10. Manjunath, A., K. Sujatha, and R. Vani, Comparison of three risk of malignancy indices in evaluation of pelvic masses. Gynecologic oncology, 2001. 81(2): p. 225-229.
  • 11. Ma, S., K. Shen, and J. Lang, A risk of malignancy index in preoperative diagnosis of ovarian cancer. Chinese medical journal, 2003. 116(3): p. 396-399.
  • 12. Geomini, P., et al., The accuracy of risk scores in predicting ovarian malignancy: a systematic review. Obstetrics & Gynecology, 2009. 113(2, Part 1): p. 384-394.
  • 13. Van den Akker, P.A., et al., External validation of the adapted Risk of Malignancy Index incorporating tumor size in the preoperative evaluation of adnexal masses. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011. 159(2): p. 422-425.
  • 14. Yamamoto, Y., et al., Comparison of 4 Risk-of-Malignancy Indexes in the Preoperative Evaluation of Patients With Pelvic Masses: A Prospective Study. Clinical Ovarian and Other Gynecologic Cancer, 2014. 7(1): p. 8-12.
  • 15. Timmerman, D., et al., Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. American journal of obstetrics and gynecology, 2016. 214(4): p. 424-437.
  • 16. Szubert, S., et al., External validation of the IOTA ADNEX model performed by two independent gynecologic centers. Gynecologic Oncology, 2016. 142(3): p. 490-495.
  • 17. Sayasneh, A., et al., Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study. British Journal of Cancer, 2016. 115(5): p. 542-548.
  • 18. Simsek, H.S., et al., Role of a risk of malignancy index in clinical approaches to adnexal masses. Asian Pac J Cancer Prev, 2014. 15(18): p. 7793-7797.
  • 19. Arun-Muthuvel, V. and V. Jaya, Pre-operative evaluation of ovarian tumors by risk of malignancy index, CA125 and ultrasound. Asian Pac J Cancer Prev, 2014. 15(6): p. 2929-2932.
  • 20. Terzic, M., et al., Risk of malignancy index validity assessment in premenopausal and postmenopausal women with adnexal tumors. Taiwanese Journal of Obstetrics and Gynecology, 2013. 52(2): p. 253-257.
  • 21. Van Gorp, T., et al., Subjective assessment by ultrasound is superior to the risk of malignancy index (RMI) or the risk of ovarian malignancy algorithm (ROMA) in discriminating benign from malignant adnexal masses. European Journal of Cancer, 2012. 48(11): p. 1649-1656.
  • 22. Ashrafgangooei, T. and M. Rezaeezadeh, Risk of malignancy index in preoperative evaluation of pelvic masses. Asian Pac J Cancer Prev, 2011. 12(7): p. 172.
  • 23. van den Akker, P.A., et al., Evaluation of the Risk of Malignancy Index in daily clinical management of adnexal masses. Gynecologic oncology, 2010. 116(3): p. 384-388.
  • 24. Obeidat, B., et al., Risk of malignancy index in the preoperative evaluation of pelvic masses. International Journal of Gynecology & Obstetrics, 2004. 85(3): p. 255-258.
  • 25. Andersen, E.S., et al., Risk of malignancy index in the preoperative evaluation of patients with adnexal masses. Gynecologic oncology, 2003. 90(1): p. 109-112.
  • 26. Davies, A.P., et al., The adnexal mass: benign or malignant? Evaluation of a risk of malignancy index. BJOG: An International Journal of Obstetrics & Gynaecology, 1993. 100(10): p. 927-931.
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Kemal Sandal

Mesut Polat

Murat Yassa

Taner Günay

Gamze Erdem This is me

Kadir Güzin

Publication Date December 15, 2018
Published in Issue Year 2018 Volume: 49 Issue: 4

Cite

APA Sandal, K., Polat, M., Yassa, M., Günay, T., et al. (2018). Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması. Zeynep Kamil Tıp Bülteni, 49(4). https://doi.org/10.16948/zktipb.445755
AMA Sandal K, Polat M, Yassa M, Günay T, Erdem G, Güzin K. Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması. Zeynep Kamil Tıp Bülteni. December 2018;49(4). doi:10.16948/zktipb.445755
Chicago Sandal, Kemal, Mesut Polat, Murat Yassa, Taner Günay, Gamze Erdem, and Kadir Güzin. “Adneksiyal Kitlelerde Risk of Malignancy Index Versiyonları Ile Assesment of Different Neoplasias in the Adnexa (ADNEX) Skorlama Sisteminin karşılaştırılması”. Zeynep Kamil Tıp Bülteni 49, no. 4 (December 2018). https://doi.org/10.16948/zktipb.445755.
EndNote Sandal K, Polat M, Yassa M, Günay T, Erdem G, Güzin K (December 1, 2018) Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması. Zeynep Kamil Tıp Bülteni 49 4
IEEE K. Sandal, M. Polat, M. Yassa, T. Günay, G. Erdem, and K. Güzin, “Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması”, Zeynep Kamil Tıp Bülteni, vol. 49, no. 4, 2018, doi: 10.16948/zktipb.445755.
ISNAD Sandal, Kemal et al. “Adneksiyal Kitlelerde Risk of Malignancy Index Versiyonları Ile Assesment of Different Neoplasias in the Adnexa (ADNEX) Skorlama Sisteminin karşılaştırılması”. Zeynep Kamil Tıp Bülteni 49/4 (December 2018). https://doi.org/10.16948/zktipb.445755.
JAMA Sandal K, Polat M, Yassa M, Günay T, Erdem G, Güzin K. Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması. Zeynep Kamil Tıp Bülteni. 2018;49. doi:10.16948/zktipb.445755.
MLA Sandal, Kemal et al. “Adneksiyal Kitlelerde Risk of Malignancy Index Versiyonları Ile Assesment of Different Neoplasias in the Adnexa (ADNEX) Skorlama Sisteminin karşılaştırılması”. Zeynep Kamil Tıp Bülteni, vol. 49, no. 4, 2018, doi:10.16948/zktipb.445755.
Vancouver Sandal K, Polat M, Yassa M, Günay T, Erdem G, Güzin K. Adneksiyal kitlelerde Risk of Malignancy Index versiyonları ile Assesment of Different Neoplasias in the Adnexa (ADNEX) skorlama sisteminin karşılaştırılması. Zeynep Kamil Tıp Bülteni. 2018;49(4).