Adneksiyal Kitlelerin Kriterleri, International Ovarian Tumor Analysis (IOTA) Malignite Risk İndeksi, Morfolojik İndeks ve Sadece Ultrasonografide Tümör Boyutu ile Değerlendirilmesi ve Bulguların Malignite ile İlişkisinin Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı adneksiyal kitlesi olan premenapozal ve postmenapozal hastalarda preoperative dönemde malignite riskini değerlendirmek ve benign ve malign adneksiyal kitle ayırımını öngörmede tekniklerin etkilerini karşılaştırmaktır. Materyal Metod: Ankara Dr Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Jinekoloji ve Onkoloji polikliniğine başvuran adneksiyal kitlesi olan, perimenapozal veya postmenapozal dönemde olan 160 hasta çalışmaya dahil edildi. Hastalar 4 gruba ayrılarak IOTA kriterleri, malignite risk indeksi, morfolojik indeks ve ultrasonografide tümör boyutu ile değerlendirildi. Bu prospektif değerlendirmelerin sonuçları postoperatif patoloji sonuçlarıyla karşılaştırıldı. Istatistiksel analizlerde modele dahil edilme olasılığı 0,05, çıkarılma olasılığı 0,10 olarak kabul edildi. Odds oranı (OR) lojistik regresyon analizinden elde edildi ve güven aralığı %95 olarak belirlendi. Gebeliği olan ve yapılan ultrasonografi tarihinden itibaren 3 ay içinde opere olmayan hastalar çalışmaya dahil edilmedi. Bulgular: Preoperatif olarak malignite indekslerinden elde ettiğimiz sensitivite ve spesifite oranları sırasıyla IOTA’nın sensitivitesi %85.7, spesifitesi %80.8; malignite risk indeksin sensitivitesi %50, spesifitesi %94.1; morfolojik indeksin sensitivitesi %23.5, spesifitesi %94.1; ultrasonografide tümör boyutu değerlendirmesinin sensitivitesi %100, spesifitesi %31.3 olarak bulundu. Sonuç: Sonuç olarak geniş popülasyonlar üzerinde yapılan çalışmalarla tanı doğruluğu kanıtlanmış ve bizim çalışmamızda da tanı doğruluğu (%85,7) en yüksek saptanan IOTA modelleri ile hastanın preoperatif malignite riski tahmin edilebilecek ve hastanın operasyonu bu doğrultuda planlanabilecektir.

Anahtar Kelimeler

• Adneksiyal kitle
• malignite
• skorlama sistemi
• ultrason
• menapoz

International Ovarian Tumor Analysis (IOTA) the Malignancy Risk Index, Morphologic Index, and the Ultrasonographically Determined Tumor Size in the Assessment of Adnexal Masses and the Correlation of the Relevance of the Results in the with Malignancy

Öz

Aim: The aim of this study is to assess the malignancy risk in the pre-operative period and compare the effectiveness of the methods used in predicting the discrimination between benign and malignant adnexal masses in perimenopausal and postmenopausal patients presenting with an adnexal mass. Material and methods: Presenting to Ankara Dr. Zekai Tahir Burak Women Health Educational and Research Hospital Gynecology and Oncology Outpatient Clinics, a total of 160 patients who were either in the perimenopausal or postmenopausal period and who were diagnosed with adnexal masses were included in the study. The patients were assigned into four respective groups and to be evaluated with IOTA (International Ovarian Tumor Analysis), malignancy risk index, morphological index, and the tumor size as determined by the ultrasound. The results of these prospective assessments were then compared with the postoperative histopathological results. In the statistical analysis, the probability of being included in the model was accepted to be 0.05, while, the probability of exclusion from the model was accepted to be 0.10. The Odds Ratios (OR) were derived from the logistic regression, and the level of confidence was determined to be 95%. Patients who hadn’t undergone the operation after 120 days from ultrasound and pregnants excluded from the study. Results: Preoperatively yielded sensitivity and specificity rates of malignancy indexes for predicting a malignancy were found to be 85.7% and 80.8% for IOTA; 50% and 94.1% for the malignancy risk index; 23.5% and 94% for the morphological index; and 100% and 31.3% for the tumor size as determined by the ultrasound respectively. Conclusion: Owing to the highest level of sensitivity of about 85.7% obtained by the IOTA models as proven also by large population-based studies, the risk of malignancy can be predicted and the surgical approaches can be planned accordingly in the pre-operative period.

Anahtar Kelimeler

• adnexal mass
• malignancy
• scoring system
• ultrasound

Kaynakça

1. 1. Horner MJ, Ries LAG, Krapcho M at al. SEER cancer statistics rewiev, 1975-2006, National Cancer Institute, SEER website.seer.cancer.gov/csr/1975-2006. Based on November 2008 SEER data submission.Published May 29, 2009. Accessed August 20, 2013.
2. 2. National Institute of Health Concensus Development Conference Statement. 1994 Ovarian cancer: screening, treatment and follow up. Gynecol Oncol;55:S4.
3. 3. Scully RE. Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament. In: Young RH, Clement PB.(eds) Atlas of tumor pathology.3th edition. Washington, DC: Armed Forces Institute of Pathology; 1998. pp51-79.
4. 4. Penson RT, Wenzel LB, Vergote I, Cella D. Quality of life considerations in gynecologic cancer. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006; 95(Suppl 1): S247-57.
5. 5. Webb PM, Purdie DM, Grover S, Jordan S, Dick ML, Green AC. Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer. Gynecol Oncol. 2004;92:232-9.
6. 6. Timmerman D. Lack of standardization in gynecological ultrasonography. Ultrasound Obstet Gynecol. 2000;16:395-98.
7. 7. DePriest PD, Varner E, Powell J, Fried A, Puls L, Higgins R. The efficacy of a sonographic morphology index in identifying ovarian cancer: a multi-institutional investigation. Gynecol Oncol. 1994; 55: 174–8.
8. 8. Manjunath AP, Pratapkumar, Sujatha K, Vani R. Comparison of three risk of malignancy indices in evaluation of pelvic masses. Gynecol Oncol .2001;81:225–9.

9. 9. Partridge EE, Barnes MN. Epithelial Ovarian Cancer: Prevention, Diagnosis and Treatment. CA Cancer J Clin. 1999;49:297-320.
10. 10. Shalev E, Eliyahu S, Peleg , Tsabari A. Laparoscopic management of adnexal cystic masses in postmenopausal women. Obstet Gynecol. 1994;83:594-9.
11. 11. Atasü T, Şahmay S. Bening Neoplasms of Ovary. In: Atasü T, Şahmay S.(eds) Gynecology. 2nd edition. Nobel Medical Bookstore Istanbul 2001: pp 339-347.
12. 12. Granberg S, Wikland M, Jansson I. Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: criteria to be used for ultrasound evaluation. Gynecol Oncol. 1989; 35:139–44.
13. 13. Jacobs IJ, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol. 1990;97:922–9.
14. 14. Sassone AM, Timor-Tritsch IE, Artner A, Westhoff C, Warren WB. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol. 1991;78:70-6.
15. 15. Van Calster B, Timmerman D, Bourne T. Discrimination between benign and malignant adnexal masses by specialist ultrasound examination versus serum CA-125. J Natl Cancer Inst 2007;99:1706–14.
16. 16. Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16:500–5.
17. 17. Twickler M, Moschos E. Ultrasound and assessment of ovarian cancer risk. AJR Women’s Imaging. 2010;194:322-9.
18. 18. Van Calster B, Timmerman D, Lu C, Suykens JA, Valentin L. Preoperative diagnosis of ovarian tumors using Bayesian kernel-based methods. Ultrasound Obstet Gynecol. 2007;29:496–504.
19. 19. Timmerman D., Ameye L., Fischerova D., Epstein E., Melis GB. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;110:341-50.
20. 20. Timmerman D, Van Calster B., Testa AC., Guerriero S.,. 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. 2010;36: 226–34.