1. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group
- Author
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Antonia Carla Testa, Lil Valentin, Dirk Timmerman, Caroline Van Holsbeke, Ben Van Calster, Ignace Vergote, Elisabeth Epstein, Laure Wynants, Chiara Landolfo, J. Kaijser, Luca Savelli, Artur Czekierdowski, Dorella Franchi, Alberto Rossi, Daniela Fischerova, Wouter Froyman, Tom Bourne, Stefano Guerriero, F. Leone, Robert Fruscio, Timmerman, D, Van Calster, B, Testa, A, Savelli, L, Fischerova, D, Froyman, W, Wynants, L, Van Holsbeke, C, Epstein, E, Franchi, D, Kaijser, J, Czekierdowski, A, Guerriero, S, Fruscio, R, Leone, F, Rossi, A, Landolfo, C, Vergote, I, Bourne, T, and Valentin, L
- Subjects
EXTERNAL VALIDATION ,diagnosis ,Simple Rule ,MULTICENTER ,Likelihood ratios in diagnostic testing ,Adnexal mass ,SIMPLE ULTRASOUND RULES ,Cohort Studies ,0302 clinical medicine ,Ultrasonography, Doppler, Color ,adnexa ,030219 obstetrics & reproductive medicine ,IOTA SIMPLE RULES ,International Ovarian Tumor Analysis ,Obstetrics and Gynecology ,Obstetrics & Gynecology ,ultrasonography ,ovarian neoplasms ,CANCER ,Hospitals ,diagnosi ,preoperative evaluation ,ovarian cancer ,Adnexal Diseases ,030220 oncology & carcinogenesis ,Predictive value of tests ,Female ,Radiology ,color Doppler ,Risk assessment ,Life Sciences & Biomedicine ,medicine.medical_specialty ,Simple Rules ,BENIGN ,REFERRAL GUIDELINES ,ovarian neoplasm ,AMERICAN-COLLEGE ,Cancer Care Facilities ,Malignancy ,Risk Assessment ,Sensitivity and Specificity ,03 medical and health sciences ,MATHEMATICAL-MODELS ,Predictive Value of Tests ,medicine ,Humans ,Obstetrics & Reproductive Medicine ,Science & Technology ,Receiver operating characteristic ,business.industry ,medicine.disease ,logistic regression analysis ,International Ovarian Tumor Analysi ,diagnostic algorithm ,Confidence interval ,Surgery ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Cross-Sectional Studies ,Logistic Models ,ROC Curve ,logistic regression analysi ,1114 Paediatrics and Reproductive Medicine ,business - Abstract
BACKGROUND: Accurate methods to preoperatively characterize adnexal tumors are pivotal for optimal patient management. A recent metaanalysis concluded that the International Ovarian Tumor Analysis algorithms such as the Simple Rules are the best approaches to preoperatively classify adnexal masses as benign or malignant. OBJECTIVE: We sought to develop and validate a model to predict the risk of malignancy in adnexal masses using the ultrasound features in the Simple Rules. STUDY DESIGN: This was an international cross-sectional cohort study involving 22 oncology centers, referral centers for ultrasonography, and general hospitals. We included consecutive patients with an adnexal tumor who underwent a standardized transvaginal ultrasound examination and were selected for surgery. Data on 5020 patients were recorded in 3 phases from 2002 through 2012. The 5 Simple Rules features indicative of a benign tumor (B-features) and the 5 features indicative of malignancy (M-features) are based on the presence of ascites, tumor morphology, and degree of vascularity at ultrasonography. Gold standard was the histopathologic diagnosis of the adnexal mass (pathologist blinded to ultrasound findings). Logistic regression analysis was used to estimate the risk of malignancy based on the 10 ultrasound features and type of center. The diagnostic performance was evaluated by area under the receiver operating characteristic curve, sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), negative predictive value (NPV), and calibration curves. RESULTS: Data on 4848 patients were analyzed. The malignancy rate was 43% (1402/3263) in oncology centers and 17% (263/1585) in other centers. The area under the receiver operating characteristic curve on validation data was very similar in oncology centers (0.917; 95% confidence interval, 0.901-0.931) and other centers (0.916; 95% confidence interval, 0.873-0.945). Risk estimates showed good calibration. In all, 23% of patients in the validation data set had a very low estimated risk (
- Published
- 2016