Predictive factors of malignancy in patients with adnexal masses

Introduction: Good preoperative tumor triage is essential for choosing the appropriate approach. Objective: The study aim was to identify factors from standard preoperatively collected data, which could predict the nature of adnexal masses prior surgery. Material and Methods: The study involved all women treated in the Clinic for Gynecology and Obstetrics Clinical Center of Serbia for adnexal tumors throughout a period of 18 months. On admission, detailed anamnestical and laboratory data were obtained and ultrasound scans were performed. Obtained data were compared with hystopathological findings of tumors. Methods of correlation and logistic regression were applied to create association models. Results: Three new models for predicting tumor nature were achieved from anamnestical data, characteristics of women and tumors, and laboratory analyses. Two statistically significant (p = 0.000) equations were obtained for anamnestical data and characteristics of women and tumors, while three were made for laboratory analyses. Sensitivity of anamnestical malignancy index (AMI) was 73.33%, specificity 72.87%, positive predictive value (PPV) 39.49% and negative predictive value (NPV) 91.88%. Sensitivity of characteristic malignancy index (CMI) was 92.38%, specificity 67.36%, PPV 40.59% and NPV 97.34%. Sensitivity of laboratory malignancy index (LMI) was 56.45%, specificity 90.24%, PPV 68.63%, and NPV 84.57%. Conclusions: The best predictors of malignancy are menopausal status, body mass index (BMI), age, metastases, ascites, tumor marker CEA level, and erythrocyte sedimentation rate (ESR). Along with the risk of malignancy index (RMI), for more reliable triage and preoperative tumor evaluation the authors propose introduction of another three indexes (AMI, CMI, LMI) in clinical practice.

Adnexal masses; Preoperative triage; Predictors; Models.

[1] Pfisterer J., Schmalfeldt B., du Bois A.: “Ovarian cancer. A challenge for physician and patient”. Gynäkologe, 2006, 39, 239.

[2] Ameye L., Valentin L., Testa A.C., Van Holsbeke C., Domali E., Van Huffel S. et al.: “A scoring system to differentiate malignant from benign masses in specific ultrasound-based subgroups of adnexal tumors”. Ultrasound Obstet. Gynecol., 2009, 33, 92.

[3] Håkansson F., Høgdall E.V., Nedergaard L., Lundvall L., Engelholm S.A., Pedersen A.T. et al.: “Risk of malignancy index (RMI) used as a diagnostic tool in a tertiary centre for patients with a pelvic mass”. Acta Obstet. Gynecol. Scand., 2012, 91, 496.

[4] Sehouli J., Henrich W., Braicu I., Lichtenegger W.: “Preoperative diagnostics in ovarian cancer. What do we really need?”. Gynäkologe, 2006, 39, 428.

[5] Terzic M., Dotlic J., Likic Ladjevic I., Atanackovic J., Ladjevic N.: “Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses”. Vojnosanit Pregl., 2011, 68, 589.

[6] Meinhold-Heerlein F., Zeppernick A., Strauss N., Maass S.: “Hauptmann Heterogeneity of ovarian cancer”. Gynäkologe, 2011, 44, 708.

[7] Chia Y.N., Marsden D.E., Robertson G., Hacker N.F.: “Triage of ovarian masses”. Aust. N.Z. J. Obstet. Gynaecol., 2008, 48, 322.

[8] Tailor A., Jurkovic D., Bourne T.H., Collins W.P., Campbell S.: “Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis”. Ultrasound Obstet. Gynecol., 1997, 10, 41.

[9] Alcazar J.L., Jurado M.: “Using a logistic model to predict malignancy of adnexal masses based on menopausal status, ultrasound morphology, and color Doppler findings”. Gynecol. Oncol., 1998, 69, 146.

[10] Timmerman D., Bourne T.H., Tailor A., Collins W.P., Verrelst N., Vandenberghe K. et al.: “A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: the development of a new logistic regression model”. Am. J. Obstet. Gynecol., 1999, 181, 57.

[11] Van Trappen P.O., Rufford B.D., Mills T.D., Sohaib S.A., Webb J.A.W., Sahdev A. et al.: “Differential diagnosis of adnexal masses: risk of malignancy index, ultrasonography, magnetic resonance imaging, and radioimmunoscintigraphy”. Int. J. Gynecol. Cancer, 2007, 17, 61.

[12] Hippisley-Cox J., Coupland C.: “Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm”. BMJ, 2011, 344, d8009 doi: 10.1136/bmj.d8009

[13] Fehm T., Neubauer H., Bräutigam K., Arnold N., Meinhold-Heerlein I.: “Diagnostics and therapy of ovarian cancer. Innovative techniques”. Gynäkologe, 2010, 43, 586.

[14] Togashi K.: “Ovarian cancer: the clinical role of US, CT, and MRI”. Eur. Radiol., 2003, 13 Suppl. 4, L87.

[15] Timmerman D., Testa A.C., Bourne T., Ferrazzi E., Ameye L., Konstantinovic M.L. et al.: “International Ovarian Tumor Analysis Group. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group”. J. Clin. Oncol., 2005, 23, 8794.

[16] Schouten L.J., Rivera C., Hunter D.J., Spiegelman D., Adami H.O., Arslan A. et al.: “Height, body mass index, and ovarian cancer: a pooled analysis of 12 cohort studies”. Cancer Epidemiol. Biomarkers. Prev., 2008, 17, 902.

[17] Terzic M., Dotlic J., Berisavac M., Vukotic M., Likic I., Atanackovic J. et al.: “Ultrasound findings in postmenopausal women with adnexal masses”. Ultrasound Obstet. Gynecol., 2010, 36, 251.

[18] Dotlić J., Terzić M., Likić I., Atanacković J., Ladjević N.: “Evaluation of adnexal masses: correlation of clinical stage, ultrasound and hystopathological findings”. Vojnosanit. Pregl., 2011, 68, 861.

[19] Rong-Huan H., Wei-Miao Y., Li-Yan W., Yu-Yan M.: “Highly elevated serum CA-125 levels in patients with non-malignant gynecological diseases”. Arch. Gynecol. Obstet., 2011, 283, S107.

[20] Van Calster B., Valentin L., Van Holsbeke C., Zhang J., Jurkovic D., Lissoni A.A. et al.: “A novel approach to predict the likelihood of specific ovarian tumor pathology based on serum CA-125: a multicenter observational study”. Cancer Epidemiol. Biomarkers Prev., 2011, 20, 2420.

[21] Terzic M., Stimec B.: “Primary endometrioid adenocarcinoma of the fallopian tube”. Z. Onkol., 2000, 32, 114.

[22] Terzic M., Dokic M., Stimec B.: “Immature ovarian teratoma in a young girl: very short course and lethal outcome. A case report”. Int. J. Gynecol. Cancer, 2005, 15, 382.

[23] Van Holsbeke C.D., Van Calster B., Bourne T., Ajossa S., Testa A.C., Guerriero S. et al.: “External validation of diagnostic models to estimate the risk of malignancy in adnexal masses”. Clin. Cancer Res., 2012, 18, 815.