Title: Simple ultrasound-based rules for the diagnosis of ovarian cancer
Authors: Timmerman, Dirk ×
Testa, A C
Bourne, Tom
Ameye, Lieveke
Jurkovic, D
Van Holsbeke, C
Paladini, D
Van Calster, Ben
Vergote, Ignace
Van Huffel, Sabine
Valentin, L #
Issue Date: Jun-2008
Publisher: Blackwell Science
Series Title: Ultrasound in Obstetrics & Gynecology vol:31 issue:6 pages:681-690
Abstract: OBJECTIVE: To derive simple and clinically useful ultrasound-based rules for discriminating between benign and malignant adnexal masses. METHODS: In a multicenter study involving nine centers consecutive patients with persistent adnexal tumors underwent transvaginal gray-scale and Doppler ultrasound examination using a standardized examination technique and standardized terms and definitions. Information on 42 gray-scale ultrasound variables and six Doppler variables was collected and entered into a research protocol. When developing simple ultrasound-based rules to predict malignancy (M-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the highest positive predictive value (PPV) with regard to malignancy; when developing simple rules to predict a benign tumor (B-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the lowest PPV with regard to malignancy. We selected ten rules that were in agreement with our clinical experience and were applicable to at least 30 tumors and then tested them prospectively on 507 tumors examined in three of the nine centers. RESULTS: 1066 patients with 1233 adnexal tumors were included. There were 903 benign tumors (73%) and 330 malignant tumors (27%). In 167 patients the tumors were bilateral. We selected five simple rules to predict malignancy (M-rules): (1) irregular solid tumor; (2) ascites; (3) at least four papillary structures; (4) irregular multilocular-solid tumor with a largest diameter of at least 100 mm; and (5) very high color content on color Doppler examination. We chose five simple rules to suggest a benign tumor (B-rules): (1) unilocular cyst; (2) presence of solid components where the largest solid component is < 7 mm in largest diameter; (3) acoustic shadows; (4) smooth multilocular tumor less than 100 mm in largest diameter; and (5) no detectable blood flow on Doppler examination. These ten rules were applicable to 76% of all tumors, where they resulted in a sensitivity of 93%, specificity of 90%, positive likelihood ratio (LR+) of 9.45 and negative likelihood ratio (LR-) of 0.08. When prospectively tested the rules were applicable in 76% (386/507) of the tumors, where they had a sensitivity of 95% (106/112), a specificity of 91% (249/274), LR+ of 10.37, and LR- of 0.06. CONCLUSION: Most adnexal tumors in an ordinary tumor population can be correctly classified as benign or malignant using simple ultrasound-based rules. For tumors that cannot be classified using simple rules, ultrasound examination by an expert examiner might be useful.
ISSN: 0960-7692
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Gynaecological Imaging Section (-)
Section Woman - Miscellaneous (-)
ESAT - STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics
Gynaecological Oncology
Basic Research in Gynaecology Section (-)
× corresponding author
# (joint) last author

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