Simple ultrasound-based rules for the diagnosis of ovarian cancer
Open accessAbstract
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.
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The International Ovarian Tumor Analysis (IOTA) group has established US-based rules for classification of adnexal tumors.
“and thus the International Ovarian Tumor Analysis (IOTA) group has established US-based rules for classification of adnexal tumors [183].”
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- Authors
- Timmerman, D., Testa, A. C., Bourne, T., Ameye, L., Jurkovic, D., Van Holsbeke, C., Paladini, D., Van Calster, B., Vergote, I., Van Huffel, S., & Valentin, L.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Università Cattolica del Sacro Cuore (IT)
- KU Leuven (BE)
- King's College Hospital (GB)
- University of Naples Federico II (IT)
- Lund University (SE)
- Corresponding author
- Timmerman, D.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2008-05-27
- Volume
- 31
- Issue
- 6
- Pages
- 681-690
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W2131753057
- Cited by
- 613
- References
- 26
- Citations by year
- 2026: 34 · 2025: 47 · 2024: 51 · 2023: 54 · 2022: 50 · 2021: 50 · 2020: 49 · 2019: 37 · 2018: 27 · 2017: 34 · 2016: 37 · 2015: 30 · 2014: 23 · 2013: 23 · 2012: 21
- FWCI
- 16.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
- Keywords
- ovarian cancer, adnexal mass, transvaginal ultrasound, color Doppler ultrasound, benign versus malignant differentiation, tumor morphology, papillary structures, ascites, solid component, acoustic shadowing, blood flow, diagnostic accuracy, sensitivity and specificity, likelihood ratios, ovarian cysts, ovarian teratoma, endometrioma, ovarian fibroma, ovarian dysgerminoma
- MeSH terms
- Adnexa Uteri, Adnexal Diseases, Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Diagnosis, Differential, Female, Humans, Middle Aged, Ovarian Neoplasms, Predictive Value of Tests, Prospective Studies, Likelihood Functions, Ultrasonography, Doppler, Color
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