Titre du document / Document title
A new scoring system to differentiate benign from malignant adnexal masses
Auteur(s) / Author(s)ALCAZAR Juan Luis
MERCE Luis T.
Résumé / Abstract
In this paper, the authors present a scoring system designed to differentiate benign from malignant adnexal masses and results of a prospective investigation conducted to validate the model. The system was developed from clinical, morphologic, and Doppler sonographic data gathered from 705 adnexal masses diagnosed in 665 women. Two-thirds of the women were premenopausal and one-third were postmenopausal. A total of 705 adnexal masses were diagnosed of which 141 (20%) were malignant and 564 (80%) were benign. Morphologic evaluation was performed using tumor volume calculated with the prolate ellipsoid formula (A × B × C X 0.5233, expressed in milliliters). Mass bilaterality, wall thickness, septations, papillary projections, solid areas, and echogenicity were recorded. Color Doppler sonography was used to categorize blood flow in the mass as peripheral (in the tumor wall or periphery of a solid tumor) or central (in septa, papillary projections, solid areas, or central part of a solid tumor). Resistance index (RI) and peak systolic velocity (PSV) blood flow were measured in each vessel identified, and the tumor classified in 1 of 4 velocimetric categories, according to the best RI measured and a PSV cutoff value established in previous studies. Multivariate logistic regression analysis was performed using all variables identified in univariate analysis as having a statistical significance for adnexal mass malignancy: age, tumor volume, bilaterality, wall thickness, papillary projection thickness, presence of solid areas, solid echogenicity, presence of blood flow, central blood flow, amount of flow, RI, PSV, and velocimetry (P <.001 for all). Thick papillary projections, solid area or purely solid echogenicity, central blood flow, and high-velocity low-resistance velocimetry were independently predictive of tumor malignancy. A scoring system was developed using these 4 factors (Table 1). Total scores could range from 0 to 12. The optimal cutoff value to differentiate benign from malignant was ≥6 with a sensitivity of 91% and a false-positive rate of 7.6%. The scoring system was used prospectively to evaluate a series of 86 patients with an adnexal mass (4 of whom had bilateral tumors for a total of 90 masses). Thirty-one tumors were malignant and 59 were benign. The data from these 86 patients also were evaluated with scoring systems developed by Sassone et al., De Priest et al., and Ferrazzi et al., and compared with the results from this study. A sensitivity of 100% was seen in the current study and the De Priest system. Sassone and Ferrazzi had a sensitivity of 64.5 and 83.9, respectively. Specificity ranged from 81.4 in the De Priest system to 94.9 in this study. The 3 systems had positive predictive values ranging from 72.2% to 74.1%, compared with 94.9% for the current study. The negative predictive value was 100% for this study and the De Priest system, and 82.5% and 90.7% for Sassone and Ferrazzi, respectively. Overall accuracy was 80% for Sassone, 87.8% for De Priest, 83.3% for Ferrazzi, and 96.7% for the current study.
Revue / Journal TitleObstetrical & gynecological survey
Source / Source
2003, vol. 58, no
7, pp. 462-463 [2 page(s) (article)]
Langue / Language
Editeur / Publisher
Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS
Localisation / Location
INIST-CNRS, Cote INIST : 14335, 35400011992576.0160
Nº notice refdoc (ud4) : 14976488