Preoperative Distinguish Between The Benign And Malignant Adnexal Mass Using Logistic Model

PartⅠPreoperative distinguish between the benign and malignant adnexal mass using Logistic modelObjectivesTo assess the diagnostic value of Logistic model in differentiating between malignant and benign ovarian lesions.Methods35 indexes of clinical and ultrasound data were recorded in 601 ovarian lesions confirmed by surgical pathology.The Logistic model was developed on a training set(n=400) and tested on a test set(n=201).ResultsVariable selection resulted in a set of 10 variables for the models: personal history of ovarian cancer,maximal diameter of the lesion, maximal diameter of the solid component,multilocular solid tumor,solid tumor,ascites,flow within papillation,irregular walls,very strong intratumoral blood flow(i.e.color score 4) and acoustic shadows;Test set area under the receiver operating characreristics curve is 0.963 with a sensitivity 93.9%and a specifidity 93.1%.ConclusionsLogistic model can accuratatly separate malignant from benign ovarian masses. PartⅡA scoring system to differentiate malignant from benign masses in specific ultrasound-based subgroups of adnexal tumorsObjectivesTo investigate if the prediction of malignant adnexal masses can be improved by considering different ultrasound-based subgroups of tumors and constructinga scoring system for each subgroup instead of using a risk estimation model applicable to all tumors.MethodsWe use 601 patients with at least one persistent adnexal mass.The masses were categorized into four subgroups based on their ultrasound appearance:(1) unilocular cyst;(2) multilocular cyst;(3) presence of a solid component but no papillation;and(4) presence of papillation. For each of the four subgroups a scoring system to predict malignancy wasdeveloped in a development set consisting of 400 patients in total (respective numbers of patients:(1)111;(2) 73;(3) 114;and(4) 102). The subgroup scoring system was then tested in 201 patients.The sensitivity and specificity,with regard to the prediction of malignancy, of the scoring system were compared with the logistic regression(LR) model for the calculation of risk of malignancy in adnexal masses.The gold standard was the pathological classification of the mass as benign or malignant(borderline,primary invasive,or metastatic).ResultsIn the test set,the sensitivity of the subgroup scoring system and the LR model was 91.8%,93.8%,respectively,and the specificity was 94.7%,94.3%respectively.ConclusionsIn the hands of experienced ultrasound examiners,the subgroup scoring system for diagnosing malignancy has a performance that is similar to the LR model. PartⅢValue of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgeryObjectivesTo assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate-level laparoscopic surgery for benign adnexal masses.MethodsWomen with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy.In all cases an attempt was made to establish a likely histological diagnosis using the our scoring system.The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer,predominantly cystic lesion with no solid foci＞5cm in mean diameter,no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoidcyst＜10 cm in mean diameter.Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy.Results114 women were selected for laparoscopy and 16 for laparotomy.The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98.9%,specificity of 88.2%, positive predictive value of 97.9%,positive likelihood ratio of 8.41 and negative likelihood ratio of 0.01.ConclusionsA detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate-level laparoscopic surgery in women with benign adnexal lesions.