| 1. Bowtell DD, Bohm S, Ahmed AA, et al. Rethinking ovarian cancer II: reducing mortality from high-grade serous ovarian cancer. Nat Rev Cancer 2015;15:668-79. |
Review/Other-Dx |
N/A |
To outline a set of research priorities that we believe will reduce incidence and improve outcomes for women with this disease. |
No results stated in abstract. |
4 |
| 2. Henderson JT, Webber EM, Sawaya GF. Screening for Ovarian Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. [Review]. JAMA. 319(6):595-606, 2018 02 13. |
Meta-analysis |
4 studies |
To systematically review evidence on benefits and harms of ovarian cancer screening among average-risk women to inform the United States Preventive Services Task Force. |
Four trials (N = 293587) were included; of these, 3 (n = 293038) assessed ovarian cancer mortality, and 1 (n = 549) reported only on psychological outcomes. Evaluated screening interventions included transvaginal ultrasound alone, transvaginal ultrasound plus CA-125 testing, and CA-125 testing alone. Test positivity for CA-125 was defined by a fixed serum level cutpoint or by a proprietary risk algorithm based on CA-125 level, change in CA-125 level over time, and age (risk of ovarian cancer algorithm [ROCA]). No trial found a significant difference in ovarian cancer mortality with screening. In the 2 large screening trials (PLCO and UKCTOCS, n = 271103), there was not a statistically significant difference in complete intention-to-screen analyses of ovarian, fallopian, and peritoneal cancer cases associated with screening (PLCO: rate ratio, 1.18 [95% CI, 0.82-1.71]; UKCTOCS: hazard ratio [HR], 0.91 [95% CI, 0.76-1.09] for transvaginal ultrasound and HR, 0.89 [95% CI, 0.74-1.08] for CA-125 ROCA). Within these 2 trials, screening led to surgery for suspected ovarian cancer in 1% of women without cancer for CA-125 ROCA and in 3% for transvaginal ultrasound with or without CA-125 screening, with major complications occurring among 3% to 15% of surgery. Evidence on psychological harms was limited but nonsignificant except in the case of repeat follow-up scans and tests, which increased the risk of psychological morbidity in a subsample of UKCTOCS participants based on the General Health Questionnaire 12 (score >/=4) (odds ratio, 1.28 [95% CI, 1.18-1.39]). |
Good |
| 3. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Ovarian Cancer. Available at: https://seer.cancer.gov/statfacts/html/ovary.html. |
Review/Other-Dx |
N/A |
To provide cancer statistics for ovarian cancer. |
No results stated in abstract. |
4 |
| 4. Vernooij F, Heintz P, Witteveen E, van der Graaf Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol. 2007;105(3):801-812. |
Review/Other-Dx |
19 articles |
To present an overview and summary of the recent literature on this subject. |
Nineteen articles were retrieved. There were no randomized controlled trials on this subject. Staging and debulking were consistently found to be performed more adequately by gynecologic oncologists (pooled relative risk of optimal debulking by a gynecologic oncologist to <2 cm residual disease 1.4 (95%CI 1.2-1.5) and to no macroscopic disease 2.3 (95%CI 1.5-3.5)) and in specialized hospitals (odds ratios for optimal debulking varied between 1.9 and 6.0). There were no differences in postoperative complication rates between different providers. Chemotherapy was given 1-15% more often in specialized settings. Differences in chemotherapy did not lead to differences in survival of patients treated by gynecologic oncologists, but did influence the effect of hospital on survival. Long-term survival was better after treatment in a specialized hospital. Surgery by a gynecologic oncologist resulted in longer survival in subgroups of patients, leading to a 5- to 8-month median survival benefit for patients with advanced stage disease. |
4 |
| 5. Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO. Centralisation of services for gynaecological cancers - a Cochrane systematic review. Gynecol Oncol 2012;126:286-90. |
Meta-analysis |
11 studies |
To assess the effectiveness of centralisation of care for patients with gynaecological cancer, in particular, survival advantage. |
Five retrospective observational studies met the inclusion criteria. Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. |
Good |
| 6. Koshiyama M, Matsumura N, Konishi I. Recent concepts of ovarian carcinogenesis: type I and type II. Biomed Res Int 2014;2014:934261. |
Review/Other-Dx |
N/A |
To review concepts of ovarian carcinogenesis. |
No results stated in abstract. |
4 |
| 7. Menon U, Gentry-Maharaj A, Hallett R, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009; 10(4):327-340. |
Experimental-Tx |
202,638 post-menopausal women |
Results of the prevalence (initial) screen of the UKCTOCS. Post-menopausal women were randomly assigned to no treatment (control; n=101,359); annual CA-125 screening (interpreted using a risk of ovarian cancer algorithm) with TVUS as a second-line test (multimodal screening; n=50,640); or annual screening with TVUS (US screening; n=50,639) alone in a 2:1:1 ratio using a computer-generated random number algorithm. |
Sensitivity, specificity, and PPVs for all primary ovarian and tubal cancers were 89.4%, 99.8%, and 43.3% for multimodal screening, and 84.9%, 98.2%, and 5.3% for US screening, respectively. For primary invasive epithelial ovarian and tubal cancers, the sensitivity, specificity, and PPVs were 89.5%, 99.8%, and 35.1% for multimodal screening, and 75.0%, 98.2%, and 2.8% for US screening, respectively. Significant difference in specificity (P<0.0001) but not sensitivity between the two screening groups for both primary ovarian and tubal cancers as well as primary epithelial invasive ovarian and tubal cancers. |
1 |
| 8. Glanc P, Benacerraf B, Bourne T, et al. First International Consensus Report on Adnexal Masses: Management Recommendations. J Ultrasound Med. 36(5):849-863, 2017 May. |
Review/Other-Dx |
N/A |
To Report on Adnexal Masses. |
No results stated in abstract. |
4 |
| 9. Myers ER, Bastian LA, Havrilesky LJ, et al. Management of adnexal mass. [Review] [247 refs]. Evid rep/technol assess. (130)1-145, 2006 Feb. |
Meta-analysis |
N/A |
To assess diagnostic strategies for distinguishing benign from malignant adnexal masses. |
The majority of studies did not describe whether patients presented with asymptomatic masses detected through screening or with symptoms. Prevalence of malignant masses in a U.S. postmenopausal screening population was approximately 0.1 percent, while benign masses were found in 0.8 to 1.8 percent of women. Pooled (a) sensitivity and (b) specificity were: bimanual exam (a) 0.45, (b) 0.90; ultrasound morphology scores (a) 0.86 to 0.91, (b) 0.68 to 0.83; Doppler resistive index (a) 0.72, (b) 0.90; pulsatility index (a) 0.80, (b) 0.73; maximum systolic velocity (a) 0.74, (b) 0.81; presence of vessels (a) 0.88, (b) 0.78; combined morphology and Doppler (a) 0.86, (b) 0.91; MRI (a) 0.91, (b) 0.88; CT (a) 0.90, (b) 0.75; FDG-PET (a) 0.67, (b) 0.79; and CA-125 (a) 0.78, (b) 0.78. Both sensitivity and specificity of CA-125 were better in postmenopausal than in premenopausal women. In modeled outcomes, combinations of imaging and CA-125 were both more sensitive and more specific than either alone. Performance of scoring systems in validation studies was consistently worse than in development studies; the highest demonstrated specificity observed was 0.91, with a concurrent sensitivity of 0.74. Evidence on followup strategies was sparse, although one large study provided good evidence for safely following unilocular cysts less than 10 cm in diameter. Overall complication rates in studies of surgically managed adnexal masses were low, but important clinical information was not reported. |
Good |
| 10. Zhang X, Mao Y, Zheng R, et al. The contribution of qualitative CEUS to the determination of malignancy in adnexal masses, indeterminate on conventional US - a multicenter study. PLoS One 2014;9:e93843. |
Observational-Dx |
120 patients |
To evaluate the efficacy of qualitative analysis of contrast-enhanced ultrasound (CEUS) in discrimination of adnexal masses which were undetermined by conventional ultrasound (US). |
There were 48 malignant tumors and 72 benign tumors. The enhancement features of malignant masses were different from benign ones. Earlier or simultaneous enhancement with inhomogeneous enhancement yielded the highest capability in differential diagnosis, and Sen, Spe, PPV, NPV, ACC, Youden's index was 89.6%, 97.2%, 93.2%, 95.6%, 93.3%, and 0.88, respectively. |
3 |
| 11. Xu A, Nie F, Liu T, Dong T, Bu L, Yang D. Adnexal masses: Diagnostic performance of contrast-enhanced ultrasound using the simple rules from the International Ovarian Tumor Analysis group. Int J Gynaecol Obstet 2021. |
Observational-Dx |
180 patients |
To evaluate the role of the Simple Rules (SR) from the International Ovarian Tumor Analysis group in contrast-enhanced ultrasound (CEUS) of for the differential diagnosis of benign and malignant adnexal tumors. |
Sensitivity, negative predictive values, Youden index, and area under the curves were better for SR in CEUS than SR in US. The specificity and negative predictive value of SR in CEUS were lower than that of SR in US. Compared with SR in US, SR in CEUS significantly reduced the number of uncertain masses (21, 36.7% vs. 66, 11.7%). |
3 |
| 12. Huchon C, Metzger U, Bats AS, et al. Value of three-dimensional contrast-enhanced power Doppler ultrasound for characterizing adnexal masses. J Obstet Gynaecol Res. 38(5):832-40, 2012 May. |
Observational-Dx |
99 patients |
To assess the diagnostic performance of 3-D contrast-enhanced power Doppler ultrasonography (3-D CEPDUS) for differentiating benign and malignant adnexal masses. |
Of 99 patients, 88 had benign tumors and were compared to the 11 patients with borderline (n = 5) or malignant (n = 6) tumors. The sensitivity of the subjective 2-D score was 55% (95% confidence interval [CI], 25-84) and specificity 94% (95%CI, 89-99). The sensitivity of the subjective 3-D score was 82% (95%CI, 58-100) and specificity 90% (95%CI, 83-96). Improvement of detection of malignant or borderline tumors by subjective 3-D score was 150%. Vessel density and patterns were not more efficient than the subjective 3-D score. The mean vascular index values were significantly different between benign and borderline/malignant groups: VI, 7.2 versus 35.5 (P < 0.0001); FI, 37.0 versus 48.2 (P = 0.003); and VFI, 2.9 versus 17.6 (P < 0.0001), respectively. |
1 |
| 13. Xiang H, Huang R, Cheng J, et al. Value of three-dimensional contrast-enhanced ultrasound in the diagnosis of small adnexal masses. Ultrasound Med Biol 2013;39:761-8. |
Observational-Dx |
47 patients |
To determine whether three-dimensional contrast-enhanced ultrasound (3D-CEUS) can provide useful information to distinguish malignant from benign adnexal masses (#4 cm). |
The 51 masses included 43 benign and 8 malignant lesions. On 3D-CEUS images, benign lesions appeared as round structures formed by sparse and straight capillary vessels. Malignant lesions showed irregular stereo structures with dense and tortuous vascular distribution. A 3D-CEUS scoring system was established. There were no statistically significant differences in scores at each time point between the 20th and 70th seconds, and the area under the receiver operating characteristic curve for this time period was the largest (0.995). A cut-off score of 8 was established, with scores >/=8 being suggestive of malignancy. The 3D-CEUS scoring system had a high sensitivity (100%) and specificity (98%). |
2 |
| 14. Ma X, Zhao Y, Zhang B, et al. Contrast-enhanced ultrasound for differential diagnosis of malignant and benign ovarian tumors: systematic review and meta-analysis. [Review]. Ultrasound Obstet Gynecol. 46(3):277-83, 2015 Sep. |
Meta-analysis |
11 studies |
To assess the performance of contrast-enhanced ultrasound (CE-US) in the differential diagnosis of malignant and benign ovarian tumors. |
Preliminary screening identified 103 papers, of which 11 fulfilled our predefined inclusion criteria and underwent final analysis. The pooled sensitivity and specificity of CE-US for diagnosis of benign and malignant ovarian tumors were 93% (95% CI, 89-96%) and 95% (95% CI, 92-96%), respectively. The pooled diagnostic OR was 171.2 (95% CI, 65.9-444.6) and the AUC was 0.98. I(2) values of sensitivity, specificity and diagnostic OR were 38.3%, 31.7% and 48.4%, respectively, all indicating moderate heterogeneity. |
Good |
| 15. Pereira PN, Sarian LO, Yoshida A, et al. Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource-effective use of a magnetic resonance scoring (ADNEX MR scoring system). Abdom Radiol. 45(10):3218-3229, 2020 10. |
Observational-Dx |
171 patients |
To compare the International Ovarian Tumor Analysis (IOTA) simple rules, simple rules risk ultrasound models, alone or in combination with magnetic resonance (MR) score to predict malignancy in women with adnexal masses. |
The MR score for all patients was the approach that yielded the best-standardized net benefit regardless of the risk threshold. However, referring women with indeterminate masses on SR to MR score yielded the second-best net benefit. |
3 |
| 16. Sadowski EA, Thomassin-Naggara I, Rockall A, et al. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology 2022;303:35-47. |
Review/Other-Dx |
N/A |
To provide guidelines on using the O-RADS MRI risk stratification system in clinical practice, as well as in the educational and research settings. |
No results stated in abstract. |
4 |
| 17. Yamashita Y, Torashima M, Hatanaka Y, et al. Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging. Radiology. 1995;194(2):557-565. |
Observational-Dx |
72 patients |
To determine the accuracy of transvaginal ultrasound (TVUS) and of precontrast and contrast material-enhanced magnetic resonance (MR) imaging in the differentiation of adnexal masses. |
Higher diagnostic accuracy was attained with MR imaging in mature cystic teratomas and endometriomas. However, better accuracy was achieved with contrast-enhanced MR imaging and TVUS in simple cysts, cystadenomas, and malignant tumors because internal details could be visualized. Receiver operating characteristic study indicated that observer confidence was significantly higher with contrast-enhanced MR imaging than with precontrast MR imaging (P = .011) or TVUS (P = .002) in the differentiation of benign and malignant masses. |
2 |
| 18. Sahin H, Panico C, Ursprung S, et al. Non-contrast MRI can accurately characterize adnexal masses: a retrospective study. Eur Radiol. 31(9):6962-6973, 2021 Sep. |
Observational-Dx |
291 patients |
To determine the accuracy of interpretation of a non-contrast MRI protocol in characterizing adnexal masses. |
There were 53/350 (15.1%) malignant lesions in the whole cohort and 20/121 (16.5%) malignant lesions in the random subset. Good agreement between readers was found for the non-contrast MRI score (small ka, Cyrillic = 0.73, 95% confidence interval [CI] 0.58-0.86) whilst the intra-reader agreement was excellent (small ka, Cyrillic = 0.81, 95% CI 0.70-0.88). The non-contrast MRI score value of >/= 4 was associated with malignancy with a sensitivity of 84.9%, a specificity of 95.9%, an accuracy of 94.2% and a positive likelihood ratio of 21 (area under the receiver operating curve 0.93, 95% CI 0.90-0.96). |
3 |
| 19. Guerriero S, Ajossa S, Risalvato A, et al. Diagnosis of adnexal malignancies by using color Doppler energy imaging as a secondary test in persistent masses. Ultrasound Obstet Gynecol. 11(4):277-82, 1998 Apr. |
Observational-Dx |
192 consecutive lesions |
Prospective study to compare the accuracy of B-mode TVS alone and in combination with color Doppler energy (or power Doppler) imaging in differentiating benign from malignant adnexal masses. |
159 benign, 33 malignant. Intratumoral arterial blood flow detected in 100% malignant and in 94% benign. Combined use of TVS and color Doppler has greater accuracy for diagnosing ovarian malignancy than TVS alone (kappa: 0.81 and 0.63). |
3 |
| 20. Schelling M, Braun M, Kuhn W, et al. Combined transvaginal B-mode and color Doppler sonography for differential diagnosis of ovarian tumors: results of a multivariate logistic regression analysis. Gynecol Oncol. 77(1):78-86, 2000 Apr. |
Observational-Dx |
257 patients |
To determine if color-coded Doppler US can improve the diagnostic accuracy of B-mode US in ovarian masses. Preoperative B-mode and Doppler US was performed prospectively in 63 patients with unclear adnexal lesions prior to operation. Using multiple logistic regression, the independent variables of each procedure were selected and combined to yield a diagnostic flow chart. |
39 malignant, 218 benign. Combining independent significant variables of 2 procedures raised the diagnostic accuracy to 90% (sensitivity 86%, specificity 93%). The validity achieved by this combination was confirmed by the independent application of this method to the 257 adnexal tumors with unclear malignancy status (diagnostic accuracy 93%, sensitivity 92%, and specificity 94%).Combination of US and Doppler US yields high and reproducible diagnostic accuracy. |
3 |
| 21. Brown DL, Doubilet PM, Miller FH, et al. Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology. 208(1):103-10, 1998 Jul. |
Observational-Dx |
194 patients (211 lesions) |
To determine the gray-scale and Doppler US features that best enable discrimination between malignant and benign ovarian masses and develop a scoring system for accurate diagnosis with these features. |
28 malignant, 183 benign masses. Masses with markedly hyperechoic solid component or no solid component were benign. In masses with non-hyperechoic solid component, other features helped to discriminate between benign and malignant masses. Scoring formula developed, cut off score yielded sensitivity of 93% and specificity of 93%. |
2 |
| 22. Andreotti RF, Timmerman D, Strachowski LM, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 294(1):168-185, 2020 01. |
Review/Other-Dx |
N/A |
To present a consensus guideline on the O-RADS US Risk Stratification and Management System. |
No results stated in abstract. |
4 |
| 23. Timmerman D, Testa AC, Bourne T, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 31(6):681-90, 2008 Jun. |
Observational-Dx |
1,066 patients with 1,233 adnexal tumors |
To derive simple and clinically useful US-based rules for discriminating between benign and malignant adnexal masses. |
903 benign tumors (73%) and 330 malignant tumors (27%) were present. In 167 patients the tumors were bilateral. Five simple rules were chosen 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. Five simple rules were chosen 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 10 rules were applicable to 76% of all tumors, where they resulted in a sensitivity of 93%, specificity of 90%, LR+ of 9.45 and 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. Most adnexal tumors in an ordinary tumor population can be correctly classified as benign or malignant using simple US-based rules. For tumors that cannot be classified using simple rules, US examination by an expert examiner might be useful. |
3 |
| 24. Kim SH, Sim JS, Seong CK. Interface vessels on color/power Doppler US and MRI: a clue to differentiate subserosal uterine myomas from extrauterine tumors. J Comput Assist Tomogr 2001;25:36-42. |
Observational-Dx |
68 patients |
To assess the usefulness of demonstrating these vessels in differentiating subserosal myomas from extrauterine tumors on color or power Doppler US (CDUS/PDUS) and MRI. |
The interface vessels were demonstrated in 39 of 41 subserosal myomas (18 on CDUS/PDUS, 14 on MRI, 7 on both), whereas they were seen in only 3 of 27 extrauterine tumors (1 on CDUS/PDUS, 2 on MRI). These three extrauterine tumors were ovarian malignancies that directly invaded the uterus. The shapes of these interface vessels were 7 intervening, 12 crossing, and 20 mixed in the myoma group, whereas they were mixed in all three extrauterine tumor groups. The sensitivity/specificity of this finding in differentiating subserosal myomas and extrauterine tumors was 100/92%, 91/91%, and 95/89%, respectively, with CDUS/PDUS, MRI, and either CDUS/PDUS or MRI. |
4 |
| 25. Stein SM, Laifer-Narin S, Johnson MB, et al. Differentiation of benign and malignant adnexal masses: relative value of gray-scale, color Doppler, and spectral Doppler sonography. AJR Am J Roentgenol. 164(2):381-6, 1995 Feb. |
Observational-Dx |
161 patients |
To evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray-scale sonography in differentiating benign from malignant adnexal masses. |
Surgical pathology revealed 123 benign masses and 46 malignant masses. One malignant mass was confirmed by cytologic evaluation of ascitic fluid. On gray-scale analysis, 46 of the 47 malignant masses were classified as suggestive of tumor, and 76 of the 123 benign masses were classified as not suggestive of tumor (sensitivity, 98%; specificity, 62%; negative predictive value [NPV], 99%; and positive predictive value [PPV], 50%). The use of internal color flow as a predictor of malignant tumor yielded a sensitivity of 77%, a specificity of 69%, an NPV of 89%, and a PPV of 49%. The PI and RI values were significantly lower (p < .0001) in malignant masses than in benign masses, although the values overlapped considerably. For a PI of less than 1.0, sensitivity was 67%, specificity was 66%, NPV was 83%, and PPV was 46%. For an RI of less than 0.4, sensitivity was 24%, specificity was 90%, NPV was 73%, and PPV was 50%. |
3 |
| 26. Timmerman D, Schwarzler P, Collins WP, et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol. 13(1):11-6, 1999 Jan. |
Observational-Dx |
300 patients |
To evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses. |
The first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76). |
3 |
| 27. Valentin L.. Prospective cross-validation of Doppler ultrasound examination and gray-scale ultrasound imaging for discrimination of benign and malignant pelvic masses. Ultrasound Obstet Gynecol. 14(4):273-83, 1999 Oct. |
Observational-Dx |
173 patients |
To cross-validate, prospectively, the diagnostic performance of established ultrasound methods for discrimination of benign and malignant pelvic masses. |
Subjective evaluation of the gray-scale ultrasound image was by far the best method for distinguishing benign from malignant tumors (sensitivity 88%, false-positive rate 4%), followed in descending order by subjective evaluation of the gray-scale ultrasound image supplemented with color Doppler examination, the Lerner score and the time-averaged maximum velocity. Adding Doppler examination to subjective evaluation of the gray-scale image did not increase the number of correct diagnoses, but it increased the confidence with which a correct diagnosis was made in 14% of tumors. In 11 tumors (6% of the series as a whole), the addition of Doppler examination changed the diagnosis based on subjective evaluation of the gray-scale ultrasound image from an incorrect (n = 1) or uncertain (n = 10) diagnosis to a correct and confident diagnosis. |
3 |
| 28. Practice Bulletin No. 174 Summary: Evaluation and Management of Adnexal Masses. Obstet Gynecol 2016;128:1193-95. |
Review/Other-Dx |
N/A |
To provide guidelines for the evaluation and management of adnexal masses in adolescents, pregnant women, and nonpregnant women and to outline criteria for the identification of adnexal masses that are likely to be malignant and may warrant referral to or consultation with a gynecologic oncologist. |
No results stated in abstract. |
4 |
| 29. Friedrich L, Meyer R, Levin G. Management of adnexal mass: A comparison of five national guidelines. Eur J Obstet Gynecol Reprod Biol. 265:80-89, 2021 Oct. |
Review/Other-Dx |
5 studies |
To summarize and compare five different adnexal mass management guidelines, enabling clinicians to peruse consensus and controversy issues, thus choosing the optimal management method. |
There is a broad consensus regarding the role of transvaginal ultrasound as part of the initial evaluation of an adnexal mass and the radiological characteristics suggesting it being malignant. The role of transabdominal ultrasound or doppler mode is controversial. The use of MRI in cases of indeterminate adnexal masses is widely accepted. Ultrasound-guided aspiration is generally not recommended. There is a broad consensus that CA-125 should not be used as an ovarian cancer disease screening tool, though its role in the initial evaluation of adnexal masses is controversial. Risk prediction models are generally accepted, particularly the 'International Ovarian Tumor Analysis simple rules' and the 'Risk of Malignancy Index'. |
4 |
| 30. Salvador S, Scott S, Glanc P, et al. Guideline No. 403: Initial Investigation and Management of Adnexal Masses. [Review]. J Obstet Gynaecol Can. 42(8):1021-1029.e3, 2020 08. |
Review/Other-Dx |
N/A |
To aid primary care physicians, emergency medicine physicians, and gynaecologists in the initial investigation of adnexal masses, defined as lumps that appear near the uterus or in or around ovaries, fallopian tubes, or surrounding connective tissue, and to outline recommendations for identifying women who would benefit from a referral to a gynaecologic oncologist for further management. |
No results stated in abstract. |
4 |
| 31. Alcazar JL, Merce LT, Laparte C, Jurado M, Lopez-Garcia G. A new scoring system to differentiate benign from malignant adnexal masses. Am J Obstet Gynecol 2003;188:685-92. |
Observational-Dx |
665 patients |
To develop and cross-validate a new sonographic scoring system for differentiation between benign and malignant adnexal masses. |
Multivariate logistic regression analysis revealed that the only independent predictor parameters were thick papillary projections, solid areas, central flow, and velocimetric features of high velocity and low resistance. In the prospective cross-validation study, our scoring system had the best diagnostic performance (area under the curve, 0.98) compared with Sassone (area under the curve, 0.89; P =.017), De Priest (area under the curve, 0.92; P =.048), and Ferrazzi (area under the curve, 0.90; P =.013) scoring systems. |
4 |
| 32. Amor F, Vaccaro H, Alcazar JL, Leon M, Craig JM, Martinez J. Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings. J Ultrasound Med. 28(3):285-91, 2009 Mar. |
Observational-Dx |
171 women |
To describe a new reporting system called the GI-RADS for reporting findings in adnexal masses based on TVS. |
187 masses were evaluated. The prevalence rate for malignant tumors was 13.4%. Overall GI-RADS classification rates were as follows: GI-RADS 1, 4 cases (2.1%); GI-RADS 2, 52 cases (27.8%); GI-RADS 3, 90 cases (48.1%); GI-RADS 4, 13 cases (7%); and GI-RADS 5, 28 cases (15%). The sensitivity, specificity, PPV, NPV, and accuracy were 92%, 97%, 85%, 99%, and 96%, respectively. The proposed reporting system showed good diagnostic performance. It is simple and could facilitate communication between sonographers/sonologists and clinicians. |
3 |
| 33. Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2010;256:943-54. |
Review/Other-Dx |
N/A |
To provide consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. |
No results stated in abstract. |
4 |
| 34. Suh-Burgmann E, Flanagan T, Osinski T, Alavi M, Herrinton L. Prospective Validation of a Standardized Ultrasonography-Based Ovarian Cancer Risk Assessment System. Obstet Gynecol. 132(5):1101-1111, 2018 11. |
Observational-Dx |
6838 patients |
To evaluate the performance of a system that standardizes ovarian cancer risk assessment and reporting on ultrasonography. |
Among 43,606 women undergoing ultrasonography, 6,838 (16%) had an abnormal adnexal mass reported: 70% were category 1, 21% category 2, 3.7% category 3, and 5.4% category X. Among these women, 89 (1.3%) were subsequently diagnosed with ovarian cancer and 59 (0.9%) with borderline tumors. The risks of ovarian cancer diagnosis associated with masses reported as categories 1, 2, 3, and X were 0.2% (95% CI 0.05-0.3%), 1.3% (95% CI 0.7-1.9%), 6.0% (95% CI 3.0-8.9%), and 13.0% (95% CI 9.5-16.4%), respectively; risks of either ovarian cancer or borderline tumor were 0.4% (95% CI 0.2-0.6%), 2.3% (95% CI 1.6-3.1%), 10.4% (95% CI 6.6-14.1%), and 18.9% (95% CI 14.9-23.0%) respectively. Among 36,768 (84%) women with normal or benign adnexal findings reported, 38 women were diagnosed with ovarian cancer, for a risk of 0.1% (95% CI 0.07-0.14%). |
3 |
| 35. Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, van Nagell JR, Jr. Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography. Gynecol Oncol. 2003; 91(1):46-50. |
Observational-Dx |
442 women with ovarian tumors; Doppler studies performed in 371 |
To determine the efficacy of morphology indexing and Doppler flow sonography as methods to predict risk of malignancy in sonographically confirmed ovarian tumors. |
Of 315 tumors with a morphology index <5 there was only 1 malignancy (a stage IA granulosa cell tumor <2 cm in diameter), whereas there were 52 malignancies in 127 tumors with a morphology index =5. Stage of disease was as follows: stage I, 33; stage II, 6; stage III, 14. Risk of malignancy was related directly to morphology index score, varying from 0.3% in tumors with a morphology index <5 to 84% in tumors with a morphology index =8. A morphology index value of =5 as indicative of malignancy was associated with the following statistical parameters: sensitivity 0.981, specificity 0.808, PPV 0.409, NPV 0.997. A pulsatility index <1.0 as indicative of malignancy was associated with: sensitivity 0.528, specificity 0.776, PPV 0.288, NPV 0.906. A resistive index <0.4 as indicative of malignancy was associated with: sensitivity 0.222, specificity 0.867, PPV 0.222, and NPV 0.867. Morphology indexing is an accurate and inexpensive method of differentiating benign from malignant ovarian tumors, and can be a valuable adjunct in treatment planning. The addition of Doppler flow studies did not improve diagnostic accuracy of morphology index. |
3 |
| 36. Van Calster B, Van Hoorde K, Valentin L, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ. 349:g5920, 2014 Oct 15. |
Observational-Dx |
5909 women |
To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive. |
The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. |
3 |
| 37. Andreotti RF, Timmerman D, Benacerraf BR, et al. Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J. Am. Coll. Radiol.. 15(10):1415-1429, 2018 Oct. |
Review/Other-Dx |
N/A |
To describe the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions and the resultant lexicon. |
No results stated in abstract. |
4 |
| 38. Testa A, Kaijser J, Wynants L, et al. Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study. Br J Cancer. 111(4):680-8, 2014 Aug 12. |
Observational-Dx |
2403 patients |
|
|
3 |
| 39. Timmerman D, Valentin L, Bourne TH, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. [Review] [12 refs]. Ultrasound Obstet Gynecol. 16(5):500-5, 2000 Oct. |
Review/Other-Dx |
N/A |
To describe the sonographic features of adnexal tumors |
No results stated in abstract. |
4 |
| 40. Timmerman S, Valentin L, Ceusters J, et al. External Validation of the Ovarian-Adnexal Reporting and Data System (O-RADS) Lexicon and the International Ovarian Tumor Analysis 2-Step Strategy to Stratify Ovarian Tumors Into O-RADS Risk Groups. JAMA Oncol 2023;9:225-33. |
Observational-Dx |
8519 patients |
|
|
3 |
| 41. Levine D, Patel MD, Suh-Burgmann EJ, et al. Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting. Radiology. 293(2):359-371, 2019 11. |
Review/Other-Dx |
N/A |
To align prior Society of Radiologists in Ultrasound (SRU) guidelines on simple adnexal cysts with recent large studies showing exceptionally low risk of cancer associated with simple adnexal cysts. |
No results stated in abstract. |
4 |
| 42. Ghosh E, Levine D. Recommendations for adnexal cysts: have the Society of Radiologists in Ultrasound consensus conference guidelines affected utilization of ultrasound? Ultrasound Q 2013;29:21-4. |
Observational-Dx |
N/A |
To assess the impact of using the resulting guidelines in our institution during 1-month periods before and after publication of the guidelines. |
Over the time period evaluated, the number of pelvic sonograms performed in our department decreased by 27%. The overall number of cysts with recommendations for follow-up decreased from February 2009 (132 studies with recommendations for follow-up in 870 pelvic ultrasound examinations, 15%) to February 2011 (71 recommendations for follow-up in 639 examinations, 11%; P = 0.02). The percentage of premenopausal simple cysts and classic hemorrhagic cysts described as less than 5 cm where follow-up was recommended decreased from 39/48 (89%) to 2/29 (7%, P < 0.0001). |
3 |
| 43. Maturen KE, Blaty AD, Wasnik AP, et al. Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines. Radiology. 285(2):650-659, 2017 11. |
Observational-Dx |
500 patients |
To evaluate the performance of the 2010 Society of Radiologists in Ultrasound (SRU) consensus guidelines in the risk stratification of symptomatic and asymptomatic adnexal cysts. |
A total of 570 cysts in 500 women aged 18-90 years (mean, 42 years) were included. There were 475 (83.3%) nonneoplastic cysts, 77 (13.5%) benign neoplasms, and 18 (3.2%) malignant neoplasms. Of the 500 women, 161 (32.2%) were asymptomatic. In the surgically focused interpretation of guidelines, proportions of any neoplasm and malignant neoplasm, respectively, were 1% and 0% in SRU 0, 17% and 1% in SRU 1, 48% and 0% in SRU 2, and 48% and 16% in SRU 3 (P < .0001 for both trends). In the interpretation of SRU guidelines with MR imaging when it was an option, proportions of any neoplasm and malignant neoplasm, respectively, were 1% and 0% in SRU 0, 17% and 1% in SRU 1, 38% and 5% in SRU 2, and 81% and 52% in SRU 3 (P < .0001, both trends) and 82 (89.1%) fewer benign cysts would have gone directly to surgical evaluation. In multivariate regression, SRU rating predicted both any neoplasm (odds ratio, 2.58; P < .0001) and malignant neoplasm (odds ratio, 4.94; P = .005). |
3 |
| 44. Patel-Lippmann KK, Sadowski EA, Robbins JB, et al. Comparison of International Ovarian Tumor Analysis Simple Rules to Society of Radiologists in Ultrasound Guidelines for Detection of Malignancy in Adnexal Cysts. AJR Am J Roentgenol. 214(3):694-700, 2020 03. |
Observational-Dx |
697 patients |
To evaluate the International Ovarian Tumor Analysis (IOTA) simple rules and the Society of Radiologists in Ultrasound (SRU) guidelines for detecting ovarian malignancy in a general population of women presenting to radiology departments with adnexal cystic lesions. |
A total of 697 women with 764 cystic lesions were included; 85.2% (651/764) of the lesions were nonneoplastic, 12.2% (93/764) were benign neoplasms, and 2.6% (20/764) were malignant neoplasms. Nearly all malignancies were classified into indeterminate and malignant categories. The prevalence of malignancy in the indeterminate category was 4.8% (7/145) (SRU) to 10.7% (7/65) (IOTA) and in the malignant category was 18.1% (13/72) (SRU) to 34.3% (12/35) (IOTA). Only one malignancy was misclassified as benign by the IOTA simple rules. The sensitivity of the IOTA simple rules for malignancy was 90.0%; specificity, 96.5%; PPV, 29.0%; NPV, 99.8%; and accuracy, 96.4%. The corresponding values for the SRU guidelines were 100%, 89.6%, 14.9%, 100%, and 89.8%. In ROC analysis, the IOTA simple rules were slightly more accurate than the SRU guidelines (AUC, 0.9805 versus 0.9713; p = 0.0003). |
3 |
| 45. Basha MAA, Metwally MI, Gamil SA, et al. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur Radiol. 31(2):674-684, 2021 Feb. |
Observational-Dx |
609 patients |
To compare the O-RADS with two other well-established US classification systems for diagnosis of AM. |
Of the 647 AM, 178 were malignant and 469 were benign. Malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. O-RADS had significantly higher sensitivity for malignancy than GI-RAD and IOTA (p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (p > 0.05). O-RADS, GI-RADS, and IOTA showed similar overall IRA (kappa = 0.77, 0.69, and 0.63, respectively) with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA. |
2 |
| 46. Greenlee RT, Kessel B, Williams CR, et al. Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial. Am J Obstet Gynecol 2010;202:373 e1-9. |
Review/Other-Dx |
15735 patients |
To measure the occurrence and natural history of simple ovarian cysts in a cohort of older women. |
Simple cysts were seen in 14% of women the first time that their ovaries were visualized. The 1-year incidence of new simple cysts was 8%. Among ovaries with 1 simple cyst at the first screen, 54% retained 1 simple cyst, and 32% had no cyst 1 year later. Simple cysts did not increase risk of subsequent invasive ovarian cancer. |
4 |
| 47. Sharma A, Gentry-Maharaj A, Burnell M, et al. Assessing the malignant potential of ovarian inclusion cysts in postmenopausal women within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a prospective cohort study. BJOG 2012;119:207-19. |
Observational-Dx |
48,230 patients |
To evaluate the malignant potential of ultrasound-detected ovarian inclusion cysts in the development of ovarian cancer (OC) in postmenopausal women. |
Postmenopausal women (n = 48,230) attended the year 1 (11 June 2001-6 December 2006) screen; 1234 (2.5%) had inclusion cysts alone and 22,914 had normal scans. By 1 November 2009 (median follow-up, 6.13 years; interquartile range, 4.96-6.98 years), four, three (one Type II), seven and 22 women with inclusion cysts and 32, 29 (20 Type II), 90 and 397 women with normal ovaries were diagnosed with OC, iEOC, EC and BC, respectively. The RR values for the respective cancers (OC [RR, 2.32; confidence interval [CI], 0.86-6.28], iEOC [RR, 1.92; CI, 0.62-5.92], EC [RR, 1.44; CI, 0.68-3.05], BC [RR, 1.12; CI, 0.73-1.73]) were not increased. There was no difference between the observed versus expected incidence rates for these cancers in women with inclusion cysts. |
3 |
| 48. Smith-Bindman R, Poder L, Johnson E, Miglioretti DL. Risk of Malignant Ovarian Cancer Based on Ultrasonography Findings in a Large Unselected Population. JAMA Intern Med. 179(1):71-77, 2019 01 01. |
Observational-Dx |
210 patients |
To quantify the risk of ovarian cancer based on ultrasonographic characteristics of ovarian masses, including simple cysts, in a large unselected population. |
Among 210 women who were diagnosed as having ovarian cancer, 49 were younger than 50 years, and 161 were 50 years or older. Ultrasonography findings were predictive of cancer (C statistic, 0.89). The risk of cancer was significantly elevated in women with complex cysts or solid masses, with likelihood ratios relative to women with normal ovaries ranging from 8 to 74 and the 3-year risk of cancer ranging from 9 to 430 cases per 1000 women based on patient age and ultrasonography findings. In contrast, the 23.8% of women younger than 50 years and the 13.4% of women 50 years or older with simple cysts were not at a significantly increased risk of ovarian cancer compared with women with normal ovaries. Likelihood ratios associated with the detection of a simple cyst were 0.00 in women younger than 50 years (no cancers were identified) and 0.10 (95% CI, 0.01-0.48) in women 50 years or older, and the absolute 3-year risk of cancer ranged from 0 to 0.5 cases per 1000 women. |
3 |
| 49. Erickson BK, Conner MG, Landen CN, Jr. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol 2013;209:409-14. |
Review/Other-Dx |
N/A |
To review epithelial ovarian cancer classification and genetics, theories regarding cells of origin with a focus on tubal intraepithelial carcinoma, and implications for prevention and screening. |
No results stated in abstract. |
4 |
| 50. Froyman W, Landolfo C, De Cock B, et al. Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study. Lancet Oncol. 20(3):448-458, 2019 03. |
Observational-Dx |
8519 patients |
To estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified as benign by use of ultrasonography. |
3144 (37%) patients selected for conservative management were eligible for inclusion in our analysis, of whom 221 (7%) had no follow-up data and 336 (11%) were operated on before a planned follow-up scan was done. Of 2587 (82%) patients with follow-up data, 668 (26%) had a mass that was already in follow-up at recruitment, and 1919 (74%) presented with a new mass at recruitment (ie, not already in follow-up in the centre before recruitment). Median follow-up of patients with new masses was 27 months (IQR 14-38). The cumulative incidence of spontaneous resolution within 2 years of follow-up among those with a new mass at recruitment (n=1919) was 20.2% (95% CI 18.4-22.1), and of finding invasive malignancy at surgery was 0.4% (95% CI 0.1-0.6), 0.3% (<0.1-0.5) for a borderline tumour, 0.4% (0.1-0.7) for torsion, and 0.2% (<0.1-0.4) for cyst rupture. |
2 |
| 51. Guerriero S, Van Calster B, Somigliana E, et al. Age-related differences in the sonographic characteristics of endometriomas. Hum Reprod. 31(8):1723-31, 2016 08. |
Observational-Dx |
5914 patients |
To evaluate age-related differences in the sonographic characteristics of endometriomas. |
Maximal lesion diameter did not vary substantially with age (+1.3 mm difference per 10 years increase in age, 95% confidence interval (CI) -1.4 to 4.0). Tender mass at scan was less common in the older the woman (OR 0.75, 95% CI 0.63-0.89), as were unilocular cysts relative to multilocular cysts (OR 0.70, 95% CI 0.57-0.85) and to lesions with solid components (OR 0.61, 95% CI 0.48-0.77), and ground glass echogenicity relative to homogeneous low-level echogenicity (OR 0.74, 95% CI 0.58-0.94) and other types of echogenicity of cyst contents (OR 0.64, 95% CI 0.50-0.81). Papillations were more common the older the woman (OR 1.65, 95% CI 1.24-2.21), but their height and vascularization showed no clear relation to age. |
3 |
| 52. Testa AC, Timmerman D, Van Holsbeke C, et al. Ovarian cancer arising in endometrioid cysts: ultrasound findings. Ultrasound Obstet Gynecol 2011;38:99-106. |
Observational-Dx |
324 patients |
To describe sonographic characteristics of malignant transformation in endometrioid cysts. |
Of 324 cases collected for the study, 309 (95.3%) lesions were classified as endometrioid cysts, four (1.2%) as borderline tumors arising in endometrioid cysts and 11 (3.4%) as carcinoma arising in endometrioid cysts. Women with malignant findings (borderline ovarian tumors and cancers) were older (median age 52 (range, 28-79) years) than those with benign endometrioid cysts (median age 34 (range, 18-76) years) (P<0.0001), and the prevalence of postmenopausal status was significantly higher in malignant cases. All (15/15) malignant tumors vs. 16% (50/309) of benign tumors were characterized by the presence of solid tissue (P<0.0001). The prevalence of solid tissue with positive Doppler signals was higher in malignant tumors (100%) than in benign cysts (7.8%) (P<0.0001). Papillary projections were a more frequent sonographic feature among malignant lesions (86.7%) than among benign endometrioid cysts (11.3%) (P<0.0001); power Doppler signals were detected within the projections in 92.3% and 37.1% of malignant and benign lesions, respectively. The examiner correctly diagnosed 94.8% (293/309) of benign lesions as benign and 93.3% (14/15) of malignant lesions as malignant. The risk estimation of the examiner was 'uncertain' in three (20%) and 'probably/certainly malignant' in 12 (80%) of 15 malignant cases. |
3 |
| 53. Pascual MA, Graupera B, Pedrero C, et al. Long-term Results for Expectant Management of Ultrasonographically Diagnosed Benign Ovarian Teratomas. Obstet Gynecol. 130(6):1244-1250, 2017 12. |
Observational-Dx |
408 patients |
To assess the natural history of ultrasonographically diagnosed benign ovarian teratomas in asymptomatic women. |
During follow-up, 130 of 408 (31.8%) women underwent surgery. The main reason for surgery was the physician's recommendation according to our protocol (n=115). One patient had adnexal torsion. Most surgeries (112/130 [86.2%]) were performed within the first 5 years after diagnosis. The remainder (278/408) is still being followed (median time 45.6 months, range 6-147 months). The vast majority of these lesions had no change and women remain asymptomatic. Histologic diagnosis of tumors removed surgically revealed a benign ovarian teratoma in 103 of 130 (79.2%) of the women. There were two borderline tumors, four endometriomas, three fibromas, seven serous cysts, two mucinous cysts, two stroma ovarii, seven other benign, and no case of malignant tumor. |
3 |
| 54. Gupta A, Jha P, Baran TM, et al. Ovarian Cancer Detection in Average-Risk Women: Classic- versus Nonclassic-appearing Adnexal Lesions at US. Radiology. 303(3):603-610, 2022 06. |
Observational-Dx |
878 patients |
To explore whether a US-based classification scheme of classic versus nonclassic appearance can be used to help appropriately triage women at average risk of ovarian cancer without compromising diagnostic performance. |
A total of 970 isolated lesions in 878 women (mean age, 42 years +/- 14 [SD]) were included. The malignancy rate for classic lesions was less than 1%. Of 970 lesions, 53 (6%) were malignant. The malignancy rate for nonclassic lesions was 32% (33 of 103) when blood flow was present and 8% (16 of 194) without blood flow (P < .001). For women older than 60 years, the malignancy rate was 50% (10 of 20 lesions) when blood flow was present and 13% (five of 38) without blood flow (P = .004). The sensitivity, specificity, positive predictive value, and negative predictive value of the classic-versus-nonclassic schema was 93% (49 of 53 lesions), 73% (669 of 917 lesions), 17% (49 of 297 lesions), and 99% (669 of 673 lesions), respectively, for detection of malignancy. |
3 |
| 55. Parazzini F, Frattaruolo MP, Chiaffarino F, Dridi D, Roncella E, Vercellini P. The limited oncogenic potential of unilocular adnexal cysts: A systematic review and meta-analysis. [Review]. Eur J Obstet Gynecol Reprod Biol. 225:101-109, 2018 Jun. |
Meta-analysis |
34 studies |
To quantify the risk of malignancies among echoic and anechoic unilocular adnexal cysts, in premenopausal and postmenopausal women. |
Of the 2177 surgically removed lesions classified as unilocular cysts on pre-operative ultrasound, 24 (1.1%; 95% CI: 0.74-1.66) were malignant (among these 12 had borderline malignancy: 0.6%). The rates were lower for premenopausal women (6/987, 0.6%) than postmenopausal ones (12/372, 3.2%). Of the 2290 surgically removed lesions classified as anechoic unilocular cysts on ultrasound, 20 (0.9%; 95% CI: 0.57-1.35) were malignant (among these 8 had borderline malignancy: 0.3%). The rates were lower for premenopausal women (3/907, 0.3%) than postmenopausal ones (13/681, 1.9%) (Pearson chi-square P=0.002). When we performed meta-analysis selecting studies including only anechoic unilocular cysts published after 2000 and with 100 or more patients, the estimate was 0.5 (95% CI 0.1-1.2) with no heterogeneity (heterogeneity chi-square P=0.175). |
Good |
| 56. Valentin L, Ameye L, Franchi D, et al. Risk of malignancy in unilocular cysts: a study of 1148 adnexal masses classified as unilocular cysts at transvaginal ultrasound and review of the literature. [Review]. Ultrasound Obstet Gynecol. 41(1):80-9, 2013 Jan. |
Observational-Dx |
3511 patients |
To estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination and to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. |
Of the 3511 masses, 1148 (33%) were classified as unilocular cysts on ultrasound. Of these, 11 (0.96% (95% CI, 0.48-1.71)) were malignant. The malignancy rate was lower in premenopausal than in postmenopausal women: 0.54% (5/931; 95% CI, 0.17-1.25) vs. 2.76% (6/217; 95% CI, 1.02-5.92); P?=?0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% vs. 2%; P?=?0.02) or ovarian cancer (18% vs 0.6%; P?=?0.003). Hemorrhagic cyst contents on ultrasound were more common in malignant than in benign unilocular cysts (18% vs. 2%; P?=?0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. |
3 |
| 57. Jha P, Shekhar M, Goldstein R, Morgan T, Poder L. Size threshold for follow-up of postmenopausal adnexal cysts: 1 cm versus 3 cm. Abdom Radiol. 45(10):3213-3217, 2020 10. |
Observational-Dx |
896 patients |
To assess 3 cm size threshold for follow-up of simple cysts in postmenopausal women. |
4388 patients met the initial search criteria. 919 cysts in 896 women (age: 50-91 years, mean: 61.5 years) were identified. We found 162 cysts </= 1 cm, 352 1-3 cm, 296 3-7 cm , and 51 >/= 7 cm cysts. 127 patients with 1-3 cm cysts had no follow-up. Final analysis of 225 1-3 cm cysts included 203 ovarian and 22 paraovarian cysts (average size = 1.95 cm (1.1-3.0 cm)). 103 ovarian cysts had less than 2 years, and 100 cysts had more than 2 years follow-up. All except one ovarian cyst were stable for the entire duration of their follow-up (Mean duration of follow-up 5.4 years) (0.3%, 95% CI 0.0-0.05). 40 cysts resolved. One simple cyst increased in size (followed over 3.25 years) without suspicious imaging features and benign on surgery. |
3 |
| 58. Modesitt SC, Pavlik EJ, Ueland FR, DePriest PD, Kryscio RJ, van Nagell JR, Jr. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol. 2003;102(3):594-599. |
Review/Other-Dx |
15,106 asymptomatic women |
To determine the natural history and estimate the risk of malignancy of unilocular ovarian cystic tumors <10 cm in diameter followed by TVS. |
The risk of malignancy in unilocular ovarian cystic tumors <10 cm in diameter in women 50 years or older is extremely low. Majority will resolve and can be followed with serial TVS. |
4 |
| 59. Van Holsbeke C, Van Calster B, Guerriero S, et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 35(6):730-40, 2010 Jun. |
Observational-Dx |
713 patients |
To describe the ultrasound characteristics of endometriomas in pre- and postmenopausal patients and to develop rules that characterize endometriomas. |
Of all 3511 patients included in the IOTA studies, 713 (20%) had endometriomas. Fifty-one per cent of the endometriomas were unilocular cysts with ground glass echogenicity of the cyst fluid. These characteristics were found less often among other benign tumors or malignancies, or among the small set of endometriomas (4%) that were found in postmenopausal patients. Based on the decision-tree analysis, the optimal rule to detect endometriomas was 'an adnexal mass in a premenopausal patient with ground glass echogenicity of the cyst fluid, one to four locules and no papillations with detectable blood flow'. Based on clinical considerations, the following rule: 'premenopausal status, ground glass echogenicity of the cyst fluid, one to four locules and no solid parts' seems preferable. |
3 |
| 60. Sadowski EA, Paroder V, Patel-Lippmann K, et al. Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer. Radiology. 287(3):1041-1049, 2018 Jun. |
Observational-Dx |
1637 patients |
To assess the prevalence of indeterminate adnexal cysts in women presenting to academic medical centers for pelvic ultrasonography (US), determine the incidence of malignancy, and identify cyst and patient characteristics that are predictive of malignancy. |
There were 1637 women with an adnexal cyst at US; 391 (mean age = 41.8 years +/- 13.5.1; range = 17-91 years) had an indeterminate adnexal cyst at US. The prevalence of indeterminate adnexal cysts was 23.9% (391 of 1637; 95% confidence interval [CI]: 0.22, 0.26). Three hundred three indeterminate cysts in 280 women (mean age = 42.9 years +/- 14.1; range = 17-88 years) had adequate follow-up. The incidence of ovarian neoplasms (benign and malignant) was 24.8% (75 of 303 cysts; 95% CI: 0.20, 0.30), and the incidence of malignant tumors was 3.6% (11 of 303 cysts; 95% CI: 0.02, 0.06). The proportion of ovarian neoplasms differed between category 1 and category 2 cysts (17.5% [25 of 143 cysts; 95% CI: 0.12, 0.25] vs 31.3% [50 of 160 cysts; 95% CI: 0.24, 0.39], respectively; P = .001). The proportion of malignant tumors differed between categories 1 and 2 cysts (0% [0 of 143 cysts] vs 6.9% [11 of 160 cysts; 95% CI: 0.03, 0.12]; P < .001). The presence of an avascular nodular component was a significant predictor of malignancy at stepwise logistic regression analysis (odds ratio = 2.83; P </= .0001; 95% CI: 1.69, 4.70). |
3 |
| 61. Timmerman D, Ameye L, Fischerova D, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 341:c6839, 2010 Dec 14. |
Observational-Dx |
1938 patients |
To prospectively assess the diagnostic performance of simple ultrasound rules to predict benignity/malignancy in an adnexal mass and to test the performance of the risk of malignancy index, two logistic regression models, and subjective assessment of ultrasonic findings by an experienced ultrasound examiner in adnexal masses for which the simple rules yield an inconclusive result. |
Of the 1938 patients with an adnexal mass, 1396 (72%) had benign tumours, 373 (19.2%) had primary invasive tumours, 111 (5.7%) had borderline malignant tumours, and 58 (3%) had metastatic tumours in the ovary. The simple rules yielded a conclusive result in 1501 (77%) masses, for which they resulted in a sensitivity of 92% (95% confidence interval 89% to 94%) and a specificity of 96% (94% to 97%). The corresponding sensitivity and specificity of subjective assessment were 91% (88% to 94%) and 96% (94% to 97%). In the 357 masses for which the simple rules yielded an inconclusive result and with available results of CA-125 measurements, the sensitivities were 89% (83% to 93%) for subjective assessment, 50% (42% to 58%) for the risk of malignancy index, 89% (83% to 93%) for logistic regression model 1, and 82% (75% to 87%) for logistic regression model 2; the corresponding specificities were 78% (72% to 83%), 84% (78% to 88%), 44% (38% to 51%), and 48% (42% to 55%). Use of the simple rules as a triage test and subjective assessment for those masses for which the simple rules yielded an inconclusive result gave a sensitivity of 91% (88% to 93%) and a specificity of 93% (91% to 94%), compared with a sensitivity of 90% (88% to 93%) and a specificity of 93% (91% to 94%) when subjective assessment was used in all masses. |
3 |
| 62. Timmerman D, Planchamp F, Bourne T, et al. ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. Int J Gynecol Cancer 2021;31:961-82. |
Review/Other-Dx |
N/A |
To present ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement. |
No results stated in abstract. |
4 |
| 63. Nishizawa S, Inubushi M, Okada H. Physiological 18F-FDG uptake in the ovaries and uterus of healthy female volunteers. Eur J Nucl Med Mol Imaging 2005;32:549-56. |
Review/Other-Dx |
133 patients |
To investigate the physiological 18F-FDG uptake in the ovaries and uterus of healthy female volunteers. |
Distinct ovarian 18F-FDG uptake with an SUV of 3.9+/-0.7 was observed in 26 premenopausal women out of 32 examined during the late follicular to early luteal phase of the menstrual cycle. Eighteen of the 32 women also showed focal 18F-FDG uptake in the endometrium, with an SUV of 3.3+/-0.3. On the other hand, all nine women in the first 3 days of the menstrual cycle demonstrated intense 18F-FDG uptake in the endometrium, with an SUV of 4.6+/-1.0. No physiological 18F-FDG uptake was observed in the ovaries or uterus of any postmenopausal women. |
4 |
| 64. Takagi H, Sakamoto J, Osaka Y, Shibata T, Fujita S, Sasagawa T. Utility of 18F-fluorodeoxyglucose-positron emission tomography in the differential diagnosis of benign and malignant gynaecological tumours. J Med Imaging Radiat Oncol 2018. |
Observational-Dx |
63 patients |
To investigate the intensity of FDG uptake/metabolic activity for the differential diagnosis of benign and malignant gynaecological tumours. |
Among the 63 patients with ovarian tumours, the mean SUVmax of 22 patients with benign ovarian tumours was 2.48 and the mean SUVmax of 41 patients with malignant ovarian tumours was 10.98 (P < 0.001). In the ROC curve analysis, the area under the curve (AUC) was 0.977, with a 95% confidence interval of 0.947-1.000. With a cut-off value of 3.97 for the optimal SUVmax, the sensitivity and specificity were 95.1% and 86.4%, respectively. In addition, the AUC was 0.911 (95% CI: 0.768-1.000) for the assessment of uterine myomas and sarcomas. With a cut-off value of 10.62 for the optimal SUVmax, the sensitivity and specificity were 91.7% and 86.7% respectively. |
3 |
| 65. Tanizaki Y, Kobayashi A, Shiro M, et al. Diagnostic value of preoperative SUVmax on FDG-PET/CT for the detection of ovarian cancer. Int J Gynecol Cancer 2014;24:454-60. |
Observational-Dx |
160 patients |
To investigate the preoperative diagnostic value of F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) in patients with ovarian cancer. |
Postoperative pathological diagnoses showed that 67 were malignant, 14 were borderline malignant, and 79 were benign tumors. With the use of a cutoff SUVmax of 2.9 obtained from the receiver operating characteristic curve analysis, the sensitivity, specificity, positive predictive value, and negative predictive value for detecting malignancy were 80.6%, 94.6%, 91.5%, and 87.1%, respectively. Positive FDG accumulation (SUVmax >/= 2.9) was shown in 89.5% of serous adenocarcinoma and in 92.3% of endometrioid adenocarcinoma. In contrast, lower frequencies of positive FDG accumulation were shown in clear cell adenocarcinoma (54.5%), mucinous adenocarcinoma (66.7%), and metastatic carcinoma (66.7%), and the median SUVmax of these 3 histological types were significantly lower than those of serous and endometrioid types. In addition, a positive FDG accumulation was shown in all patients with malignant transformation of mature cystic teratoma. Finally, of the 14 borderline malignant tumors, only 2 (14.3%) showed positive FDG accumulation. |
3 |
| 66. Yamamoto Y, Oguri H, Yamada R, Maeda N, Kohsaki S, Fukaya T. Preoperative evaluation of pelvic masses with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography. Int J Gynaecol Obstet 2008;102:124-7. |
Observational-Dx |
30 patients |
To prospectively evaluate the diagnostic value of combined 18F-fluorodeoxyglucose position emission tomography and computed tomography (FDG-PET/CT) to discriminate malignant or borderline malignant tumors from benign pelvic masses. |
The sensitivity and specificity of FDG-PET/CT to detect malignant or borderline malignant pelvic tumors were 71.4% and 81.3%, respectively. The sensitivity and specificity of FDG-PET/CT to detect ovarian cancer were 100% and 85.0%, respectively. The maximum standardized uptake value in borderline tumors was significantly lower compared with malignant tumors, but not significantly different compared with benign tumors. |
3 |
| 67. Iyer VR, Lee SI. MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol 2010;194:311-21. |
Review/Other-Dx |
N/A |
To describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions. |
No results stated in abstract. |
4 |
| 68. Forstner R, Thomassin-Naggara I, Cunha TM, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 27(6):2248-2257, 2017 Jun. |
Review/Other-Dx |
N/A |
To provide an update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques. |
No results stated in abstract. |
4 |
| 69. Anthoulakis C, Nikoloudis N. Pelvic MRI as the "gold standard" in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review. [Review]. Gynecol Oncol. 132(3):661-8, 2014 Mar. |
Review/Other-Dx |
10 references |
To conduct a systematic review, following the PRISMA guidelines, and critically appraise pelvic MR Imaging as the preferred advanced second imaging test, as regards detection of ovarian cancer and assessment of indeterminate adnexal masses, with respect to pre-operatively improving the assignment of these patients to the appropriate level of care. |
Computerized database search revealed 37 citations of relevance, 10 of which fulfilled the inclusion/exclusion criteria. From the aforementioned, 8 articles were acquired (2 authors were contacted but did not respond) as well as assessed with AHRQ, QUADAS, and STARD evaluation tools. Finally, 6 papers (5 prospective and 1 retrospective) were included in the systematic review. |
4 |
| 70. Thomassin-Naggara I, Aubert E, Rockall A, et al. Adnexal masses: development and preliminary validation of an MR imaging scoring system. Radiology 2013;267:432-43. |
Observational-Dx |
394 patients |
To construct and undertake preliminary validation of a magnetic resonance (MR) imaging scoring system designed for use in pelvic MR imaging performed for characterization of adnexal masses that were indeterminate at ultrasonography (US). |
There was almost perfect agreement (kappa > 0.80) for each MR imaging feature except for grouped septa (kappa = 0.558) and thickened regular septa (kappa = 0.555). The classification was accurate in both the training set (area under the receiver operating characteristic [ROC] curve [AUC] = 0.981 for reader 1 and 0.961 for reader 2) and the validating set (AUC = 0.964 for reader 1 and 0.943 for reader 2). ROC curve analysis demonstrated that the optimal cutoff point was an ADNEX MR score of 3; an ADNEX MR score of 4 or higher was associated with malignancy with a sensitivity of 93.5% (58 of 62) and a specificity of 96.6% (258 of 267). |
2 |
| 71. Sadowski EA, Maturen KE, Rockall A, et al. Ovary: MRI characterisation and O-RADS MRI. [Review]. Br J Radiol. 94(1125):20210157, 2021 Sep 01. |
Review/Other-Dx |
N/A |
To review MRI characterization and risks stratification of lesions. |
No results stated in abstract. |
4 |
| 72. Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, et al. Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically Indeterminate Adnexal Masses. JAMA netw. open. 3(1):e1919896, 2020 01 03. |
Observational-Dx |
1340 patients |
To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. |
A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (kappa = 0.784; 95% CI, 0.743-0824). Of 580 of 1130 women (51.3%) with a mass on MRI and no specific gynecological symptoms, 362 (62.4%) underwent surgery. Of them, 244 (67.4%) had benign lesions and a score of 3 or less. The MRI score correctly reclassified the mass origin as nonadnexal with a sensitivity of 0.99 (95% CI, 0.98-0.99; 1360 of 1372 patients) and a specificity of 0.78 (95% CI, 0.71-0.85; 102 of 130 patients). |
3 |
| 73. Bernardin L, Dilks P, Liyanage S, Miquel ME, Sahdev A, Rockall A. Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation. Eur Radiol 2012;22:880-90. |
Observational-Dx |
63 patients |
To determine whether threshold criteria using semi-quantitative multiphase-dynamic contrast-enhanced magnetic resonance imaging (DCE- MRI) can improve prediction of malignancy in complex adnexal masses. |
There was a significant difference in mean SI(max) (P < 0.05), SI(rel) (P < 0.01) and WIR (P < 0.001) between benign and borderline/invasive malignant groups. A cut-off WIR >/= 9.5 l/s had a specificity of 88% and positive predictive value of 86% for predicting malignancy, significantly better than conventional MRI (62%, P < 0.01). WIR <8.2 l/s had a negative predictive value of 94%. |
2 |
| 74. Dilks P, Narayanan P, Reznek R, Sahdev A, Rockall A. Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass? Eur Radiol 2010;20:2176-83. |
Observational-Dx |
25 patients |
To establish threshold criteria based on quantitative DCE-MRI data as independent predictors of malignancy in a complex (solid, solid/cystic) ovarian mass. |
There was a significant difference in SImax (p < 0.001), SIrel (p < 0.05), WIR (p < 0.001) and SImax (tumour)/SImax (psoas) between the two groups. Optimal threshold criteria for malignancy were established; SImax > or = 250 or SImax (tumour)/SImax (psoas) > or = 2.35 divided the two groups with 100% sensitivity, specificity and accuracy. |
3 |
| 75. Kazerooni AF, Malek M, Haghighatkhah H, et al. Semiquantitative dynamic contrast-enhanced MRI for accurate classification of complex adnexal masses. J Magn Reson Imaging. 45(2):418-427, 2017 02. |
Observational-Dx |
55 sonographically indeterminate ovarian masses |
To identify the best dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) descriptive parameters in predicting malignancy of complex ovarian masses, and develop an optimal decision tree for accurate classification of benign and malignant complex ovarian masses. |
TTP (P = 6.15E-8) and WIR (P = 5.65E-5) parameters induced the highest sensitivity (89% for LDA, and 97% for SVM) and specificity (93% for LDA, and 100% for SVM), respectively. Regarding the high sensitivity of TTP and high specificity of WIR and through their combination, an accurate and simple decision-tree classifier was designed using the line equation obtained by LDA classification model. The proposed classifier achieved an accuracy of 89% and area under the ROC curve of 93%. |
3 |
| 76. Tang YZ, Liyanage S, Narayanan P, et al. The MRI features of histologically proven ovarian cystadenofibromas-an assessment of the morphological and enhancement patterns. Eur Radiol 2013;23:48-56. |
Observational-Dx |
47 patients |
To assess the morphological and enhancement features of histologically proven cystadenofibromas (CAFs) on magnetic resonance imaging (MRI). |
The mean long axis diameter of the CAFs was 80 mm. The contralateral ovary was abnormal in 45 % of cases. A solid component was seen in 85 %, which returned low T2-weighted signal in 75 % of CAFs. Septa were seen in 74 % and one CAF was purely cystic. The majority of solid components and septa demonstrated enhancement that was less than the myometrium. Wash-in rates (WIR) of the solid tissue were available for measurement in nine patients with an average WIR of 3.2 l/s. |
3 |
| 77. Thomassin-Naggara I, Balvay D, Aubert E, et al. Quantitative dynamic contrast-enhanced MR imaging analysis of complex adnexal masses: a preliminary study. Eur Radiol. 22(4):738-45, 2012 Apr. |
Observational-Dx |
56 women |
To evaluate the ability of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate malignant from benign adnexal tumours. |
Malignant tumours displayed higher F(T), Vb, rAUC and lower Ve than benign tumours (P < 0.0001, P = 0.0006, P = 0.04 and P = 0.0002, respectively). F(T) was the most relevant factor for discriminating malignant from benign tumours (AUROC = 0.86). Primary ovarian invasive tumours displayed higher F(T) and shorter Dt than borderline tumours. Malignant adnexal tumours with associated peritoneal carcinomatosis at surgery displayed a shorter Dt than those without peritoneal carcinomatosis at surgery (P = 0.01). |
3 |
| 78. Thomassin-Naggara I, Darai E, Cuenod CA, Rouzier R, Callard P, Bazot M. Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors. J Magn Reson Imaging 2008;28:111-20. |
Observational-Dx |
37 patients |
To evaluate the utility of dynamic contrast enhancement (DCE) MRI for distinguishing among benign, borderline and invasive epithelial ovarian tumors. |
Morphological criteria such as septa, papillary projection, solid portion, and T2-weighted MR signal intensity of solid tissue were useful for discriminating invasive from noninvasive ovarian tumors (P = 0.01, P = 0.02, P = 0.002, and P < 0.0001 respectively) but not for discriminating benign from borderline tumors. Curve type 3 was specific for invasive ovarian tumors. EAr, MSr, and IAUC(60) ratio were higher for invasive than for benign (P < 0.0001) and borderline tumors (P = 0.005, P = 0.002, and P = 0.001, respectively). The IAU(60) ratio was the most relevant factor for discriminating benign from borderline and invasive tumors. MSr and IAU(60) ratio could be combined to generate a decision tree with 81% accuracy. |
3 |
| 79. Thomassin-Naggara I, Toussaint I, Perrot N, et al. Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging. Radiology. 2011;258(3):793-803. |
Observational-Dx |
87 women |
To retrospectively determine the value of adding perfusion-weighted and DWI sequences to a conventional MRI protocol to differentiate benign from malignant tumors. Three independent observers reviewed images. |
There was almost perfect agreement for lesion characterization regardless of the reader experiment or step considered (? = 0.811-0.929). AUC values were higher for conventional and DW images combined, conventional and perfusion-weighted images combined, and conventional, DWI, and perfusion-weighted images combined compared with conventional MRI alone (P<.05). For all readers, the accuracy of conventional, perfusion-weighted, and DWI combined was higher than that of conventional MRI alone for benign masses (P<.01) but not for malignant masses (P=.24). The addition of both perfusion-weighted and DWI led to a correct change in the diagnosis in 19% (11/57 patients), 23% (13/57 patients), and 24% (14/57 patients) of cases for readers 1, 2, and 3, respectively, with no incorrect changes. Conventional, perfusion-weighted, and DWI MRI criteria were combined to generate a decision tree giving an accuracy of 95%. The addition of perfusion-weighted and DWI sequences to a conventional MRI protocol improved the diagnostic accuracy in the characterization of complex adnexal masses. |
2 |
| 80. Fujii S, Kakite S, Nishihara K, et al. Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging 2008;28:1149-56. |
Observational-Dx |
119 patients |
To clarify the diagnostic accuracy of diffusion-weighted imaging (DWI) in differentiating benign from malignant ovarian lesions. |
The majority of malignant ovarian tumors and mature cystic teratomas, and almost half of the endometriomas, showed abnormal signal intensity on DWI, whereas most fibromas and other benign lesions did not. The main locations of abnormal signal intensity were solid portions in malignant ovarian tumors, cystic components suggestive of keratinoid substances and Rokitansky protuberance in mature cystic teratomas, and intracystic clots in endometriomas. On DW imaging, receiver-operating characteristic analysis yielded mean Az values of 0.703. There was no significant difference in mean and lowest ADC values between malignant and benign lesions. |
3 |
| 81. Thomassin-Naggara I, Darai E, Cuenod CA, et al. Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol. 2009;19(6):1544-1552. |
Observational-Dx |
77 women with complex adnexal masses (30 benign and 47 malignant) |
To prospectively assess the contribution of DWI MRI for characterizing complex adnexal masses. |
The most significant criteria for predicting benignity were low b(1,000) signal intensity within the solid component (PLR = 10.9), low T2 signal intensity within the solid component (PLR = 5.7), absence of solid portion (PLR = 3.1), absence of ascites or peritoneal implants (PLR = 2.3) and absence of papillary projections (PLR = 2.3). ADC measurements did not contribute to differentiating benign from malignant adnexal masses. All masses that displayed simultaneously low signal intensity within the solid component on T2-weighted and on b(1,000) DWIs were benign. Alternatively, the presence of a solid component with intermediate T2 signal and high b(1,000) signal intensity was associated with a PLR of 4.5 for a malignant adnexal tumor. DWI signal intensity is an accurate tool for predicting benignity of complex adnexal masses. |
3 |
| 82. Reinhold C, Rockall A, Sadowski EA, et al. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee. J. Am. Coll. Radiol.. 18(5):713-729, 2021 May. |
Review/Other-Dx |
N/A |
To the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions for MRI and the resultant lexicon. |
No results stated in abstract. |
4 |
| 83. Basha MAA, Abdelrahman HM, Metwally MI, et al. Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses. J Magn Reson Imaging. 53(1):292-304, 2021 01. |
Observational-Dx |
531 patients |
To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. |
In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (kappa = 0.861). |
2 |
| 84. Pereira PN, Sarian LO, Yoshida A, et al. Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses. Diagn Interv Radiol. 24(2):63-71, 2018 Mar-Apr. |
Observational-Dx |
200 patients |
To evaluate the ADNEX MR scoring system for the prediction of adnexal mass malignancy, using a simplified magnetic resonance imaging (MRI) protocol. |
Of 237 lesions, 79 (33.3%) were malignant. The ADNEX MR scoring system, using a simplified MRI protocol, showed 94.9% (95% confidence interval [CI], 87.5%-98.6%) sensitivity and 97.5% (95% CI, 93.6%-99.3%) specificity in malignancy prediction; it was thus highly accurate, like the original system. The level of interobserver agreement on simplified scoring was high (kappa = 0.91). |
3 |
| 85. Ruiz M, Labauge P, Louboutin A, Limot O, Fauconnier A, Huchon C. External validation of the MR imaging scoring system for the management of adnexal masses. Eur J Obstet Gynecol Reprod Biol. 205:115-9, 2016 Oct. |
Observational-Dx |
148 patients |
To investigate the prognostic value of ADNEX Magnetic Resonance Imaging Scoring in the preoperative management of adnexal masses. |
One-hundred-and-forty-eight patients were included in the study of which 24 had malignant or borderline ovarian tumors. The proportion of malignant or borderline ovarian tumors in each class of the ADNEX MR score in our study was: ADNEX I: 0% (95%CI, 0-8); ADNEX II: 1.7% (95%CI, 0.04-8.9); ADNEX III: 7.7% (95%CI, 0.2-36); ADNEX IV: 57.1% (95%CI, 34.2-78.8) and ADNEX V: 100% (95%CI, 69.2-100). Thus, for an ADNEX MR score greater than or equal to 4, the sensitivity was 91.7% (95%CI, 73-99) and the specificity 92.7% (95%CI, 86.7-96.6) for the diagnosis of a malignant or borderline ovarian tumor. The area under the ROC curve was 0.92 (95% CI%, 0.86-0.98). |
3 |
| 86. Sadowski EA, Rockall AG, Maturen KE, Robbins JB, Thomassin-Naggara I. Adnexal lesions: Imaging strategies for ultrasound and MR imaging. [Review]. Diagn Interv Imaging. 100(10):635-646, 2019 Oct. |
Review/Other-Dx |
N/A |
To review the imaging evaluation of adnexal lesions and how to incorporate the ADNEx MR score to help guide clinical management. |
No results stated in abstract. |
4 |
| 87. Chung BM, Park SB, Lee JB, Park HJ, Kim YS, Oh YJ. Magnetic resonance imaging features of ovarian fibroma, fibrothecoma, and thecoma. Abdom Imaging 2015;40:1263-72. |
Observational-Dx |
26 patients |
To retrospectively evaluate the conventional and functional (diffusion- or perfusion-weighted) magnetic resonance (MR) imaging features of ovarian fibroma, fibrothecoma, and thecoma. |
Twenty-two cases (79%) were predominantly solid tumor. Majority of the detected lesions exhibited the characteristic homogeneous low SI on T1- (24/28, 86%) and T2- (19/28, 68%) weighted image. Conversely, a number of lesions exhibited high SI (9/28, 32%) on T2-weighted image. Most lesions presented with a detectable ipsilateral ovary on T2-weighted image (24/28, 86%). Tumors larger than 6 cm more likely showed atypical morphology (mixed solid and cystic, cystic), atypical SI (high on T1- and T2-weighted image), and large amount ascites. Larger tumor group (>6 cm) was more likely diagnosed as fibrothecoma or thecoma than fibroma by pathology. On DWI, 16 lesions showed low b 1000 signal intensity (16/22, 73%). On PWI, all lesions showed curve type 1 or 2 (7/7, 100%), which tends to characterize benign lesions. All (16/16, 100%) pre-menopausal women had a detectable ipsilateral ovary, and six (60%) out of 10 post-menopausal women had a detectable ipsilateral ovary (p < 0.05). |
3 |
| 88. Suh-Burgmann E, Hung YY, Kinney W. Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50. Am J Obstet Gynecol. 211(6):623.e1-7, 2014 Dec. |
Observational-Dx |
1363 patients |
To evaluate outcomes for a large population-based cohort of women older than age 50 years with a small complex adnexal mass reported on ultrasound, without elevated CA125 or other evidence of malignancy, including time to detection of malignancy and stage at diagnosis for those initially observed. |
Among 1363 complex masses identified, 18 cancers or borderline tumors (1.3%; 95% confidence interval, 0.8-2.1%) were found. Six cases were diagnosed among 204 women who had immediate surgery after initial ultrasound (15%), and 12 additional cases were found among 994 women with at least 1 repeat ultrasound (73%). Growth was apparent on ultrasound by 7 months for all borderline and epithelial ovarian cancers. Of the 12 cases diagnosed during follow-up, 10 were found to be stage 1 at surgery. |
3 |
| 89. Suh-Burgmann E, Brasic N, Jha P, Hung YY, Goldstein RB. Ultrasound characteristics of early-stage high-grade serous ovarian cancer. Am J Obstet Gynecol. 225(4):409.e1-409.e8, 2021 10. |
Observational-Dx |
111 patients |
To evaluate the ultrasound findings associated with clinically detected early-stage high-grade serous ovarian cancer. |
Among 111 women identified, 4 had bilateral ovarian involvement, for a total of 115 adnexal masses characterized by ultrasound examination. The mean age at diagnosis was 61.8 years (range, 42-91 years). The median mass size was 9.6 cm (range, 2.2-23.6 cm) with 87% of cases having a mass size of >/=5 cm. A mixed cystic and solid appearance was most common (77.4%), but a completely solid appearance was more frequently seen for tumors of <5 cm compared with larger tumors (26.7% vs 13.0%). Solid components other than septations were seen in 97.4% of cases. The characteristics of stage I and II cases were similar other than ascites, which was more commonly seen in stage II cases (18.0% vs 3.1%, respectively). Interobserver concordance was high for size and volume measurements (correlation coefficients, 0.96-0.99), with moderate agreement observed across the other ultrasound characteristics (Fleiss kappa, 0.45-0.58). |
3 |
| 90. Chen H, Liu Y, Shen LF, Jiang MJ, Yang ZF, Fang GP. Ovarian thecoma-fibroma groups: clinical and sonographic features with pathological comparison. J Ovarian Res. 9(1):81, 2016 Nov 22. |
Observational-Dx |
61 patients |
To demonstrate clinical and sonographic features of OTFG and compare with surgical histopathology. |
The mean patient age was 53.57 (range, 26-86) years. There were 63.93% (39/61) patients in postmenopausal and 63.93% (39/61) patients with no clinical symptoms. Ultrasound findings of OTFG revealed as solid tumors with a typical feature of well-demarcated hypoechoic masses in 70.49% (43/61), among which 74.41% (32/43) tumors were smaller than 5 cm in diameter. There were 17 mixed echogenic masses with calcification, hemorrhage, or cyst, among which 70.59% (12/17) lesions were larger than 5 cm in diameter. Acoustic attenuation of the tumor was presented in 44.26% (27/61) of the cases. Doppler flow signals within the tumors were found in 20 cases (32.79%), in which 80% (16/20) had minimal or moderate flow signals. Ascites was detected in 32.79% (20/61) of the cases, Megi's syndrome was found in 1 case. Final pathology revealed 41 (67.21%) thecoma-fibromas, 15 (24.59%) fibromas, 4 (6.56%) thecomas and 1 (1.64%) fibrosarcoma. There were 58 patients underwent cancer antigen 125 (CA125) test, and 20.69% (12/58) showed an elevated level. The diameter of tumors was found to be significantly correlated with CA125 level (p < 0.01) and the amount of ascites fluid (p < 0.05). |
3 |
| 91. Alcazar JL, Pascual MA, Marquez R, et al. Malignancy risk of sonographically benign appearing purely solid adnexal masses in asymptomatic postmenopausal women. Menopause. 24(6):613-616, 2017 06. |
Observational-Dx |
99 patients |
To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women. |
Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm (range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid (n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1), primary invasive cancer (n = 2). One case of invasive cancer CA-125 was 403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5). |
4 |
| 92. Kang SK, Reinhold C, Atri M, et al. ACR Appropriateness Criteria® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2018;15:S198-S207. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for staging and follow-up of ovarian cancer. |
No results stated in abstract. |
4 |
| 93. Dauwen H, Van Calster B, Deroose CM, et al. PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer. Gynecol Oncol 2013;131:694-700. |
Observational-Dx |
69 patients |
To prospectively assess the value of PET/CT for staging, diagnosis and operability of ovarian cancer, with special attention to the peritoneal spread. |
There were 56 patients with malignant tumors and 13 with benign tumors. We observed a sensitivity and specificity of 93% and 77%, respectively for malignant tumors with PET/CT. CT alone had a sensitivity and specificity of 96% and 38%, respectively. The overall FIGO classification evaluation for PET/CT and CT were the same. For the evaluation of metastases, the sensitivity of PET/CT was worse, while the specificity was better than CT. Retroperitoneal lymph node metastases were diagnosed better with PET/CT, while there was no difference for peritoneal spread and for the intestines. PET/CT detected another unknown primary tumor in 3 (4.3%) cases. |
2 |
| 94. Wengert GJ, Dabi Y, Kermarrec E, et al. O-RADS MRI Classification of Indeterminate Adnexal Lesions: Time-Intensity Curve Analysis Is Better Than Visual Assessment. Radiology 2022:210342. |
Observational-Dx |
244 patients |
To compare the diagnostic accuracy of visual assessment with that of TIC assessment of dynamic contrast-enhanced MRI scans to categorize adnexal lesions as benign or malignant and to evaluate the influence on the O-RADS MRI score. |
A total of 320 lesions (207 malignant, 113 benign) in 244 women (mean age, 55.3 years +/- 15.8 [standard deviation]) were analyzed. Sensitivity for malignancy was 96% (198 of 207) and 76% (157 of 207) for TIC and visual assessment, respectively. TIC was more accurate than visual assessment (86% [95% CI: 81, 90] vs 78% [95% CI: 73, 82]; P < .001) for benign lesions, predominantly because of higher specificity (95% [95% CI: 92, 98] vs 76% [95% CI: 68, 81]). A total of 21% (38 of 177) of invasive lesions were rated as low risk visually. Contrast material washout and high-risk enhancement (defined as earlier enhancement than in the myometrium) were highly specific for malignancy for both TIC (97% [95% CI: 91, 99] and 94% [95% CI: 90, 97], respectively) and visual assessment (97% [95% CI: 92, 99] and 93% [95% CI: 88, 97], respectively). O-RADS MRI score was more accurate with TIC than with visual assessment (area under the receiver operating characteristic curve, 0.87 [95% CI: 0.83, 0.90] vs 0.73 [95% CI: 0.68, 0.78]; P < .001). |
3 |
| 95. American College of Radiology. ACR Committee on MR Safety. ACR Manual on MR Safety. Version 1.0. Available at: https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/Manual-on-MR-Safety.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the use of magnetic resonance (MR) safe practices. |
No abstract available. |
4 |
| 96. Fauvet R, Brzakowski M, Morice P, et al. Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study. Ann Oncol 2012;23:1481-7. |
Observational-Dx |
40 patients |
To evaluate the characteristics of borderline ovarian tumors (BOTs) diagnosed during pregnancy. |
Mean patient age was 30.2 +/- 5.4 years. Most BOTs were diagnosed during the first trimester of pregnancy (62%). Salpingo-oophorectomy (N = 24) was more frequently performed than cystectomy (N = 11) during pregnancy (P = 0.01). Only two patients had an initial complete staging. BOTs were mucinous, serous and mixed in 48%, 42% and 10% of patients, respectively. Twenty-one percent of mucinous BOTs exhibited intraepithelial carcinoma or microinvasion. Forty-seven percent of serous BOTs exhibited micropapillary features, noninvasive implants or microinvasion. Restaging surgery performed in 52% patients resulted in upstaging in 24% of cases. Recurrence rate in patients with serous BOT with micropapillary features or peritoneal implants was 7.5%. |
3 |
| 97. Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA. 2016;316(9):952-961. |
Observational-Dx |
1,424,105 children |
To evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy. |
Of 1424105 deliveries (48% girls; mean gestational age, 39 weeks), the overall rate of MRI was 3.97 per 1000 pregnancies. Comparing first-trimester MRI (n = 1737) to no MRI (n = 1418451), there were 19 stillbirths or deaths vs 9844 in the unexposed cohort (adjusted relative risk [RR], 1.68; 95% CI, 0.97 to 2.90) for an adjusted risk difference of 4.7 per 1000 person-years (95% CI, -1.6 to 11.0). The risk was also not significantly higher for congenital anomalies, neoplasm, or vision or hearing loss. Comparing gadolinium MRI (n = 397) with no MRI (n = 1418451), the hazard ratio for NSF-like outcomes was not statistically significant. The broader outcome of any rheumatological, inflammatory, or infiltrative skin condition occurred in 123 vs 384180 births (adjusted HR, 1.36; 95% CI, 1.09 to 1.69) for an adjusted risk difference of 45.3 per 1000 person-years (95% CI, 11.3 to 86.8). Stillbirths and neonatal deaths occurred among 7 MRI-exposed vs 9844 unexposed pregnancies (adjusted RR, 3.70; 95% CI, 1.55 to 8.85) for an adjusted risk difference of 47.5 per 1000 pregnancies (95% CI, 9.7 to 138.2). |
3 |
| 98. American College of Obstetricians and Gynecologists. Committee on Obstetric Practice. Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation. |
Review/Other-Dx |
N/A |
To present guidelines for diagnostic imaging during pregnancy and lactation. |
No results stated in abstract. |
4 |
| 99. Thomassin-Naggara I, Fedida B, Sadowski E, et al. Complex US adnexal masses during pregnancy: Is pelvic MR imaging accurate for characterization? Eur J Radiol. 2017;93:200-208. |
Observational-Dx |
31 pregnant women |
To retrospectively evaluate the accuracy of pelvic magnetic resonance (MR) imaging for the characterization of complex sonographic adnexal masses discovered in women during pregnancy. |
Prospective US and MR imaging correctly identified the diagnosis in 27/36 (75%) (95% confidence interval (CI): 58.9%-86.2%) and in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions, respectively. MR imaging with ADNEXMR-SCORE allowed a correct diagnosis in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions for R1 and in 30/36 (83.3%) (95% CI: 68.1%-92.1%) of lesions for R2. The sensitivities and specificities of MR imaging using the MR ADNEXMR-SCORE were 100% (95% CI: 70.1%-1000%) for both readers and 85.1% (95% CI: 67.5%-94%) and 77.7% (95% CI: 59.2%-89.4%) for R1 and R2, respectively. No malignancy was classified as benign using MR criteria. The reproducibility between the two readers was almost perfect, with a kappa of 0.914. |
2 |
| 100. Bromley B, Benacerraf B. Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med. 16(7):447-52; quiz 453-4, 1997 Jul. |
Observational-Dx |
125 patients |
To determine the accuracy of sonographic diagnosis and perinatal outcome in pregnancies with maternal adnexal masses. |
Sonographically benign appearing lesions were seen in 89.3% of patients. Ninety-five percent of dermoids, 80% of endometriomas, and 71% of simple cysts were characterized correctly. Fourteen of the 131 lesions (10.7%) had sonographic characteristics suggestive of malignancy. One of these 14 patients (7%) had ovarian cancer. This represents a 0.8% malignancy rate among the total number of lesions. Twenty-four of the 125 patients (19%) underwent second trimester laparotomy at the discretion of their managing obstetricians, with no pregnancy losses. One patient had acute torsion of a dermoid at 39 weeks. Prenatal sonography can accurately characterize maternal adnexal lesions. |
4 |
| 101. Senarath S, Ades A, Nanayakkara P. Ovarian cysts in pregnancy: a narrative review. [Review]. J Obstet Gynaecol. 41(2):169-175, 2021 Feb. |
Review/Other-Dx |
N/A |
To review ovarian cysts in pregnancy. |
No results stated in abstract. |
4 |
| 102. Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol 1999;93:585-9. |
Observational-Dx |
432 patients |
To determine factors predicting the persistence of sonographically identified adnexal masses in pregnancy. |
The rate of adnexal masses during pregnancy was 2.3% (432 of 18,391). Complete follow-up was available for 422 of 432. Most of the adnexal masses (76%; 320 of 422) were simple cysts with a mean diameter less than 5 cm. The remainder of the masses were simple or complex, measuring 5 cm or more in diameter. Seventy of 102 large or complex masses resolved. By multivariate analysis, the best predictors for persistence of these masses were complex appearance on sonography and size of the mass (P < .05 for both categories). |
3 |
| 103. Cagino K, Li X, Thomas C, Delgado D, Christos P, Acholonu U Jr. Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis. [Review]. J Minim Invasive Gynecol. 28(6):1171-1182.e2, 2021 06. |
Meta-analysis |
15 studies |
To investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies. |
Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p=.85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p=.59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p=.03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p=.31 and OR 0.95; 95% CI, 0.47-1.89; p=.88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p=.06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p=.09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p=.05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion=0.02 vs 0.07 and pooled proportion=0.02 vs 0.14, respectively). |
Good |
| 104. Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011;155:119-24. |
Review/Other-Dx |
N/A |
To outline a literature review for ovarian tumors in pregnancy. |
No results stated in abstract. |
4 |
| 105. Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol 2006;101:315-21. |
Review/Other-Dx |
4,846,505 patients |
To investigate the occurrence rates of benign and malignant ovarian tumors associated with pregnancy among women identified in three large California databases between 1991 and 1999. |
9375 women had a hospital diagnosis of an ovarian mass associated with pregnancy. CCR database identified 87 ovarian cancers and 115 LMP tumors in the same cohort. The occurrence rates were 0.93% (87/9375) ovarian cancers per total number of ovarian masses diagnosed during pregnancy, and 0.0179 ovarian cancers per 1000 deliveries. The summary stages of the ovarian cancers and LMP tumors were (respectively): localized 65.5% and 81.7%, regional 6.9% and 7.8%, remote 23.0% and 4.4%, and unknown 4.6% and 6.1%. 34 of the 87 ovarian cancers were germ cell tumors (GCT). Malignant ovarian tumors increased the likelihood of maternal outcomes such as cesarean delivery, hysterectomy, blood transfusions, and prolonged hospitalization compared to noncancer pregnant controls, but did not adversely affect neonatal outcomes. Cause-specific maternal mortality of patients with follow-up was 4.7% (9/191) at a mean of 2.43 years after diagnosis. |
4 |
| 106. Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005;105:1098-103. |
Observational-Dx |
63 patients |
To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy. |
Between 1990 and 2003, 127,177 deliveries were performed at our institution. An adnexal mass 5 cm in diameter or greater was diagnosed in 63 (0.05%) patients. Pathologic diagnosis was available for 59 (94%) patients. The remaining 4 patients were lost to follow-up and excluded from the analysis. Antepartum surgery was performed in 17 patients (29%): 13 because of ultrasound findings that suggested malignancy and 4 secondary to ovarian torsion. The remaining patients were observed, with surgery performed in the postpartum period or at time of cesarean delivery. The majority of masses were dermoid cysts (42%). Four patients were diagnosed with ovarian cancer (6.8% of masses, 0.0032% of deliveries), and one patient (1.7%) had a tumor of low malignant potential. Antepartum surgery due to ultrasound findings that caused concern was performed on all 5 women diagnosed with a malignancy or borderline tumor, compared with 12 (22%) of the patients with benign tumors (P < .01). |
3 |
| 107. Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181:19-24. |
Observational-Dx |
130 patients |
To determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. |
The incidence of adnexal masses in pregnant women who required surgical management was 1 in 1312 live births. A malignant tumor or a tumor of low malignant potential was found in 6.1% of cases. In 10 patients the only finding at the time of laparotomy was leiomyomas. Ultrasonography was not helpful in distinguishing tumors of low malignant potential from benign neoplasms or in identifying the source of the pelvic mass in patients found to have only leiomyomas. There were 2 intrauterine fetal deaths and 1 neonatal death in this cohort of patients. Patients who underwent laparotomy after 23 weeks' gestation had a significantly higher adverse pregnancy outcome compared with those who underwent laparotomy earlier in pregnancy (P =.005). |
4 |
| 108. Bailleux M, Bernard JP, Benachi A, Deffieux X. Ovarian endometriosis during pregnancy: a series of 53 endometriomas. Eur J Obstet Gynecol Reprod Biol. 209:100-104, 2017 Feb. |
Observational-Dx |
46 patients |
To report our experience concerning the diagnosis, spontaneous progression and management of endometriomas during pregnancy. |
Among the 53 cysts identified as "endometriomas" on the first-trimester ultrasound examination, 49 (92%) were described like "cyst fluid with ground-glass echogenicity". Fifty-two cysts (98%) had a maximum diameter<100mm, only one cyst (2%) presented papillary projection and 5 cysts (9%) were multiloculated. During the second-trimester ultrasound monitoring of these cysts, of the 33 cysts that we monitored, 8 (24%) increased in size, 11 (34%) decreased in size, 5 (15%) disappeared and 9 (27%) did not change. During the third-trimester ultrasound monitoring of these cysts, of the 13 cysts that we monitored, 5 (39%) increased in size, 5 (39%) decreased in size, 2 (15%) disappeared and 1 (7%) did not change. All children (48 newborns) were born alive at a median gestational age of 39 weeks [IQR=39-40]. Only 10 cysts (19%) required surgical treatment. In all cases, surgery consisted of cystectomy. Two cysts were operated on during pregnancy (between 14 and 17 weeks of gestation) because of symptoms of adnexal torsion, 3 during cesarean section, and 5 postpartum. Four of the 10 (40%) cysts operated on were histopathologically "endometriomas", and one of them was decidualized. Four cysts were mucinous cystadenomas, one was a serous cystadenoma and one cyst was a dermoid cyst. |
3 |
| 109. Mascilini F, Moruzzi C, Giansiracusa C, et al. Imaging in gynecological disease. 10: Clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy. Ultrasound Obstet Gynecol. 44(3):354-60, 2014 Sep. |
Review/Other-Dx |
18 patients |
To describe the clinical history and ultrasound findings in women with decidualized endometriomas surgically removed during pregnancy. |
Eighteen eligible women were identified. Median age was 34 (range, 20-43) years. Median gestational age at surgical removal of the decidualized endometrioma was 18 (range, 11-41) weeks. Seventeen women (94%) were asymptomatic and one presented with pelvic pain. In three of the 18 women an ultrasound diagnosis of endometrioma had been made before pregnancy. The original ultrasound examiner was uncertain whether the mass was benign or malignant in 10 (56%) women and suggested a diagnosis of benignity in nine (50%) women, borderline in eight women (44%), and invasive malignancy in one (6%) woman. Seventeen decidualized endometriomas contained a papillary projection, and in 16 of these at least one of the papillary projections was vascularized at power or color Doppler examination. The number of cyst locules varied between one (n = 11) and four. No woman had ascites. When using pattern recognition, most decidualized endometriomas (14/17, 82%) were described as manifesting vascularized rounded papillary projections with a smooth contour in an ovarian cyst with one or a few cyst locules and ground-glass or low-level echogenicity of the cyst fluid. |
4 |
| 110. Mascilini F, Savelli L, Scifo MC, et al. Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis. Ultrasound Obstet Gynecol. 50(1):116-123, 2017 Jul. |
Observational-Dx |
34 patients |
To elucidate the ultrasound features that can discriminate between benign and malignant ovarian cysts with papillary projections but no other solid component in pregnant women. |
Of the 34 cases included, 19 (56%) lesions were benign (16 decidualized endometriomas, one cystadenofibroma, one simple cyst, one struma ovarii), 12 (35%) were borderline tumors and three (9%) were primary invasive tumors (two immature teratomas, one endometrioid cystadenocarcinoma). The contour of the cyst papillations was smooth in 79% (15/19) of benign tumors vs 27% (4/15) of malignant tumors (P = 0.002). The cystic content showed ground-glass echogenicity in 74% (14/19) of benign tumors vs 13% (2/15) of malignant tumors (P = 0.0006). All ovarian masses with smooth papillations and ground-glass content (n = 12) were decidualized endometriomas. The papillary projections were vascularized and the color score was 3 or 4 in 88% (14/16) of decidualized endometriomas vs 42% (5/12) of borderline tumors (P = 0.013). |
4 |
| 111. Choi JR, Levine D, Finberg H. Luteoma of pregnancy: sonographic findings in two cases. J Ultrasound Med 2000;19:877-81. |
Observational-Dx |
2 patients |
To describe two cases of luteoma of pregnancy. |
The first case documents sequential ultrasonographic demonstration of a presumed luteoma of pregnancy in a patient who was seen with hirsutism during a second trimester pregnancy. The luteoma, serum androgen levels, and patient's condition improved after delivery. This case is unique in that although the mass significantly decreased in size post partum, it continued to be visualized 14 months post partum. The second case illustrates the pronounced cystic appearance that these classically described solid lesions can demonstrate because of extensive necrosis. |
4 |
| 112. Czekierdowski A, Stachowicz N, Smolen A, et al. Sonographic Assessment of Complex Ultrasound Morphology Adnexal Tumors in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems. Diagnostics (Basel) 2021;11. |
Observational-Dx |
36 patients |
To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. |
Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR- = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70-75%) except for SRR (53%). |
3 |
| 113. Lee SJ, Oh HR, Na S, Hwang HS, Lee SM. Ultrasonographic ovarian mass scoring system for predicting malignancy in pregnant women with ovarian mass. Obstet Gynecol Sci 2022;65:1-13. |
Review/Other-Dx |
N/A |
To review various scoring systems for predicting malignant tumors of the ovary and determined whether they can be applied to pregnant women. |
No results stated in abstract. |
4 |
| 114. Takeuchi M, Matsuzaki K, Harada M. Computed diffusion-weighted imaging for differentiating decidualized endometrioma from ovarian cancer. Eur J Radiol. 85(5):1016-9, 2016 May. |
Observational-Dx |
29 patients |
To evaluate the clinical diagnostic ability of computed diffusion-weighted imaging (DWI) for differentiating decidualized endometrioma from ovarian cancer. |
Mural nodules of all decidualized endometriomas showed high signal intensity on DWI800 with significantly higher ADC (2.01+/-0.26x10(-3)mm(2)/s) and low signal intensity on cDWI1500, whereas solid components of all ovarian cancers showed high signal intensity on both DWI800 with lower ADC (1.08+/-0.20x10(-3)mm(2)/s) and on cDWI1500. |
3 |
| 115. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/mr-fetal.pdf |
Review/Other-Dx |
N/A |
To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). |
No abstract available. |
4 |
| 116. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/pregnant-pts.pdf |
Review/Other-Dx |
N/A |
To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 117. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf |
Review/Other-Dx |
N/A |
To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. |
No abstract available. |
4 |
| 118. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media. Available at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. |
Review/Other-Dx |
N/A |
Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. |
No abstract available. |
4 |
| 119. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
