Preoperative diagnosis of 221 consecutive ovarian masses: scoring system and expert evaluation.
OBJECTIVE
The aim of our work was to assess the diagnostic accuracy of a scoring system versus subjective assessment of the risk of malignancy of pelvic masses achieved by gynecologist/sonologists in the preoperative triage of a busy gynecology department.


METHODS
One hundred and eighty-two consecutive patients who underwent surgical removal of ovarian neoplasms were examined. In 39 patients pelvic masses were bilateral. The total number of neoplasms analyzed in this series was 221. Lesions were examined and scored according to the sonographic characteristics. Gynecologist/sonologists also recorded a subjective evaluation of the adnexal masses defining them as "probably benign", and "suspicious/probably malignant". Preoperative ultrasound risk assessment was compared to the final pathologic report and diagnostic accuracy was calculated. CA125 was obtained in all patients and its independent and combined accuracy was calculated.


RESULTS
The sensitivity of the scoring system and subjective evaluation was 86% and 95% respectively, specificity was 79% and 91% with a positive predictive value of 41% and 53%. The frequency of positive diagnoses for CA125 was 44% due to the high prevalence of endometrosis in this series (48%). In premenopausal patients (75%) the specificity was 93% and 89% for scoring and subjective evaluation, respectively. The combined use of morphological scoring and CA125 achieved higher specificity and positive predictive values both for the whole series and in premenopausal patients.


CONCLUSIONS
These results confirmed that the experience of gynecological surgeons with ultrasound skills, outperforms the morphological indexing assessment of ovarian masses. Nonetheless an easy sonographic descriptive scoring system is not significantly lower in accuracy than the expertise achieved by gynecologists with sonographic skills.
Romagnolo
C
C
Department of Obstetrics and Gynecology, Sacro Cuore Hospital, Negrar, Italy.
Trivella
G
G
Bonacina
M
M
Fornalè
M
M
Maggino
T
T
Ferrazzi
E
E
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D010048:Ovarian Cysts / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011300:Preoperative Care; D011506:Proteins / Q000032:analysis*; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014621:Vagina
D047908:Intracellular Signaling Peptides and Proteins; C549756:NBR1 protein, human; D011506:Proteins