title: Accuracy of ultrasound subjective 'pattern recognition' for the diagnosis of borderline ovarian tumors.
abstract: OBJECTIVE
  To assess the value of pattern recognition for the preoperative ultrasound diagnosis of borderline ovarian tumors (BOTs).
  
  
  METHODS
  This was a prospective study of women who were referred to our regional cancer center with the diagnosis of an adnexal mass on a Level II (routine) gynecological ultrasound scan. Women with lesions of uncertain nature were referred for a Level III (expert) ultrasound scan in our tertiary center. The tumor pattern recognition method was used to differentiate between various types of ovarian tumors. Morphological features suggestive of BOTs were: unilocular cyst with a positive ovarian crescent sign and extensive papillary projections arising from the inner wall, or a cyst with a well defined multilocular nodule. The ultrasound findings were compared with the final histological diagnosis.
  
  
  RESULTS
  A total of 224 women with an adnexal mass of uncertain nature were referred for an expert scan, 166 (74.1%) of whom underwent surgery. In this group of women the final histological diagnoses were: 99 (60%) benign lesions, 32 (19%) invasive ovarian cancer and 35 (21%) BOTs. Using pattern recognition combining the different morphological features, a correct preoperative diagnosis of BOT was made in 24/35 (68.6%) women: area under the receiver-operating characteristics curve 0.812 (standard error 0.049; 95% CI, 0.716-0.908), sensitivity 0.69 (95% CI, 0.52-0.81), specificity 0.94 (95% CI, 0.88-0.97), positive likelihood ratio 11.3 (95% CI, 5.53-22.8) and negative likelihood ratio 0.34 (95% CI, 0.21-0.55).
  
  
  CONCLUSIONS
  Ultrasound diagnosis of BOTs is highly specific. However, typical features are absent in one-third of cases, which are typically misdiagnosed as benign lesions.
authors: Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK. joseph.yazbek@gmail.com
authors: J
authors: J
authors: Yazbek
authors: K S
authors: KS
authors: Raju
authors: J
authors: J
authors: Ben-Nagi
authors: T
authors: T
authors: Holland
authors: K
authors: K
authors: Hillaby
authors: D
authors: D
authors: Jurkovic
mesh_terms: D000290:Adnexa Uteri / Q000000981:diagnostic imaging / Q000473:pathology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010364:Pattern Recognition, Visual; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography