title: Preoperative multimodal strategies for risk assessment of adnexal masses: analysis of 1362 cases in a gynecologic cancer center.
abstract: OBJECTIVE
  Assessment of adnexal masses focuses on the accurate discrimination between benign and malignant lesions. In our tertiary referral center, we evaluated the discriminative power of expert sonography, serum CA-125 measurement, risk malignancy index (RMI) by Jacobs, and 2 preoperative triage strategies (combination of CA-125 measurement and RMI assessment with expert sonography).
  
  
  METHODS
  From 2002 to 2008, a total of 1362 surgical explorations with indication of an adnexal mass from our department were included in this study. Preoperative workup in all patients comprised a gynecologic examination, expert sonography, and serum CA-125 measurement. We calculated sensitivity, specificity, positive and negative predictive value (PPV and NPV), and Cohen κ (prevalence-adjusted measurement) to evaluate the discriminative power of each diagnostic test.
  
  
  RESULTS
  Discriminative power of the evaluated tests differed depending on patients' menopausal state. In the premenopause, expert sonography reached the highest discriminative power with a κ value of 0.53, a PPV of 0.45, and an NPV of 0.99. In the postmemopause, the combinations of expert sonography with CA-125 serum measurement or RMI assessment achieved the highest discriminative power: The combination of CA-125 and expert sonography reached a PPV of 0.89 and an NPV of 0.97; κ yielded 0.84. The RMI combined with expert sonography as a triage strategy showed comparable results with a PPV of 0.89, an NPV of 0.96, and a κ value of 0.82.
  
  
  CONCLUSIONS
  Preoperative assessment of an adnexal mass may be guided by the patient's menopausal state. In premenopausal patients, expert sonography is helpful for preoperative differentiation between benign and malignant lesions; in postmenopausal patients, the use of triage strategies of either CA-125 serum measurement or RMI combined with expert sonography can be recommended.
authors.affiliation: Department of Gynecology and Obstetrics, Jena University Hospital, Jena, Germany.
authors.forename: Marc Philipp
authors.initials: MP
authors.lastname: Radosa
authors.forename: Oumar
authors.initials: O
authors.lastname: Camara
authors.forename: Julia
authors.initials: J
authors.lastname: Vorwergk
authors.forename: Herbert
authors.initials: H
authors.lastname: Diebolder
authors.forename: Harald
authors.initials: H
authors.lastname: Winzer
authors.forename: Anke
authors.initials: A
authors.lastname: Mothes
authors.forename: Mieczyslaw
authors.initials: M
authors.lastname: Gajda
authors.forename: Ingo Bernard
authors.initials: IB
authors.lastname: Runnebaum
mesh_terms: D000291:Adnexal Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D000328:Adult; D018394:CA-125 Antigen / Q000097:blood; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D010044:Outpatient Clinics, Hospital; D011237:Predictive Value of Tests; D057234:Preoperative Period; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014218:Triage; D014463:Ultrasonography
chemical_list: D018394:CA-125 Antigen