title: Sonographic discrimination between benign and malignant adnexal masses in premenopause.
abstract: OBJECTIVE
  The aim of this study was to assess the diagnostic value of sonographic pattern recognition by experts, a standardized morphological scoring system, the risk malignancy index (RMI) and CA 125 assay for the preoperative assessment of ovarian lesions in premenopausal patients.
  
  
  METHODS
  Diagnostic work-up of 1320 patients who underwent surgical exploration due to an adnexal mass at a tertiary referral center were included. We assessed the discriminative value of pattern recognition, a sonographic morphological scoring system, RMI and CA 125 by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa for each diagnostic approach while using histopathology as the reference standard.
  
  
  RESULTS
  Pattern recognition showed the highest discriminative power with an observed kappa of 0.53. Sensitivity and specificity yielded 0.76 and 0.97 respectively. Combining pattern recognition with CA 125 serum measurement in the context of a triage system diminished the diagnostic value (kappa: 0.24; sensitivity: 0.29 specificity: 0.97). For the RMI we observed a sensitivity of 0.54 and a specificity of 0.96 and estimated kappa value yielded 0.37. Omitting the CA 125 assay and using a morphological sonographic assessment system increased the kappa value to 0.45 with sensitivity and specificity observed at 0.61 and 0.97 respectively.
  
  
  CONCLUSIONS
  Expert pattern recognition was found to be the method with the highest discriminative power in assessing an adnexal mass during premenopause. Additional assessment of serum CA 125 diminished the diagnostic accuracy. Standardized morphological sonographic assessment resulted in a moderate diagnostic accuracy. Supplementing the morphological sonographic assessment with CA 125 by using the RMI algorithm did not improve the diagnostic value.
authors.affiliation: Gynecology and Obstetrics, Jena Universtiy Hospital, Jena.
authors.forename: M P
authors.initials: MP
authors.lastname: Radosa
authors.affiliation: Gynecology and Obstetrics, Jena Universtiy Hospital, Jena.
authors.forename: J
authors.initials: J
authors.lastname: Vorwergk
authors.affiliation: Gynecology and Obstetrics, Jena Universtiy Hospital, Jena.
authors.forename: J
authors.initials: J
authors.lastname: Fitzgerald
authors.affiliation: Praxis Prof. Dr. Kaehler, Praenatologische Schwerpunktpraxis Erfurt.
authors.forename: C
authors.initials: C
authors.lastname: Kaehler
authors.affiliation: Gynecology and Obstetrics, Jena Universtiy Hospital, Jena.
authors.forename: U
authors.initials: U
authors.lastname: Schneider
authors.affiliation: Gynecology and Obstetrics, Jena Universtiy Hospital, Jena.
authors.forename: O
authors.initials: O
authors.lastname: Camara
authors.affiliation: Gynecology and Obstetrics, Jena Universtiy Hospital, Jena.
authors.forename: I B
authors.initials: IB
authors.lastname: Runnebaum
authors.affiliation: Abteilung Geburtshilfe, Universitätsfrauenklinik, Jena.
authors.forename: E
authors.initials: E
authors.lastname: Schleußner
mesh_terms: D000290:Adnexa Uteri / Q000000981:diagnostic imaging* / Q000473:pathology; D000291:Adnexal Diseases / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D005103:Expert Systems; D005185:Fallopian Tube Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D010363:Pattern Recognition, Automated; D017697:Premenopause; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen