title: Accuracy of ultrasonography performed by examiners with varied training and experience in predicting specific pathology of adnexal masses.
abstract: OBJECTIVE
  To assess the diagnostic performance of subjective assessment by Level II ultrasound examiners in predicting the specific histology of adnexal masses.
  
  
  METHODS
  The women included in this prospective multicenter cross-sectional study were older than 16 years of age and had at least one adnexal mass. They underwent transvaginal sonography (TVS) performed by Level II examiners, all of whom were familiar with the International Ovarian Tumor Analysis (IOTA) group definitions of ultrasound features of ovarian masses. The final outcome was histology. Specific diagnoses were categorized into 16 groups. Agreement between subjective assessment and final histology was measured using unweighted kappa coefficients. Sensitivities and specificities were obtained for subjective assessment.
  
  
  RESULTS
  Of the 1279 women who underwent TVS, 313 were included in the final analysis. Overall agreement (16 × 16 table) between subjective assessment and histology was moderate, with a Cohen's kappa coefficient of 0.59 (95% CI, 0.53-0.65). The specificity of subjective assessment ranged between 91% and 100% for all histological subgroups. Highest sensitivities were achieved in the diagnosis of simple cysts (100% (95% CI, 61-100%)), hydrosalpinges (100% (95% CI, 34-100%)), mature teratomas (88% (95% CI, 74-96%)), endometriomas (75% (95% CI, 61-85%)), ovarian fibromas (88% (95% CI, 47-100%)), tubo-ovarian abscesses (88% (95% CI, 47-100%)) and serous cystadenocarcinomas (82% (95% CI, 66-93%)). Serous cystadenomas were misdiagnosed most commonly (40.5%). The sensitivity of subjective assessment in diagnosing adnexal torsion was 54% (95% CI, 25-81%); the 17 confirmed and/or suspected cases of adnexal torsion were not included in the 313 cases examined and analyzed for diagnostic performance.
  
  
  CONCLUSIONS
  Overall, subjective assessment by Level II examiners was good for the detection of simple cysts, endometriomas, mature teratomas, hydrosalpinges, fibroma, tubo-ovarian abscess and serous cystadenocarcinomas.
authors.affiliation: Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK; Early Pregnancy and Acute Gynaecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sayasneh
authors.forename: J
authors.initials: J
authors.lastname: Kaijser
authors.forename: J
authors.initials: J
authors.lastname: Preisler
authors.forename: A A
authors.initials: AA
authors.lastname: Smith
authors.forename: F
authors.initials: F
authors.lastname: Raslan
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: R
authors.initials: R
authors.lastname: Husicka
authors.forename: L
authors.initials: L
authors.lastname: Ferrara
authors.forename: C
authors.initials: C
authors.lastname: Stalder
authors.forename: S
authors.initials: S
authors.lastname: Ghaem-Maghami
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.forename: T
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D010363:Pattern Recognition, Automated; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler
keywords: ovarian cancer; ovarian neoplasm; ovary; ultrasonography; visual pattern recognition