title: Reliability of preoperative evaluation of postmenopausal ovarian tumors.
abstract: BACKGROUND
  Preoperative evaluation of ovarian tumors is challenging. This study was undertaken to evaluate the performance of conventional two-dimensional (2D) ultrasound and CA125 in predicting malignant or benign nature of pelvic masses, and to investigate if three-dimensional power Doppler (3DPD) ultrasound provides any added value. Ninety-six postmenopausal and four perimenopausal women with supposed ovarian tumors were examined by standardized 2D and 3DPD ultrasounds preoperatively. The tumors were evaluated using the risk of malignancy index (RMI), International Ovarian Tumors Analysis (IOTA) group simple rules, expert opinion, IOTA logistic regression model 2 (LR2) and 3D vascular indices, and were postoperatively compared to histopathological results.
  
  
  RESULTS
  Ninety-eight tumors turned out to be ovarian in origin. Of these, 66 were benign and 32 malignant. RMI (cut-off value 200), simple rules, expert opinion and LR2 (cut-off value 25) were used to predict malignant nature of the tumors and had sensitivities of 71.9, 90.6, 87.5 and 90.6%, and specificities of 80.3, 84.6, 92.4 and 77.3%, respectively. When the 3D vascularization flow index (VFI) was added to RMI and LR2, the accuracy of the test improved from 77.6 to 81.4% and from 81.6 to 86.5%, respectively, at the expense of sensitivity, while VFI gave no added benefit for simple rules and expert opinion. Agreement between two examiners using expert opinion was good (Cohen's kappa = 0.89).
  
  
  CONCLUSIONS
  The subjective opinion of an expert seems to be the most reliable method in assessing ovarian tumors, and the 3DPD indices seem to provide no significant added value.
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland. riikka.niemi@pshp.fi.
authors.forename: Riikka Johanna
authors.initials: RJ
authors.lastname: Niemi
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
authors.forename: Sami Kristian
authors.initials: SK
authors.lastname: Saarelainen
authors.affiliation: Research and Innovation Center, Tampere University Hospital and Faculty of Social Sciences, University of Tampere, FI-33014, Tampere, Finland.
authors.forename: Tiina Hannele
authors.initials: TH
authors.lastname: Luukkaala
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.|Faculty of Medicine and Life Sciences, University of Tampere, FI-33014, Tampere, Finland.
authors.forename: Johanna Unelma
authors.initials: JU
authors.lastname: Mäenpää
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D060787:Neoplasm Grading; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000601:surgery; D017698:Postmenopause; D057234:Preoperative Period; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen
keywords: Expert opinion; IOTA LR2; IOTA simple rules; Ovarian cancer; Ovarian tumor; Power doppler; Three-dimensional ultrasound