Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort
ObjectivePrevious work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two-step strategy to estimate th...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | info:eu-repo/semantics/article |
| Language: | English |
| Published: |
2023
|
| Subjects: | |
| Online Access: | https://hdl.handle.net/10171/66063 |
| _version_ | 1793399935030263808 |
|---|---|
| author | Landolfo, C. (Chiara) Bourne, T. (Tom) Froyman, W. (Wouter) Calster, B. (Ben) van Ceusters, J. (Jolien) Testa, A.C. (Antonia C.) Wynants, L. (Laure) Sladkevicius, P. (Povilas) Van-Holsbeke, C. (Caroline) Domali, E. (Ekaterine) Fruscio, R. (Robert) Epstein, E. (Elizabeth) Franchi, D. (Dorella) Kudla, M.J. (Marek J.) Chiappa, V. (Valentina) Alcazar, J.L. (Juan Luis) Leone, F.P.G. (Francesco Paolo Giuseppe) Buonomo, F. (Francesca) Coccia, M.E. (Maria Elisabetta) Guerriero, S. (Stefano) Deo, N. (Nandita) Jokubkiene, L. (Ligita) Savelli, L. (L.) Fischerova, D. (Daniela) Czekierdowski, A. (Artur) Kaijser, J. (Jeroen) Coosemans, A. (An) Scambia, G. (Giovanni) Vergote, I. (I.) Timmerman, D. (Dirk) Valentin, L. (Lil) |
| author_facet | Landolfo, C. (Chiara) Bourne, T. (Tom) Froyman, W. (Wouter) Calster, B. (Ben) van Ceusters, J. (Jolien) Testa, A.C. (Antonia C.) Wynants, L. (Laure) Sladkevicius, P. (Povilas) Van-Holsbeke, C. (Caroline) Domali, E. (Ekaterine) Fruscio, R. (Robert) Epstein, E. (Elizabeth) Franchi, D. (Dorella) Kudla, M.J. (Marek J.) Chiappa, V. (Valentina) Alcazar, J.L. (Juan Luis) Leone, F.P.G. (Francesco Paolo Giuseppe) Buonomo, F. (Francesca) Coccia, M.E. (Maria Elisabetta) Guerriero, S. (Stefano) Deo, N. (Nandita) Jokubkiene, L. (Ligita) Savelli, L. (L.) Fischerova, D. (Daniela) Czekierdowski, A. (Artur) Kaijser, J. (Jeroen) Coosemans, A. (An) Scambia, G. (Giovanni) Vergote, I. (I.) Timmerman, D. (Dirk) Valentin, L. (Lil) |
| author_sort | Landolfo, C. (Chiara) |
| collection | DSpace |
| description | ObjectivePrevious work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two-step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. MethodsThis was a retrospective analysis using data from the 2-year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase-5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow-up. Multiple imputation was used when outcome based on follow-up was uncertain according to predefined criteria. ResultsA total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow-up at recruitment and all patients from 19 centers that did not fulfil our criteria for good-quality surgical and follow-up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two-step strategy based on ADNEX without CA125 had an area under the receiver-operating-characteristics curve (AUC) of 0.94 (95% CI, 0.92-0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two-step strategy without CA125 of 0.93 (95% CI, 0.91-0.95). ConclusionA large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two-step strategy is convenient for clinical use. (c) 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| format | info:eu-repo/semantics/article |
| id | oai:dadun.unav.edu:10171-66063 |
| institution | Universidad de Navarra |
| language | English |
| publishDate | 2023 |
| record_format | dspace |
| spelling | oai:dadun.unav.edu:10171-660632023-06-08T12:09:56Z Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort Landolfo, C. (Chiara) Bourne, T. (Tom) Froyman, W. (Wouter) Calster, B. (Ben) van Ceusters, J. (Jolien) Testa, A.C. (Antonia C.) Wynants, L. (Laure) Sladkevicius, P. (Povilas) Van-Holsbeke, C. (Caroline) Domali, E. (Ekaterine) Fruscio, R. (Robert) Epstein, E. (Elizabeth) Franchi, D. (Dorella) Kudla, M.J. (Marek J.) Chiappa, V. (Valentina) Alcazar, J.L. (Juan Luis) Leone, F.P.G. (Francesco Paolo Giuseppe) Buonomo, F. (Francesca) Coccia, M.E. (Maria Elisabetta) Guerriero, S. (Stefano) Deo, N. (Nandita) Jokubkiene, L. (Ligita) Savelli, L. (L.) Fischerova, D. (Daniela) Czekierdowski, A. (Artur) Kaijser, J. (Jeroen) Coosemans, A. (An) Scambia, G. (Giovanni) Vergote, I. (I.) Timmerman, D. (Dirk) Valentin, L. (Lil) ADNEX model Benign simple descriptor IOTA Ovarian neoplasm Ultrasonography Validation study ObjectivePrevious work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two-step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. MethodsThis was a retrospective analysis using data from the 2-year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase-5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow-up. Multiple imputation was used when outcome based on follow-up was uncertain according to predefined criteria. ResultsA total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow-up at recruitment and all patients from 19 centers that did not fulfil our criteria for good-quality surgical and follow-up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two-step strategy based on ADNEX without CA125 had an area under the receiver-operating-characteristics curve (AUC) of 0.94 (95% CI, 0.92-0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two-step strategy without CA125 of 0.93 (95% CI, 0.91-0.95). ConclusionA large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two-step strategy is convenient for clinical use. (c) 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. 2023-04-20T13:13:48Z 2023-04-20T13:13:48Z 2023 info:eu-repo/semantics/article https://hdl.handle.net/10171/66063 en https://pubmed.ncbi.nlm.nih.gov/36178788/ info:eu-repo/semantics/openAccess application/pdf |
| spellingShingle | ADNEX model Benign simple descriptor IOTA Ovarian neoplasm Ultrasonography Validation study Landolfo, C. (Chiara) Bourne, T. (Tom) Froyman, W. (Wouter) Calster, B. (Ben) van Ceusters, J. (Jolien) Testa, A.C. (Antonia C.) Wynants, L. (Laure) Sladkevicius, P. (Povilas) Van-Holsbeke, C. (Caroline) Domali, E. (Ekaterine) Fruscio, R. (Robert) Epstein, E. (Elizabeth) Franchi, D. (Dorella) Kudla, M.J. (Marek J.) Chiappa, V. (Valentina) Alcazar, J.L. (Juan Luis) Leone, F.P.G. (Francesco Paolo Giuseppe) Buonomo, F. (Francesca) Coccia, M.E. (Maria Elisabetta) Guerriero, S. (Stefano) Deo, N. (Nandita) Jokubkiene, L. (Ligita) Savelli, L. (L.) Fischerova, D. (Daniela) Czekierdowski, A. (Artur) Kaijser, J. (Jeroen) Coosemans, A. (An) Scambia, G. (Giovanni) Vergote, I. (I.) Timmerman, D. (Dirk) Valentin, L. (Lil) Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort |
| title | Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort |
| title_full | Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort |
| title_fullStr | Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort |
| title_full_unstemmed | Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort |
| title_short | Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort |
| title_sort | benign descriptors and adnex in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in iota5 multicenter cohort |
| topic | ADNEX model Benign simple descriptor IOTA Ovarian neoplasm Ultrasonography Validation study |
| url | https://hdl.handle.net/10171/66063 |
| work_keys_str_mv | AT landolfocchiara benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT bournettom benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT froymanwwouter benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT calsterbbenvan benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT ceustersjjolien benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT testaacantoniac benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT wynantsllaure benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT sladkeviciusppovilas benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT vanholsbekeccaroline benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT domalieekaterine benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT frusciorrobert benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT epsteineelizabeth benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT franchiddorella benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT kudlamjmarekj benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT chiappavvalentina benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT alcazarjljuanluis benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT leonefpgfrancescopaologiuseppe benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT buonomoffrancesca benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT cocciamemariaelisabetta benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT guerrierosstefano benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT deonnandita benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT jokubkienelligita benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT savellill benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT fischerovaddaniela benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT czekierdowskiaartur benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT kaijserjjeroen benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT coosemansaan benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT scambiaggiovanni benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT vergoteii benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT timmermanddirk benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort AT valentinllil benigndescriptorsandadnexintwostepstrategytoestimateriskofmalignancyinovariantumorsretrospectivevalidationiniota5multicentercohort |