New Method Can Improve Pre-Operative Diagnosis of Ovarian Cancer Based on Ultrasound

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PHILADELPHIA -- January 19, 2016 -- A new and simple method can accurately assess the risk of malignancy of women with an adnexal mass, according to a study published in the American Journal of Obstetrics and Gynecology (AJOG).
The method identified between 89% and 99% of patients with ovarian cancer using the results of ultrasound examination, which can be obtained in referral and non-referral centres.
The work is based on the “Simple Rules” criteria developed by the International Ovarian Tumor Analysis (IOTA) group to improve accurate diagnosis of ovarian cancer before surgery.
This new approach has the potential to level and raise the playing field and put expert interpretation and improved diagnostic capability within reach of all practitioners.

While ovarian cancer is a common and potentially lethal disease, early detection and treatment improve survival. However, adnexal masses, ovarian masses or cysts that persist and become enlarged, often pose a diagnostic dilemma because preoperative tests to determine if they are benign or malignant are often inconclusive. The IOTA group developed a set of “Simple Rules” based on ultrasound images of the adnexal masses, which allows them to be classified as either benign or malignant.
Although the Simple Rules have been well-received by clinicians, an important question from patients and physicians has been whether it is possible to calculate the individual risk of malignancy for a particular patient.
For the current study, Dirk Timmerman, MD, University Hospitals Leuven, Leuven, Belgium, and colleagues sought to develop and validate a model to predict the risk of malignancy in adnexal masses using the ultrasound features derived from the Simple Rules. This study represents the culmination of multiple consecutive multicentre studies involving 22 centres in 10 countries over 13 years (1999-2012) and approximately 5,000 patients with adnexal masses.
“The Simple Rules are intuitively attractive because of their ease of use, however, when used as originally suggested, they allow only a categorisation of tumours into 3 groups: benign, malignant, or inconclusive,” said Dr. Timmerman. “In this study we show that the Simple Rules can now be used to estimate the risk of malignancy in every adnexal mass and so can be used for individualised patient management.”
The researchers examined patients before surgery, using a standardised examination technique and standardised terms and definitions to describe ultrasound findings. The predictions based on ultrasounds were subsequently compared with the histological findings after the tumour was examined by pathologists and the risk of malignancy was calculated.
“We conclude that individual risk estimates can be derived from the five ultrasound features in the Simple Rules with performance similar to the best previously published algorithms,” said Dr. Timmerman. “A simple classification based on these risk estimates may form the basis of a clinical management approach. This will hopefully facilitate choosing optimal treatment for all patients presenting with adnexal masses.”
In an accompanying editorial, Beryl Benacerraf, MD, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, wrote: “Although an earlier systematic review indicated that magnetic resonance imaging (MRI) gives better results than ultrasound, Dr. Timmerman and his colleagues have shown that the IOTA Simple Rules provide better results than ever before and support the notion that ultrasound is at least as accurate and likely better than MRI in distinguishing benign from malignant masses. The investigators publishing in AJOG have shown here that if we use the Simple Rules with the scoring instrument developed by the IOTA group, we will make the correct diagnosis more readily than ever before and this offers the advantage that most practitioners could adopt this approach successfully.”
“I applaud this group for grappling with the challenging problem of the variability of ultrasound diagnoses of adnexal masses depending on the expertise of acquisition and interpretation, and succeeding in developing a simple, standardised, and scalable solution,” he added. “By at once levelling and elevating the playing field, application of this method places expert interpretation and improved diagnostic ability within reach of all practitioners.”