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abstract
Highlights
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- This is the first meta-analysis on subjective assessment to classify adnexal masses.
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- Subjective assessment performed best of all methods under investigation.
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- All methods yielded superior test accuracy when compared to the currently used risk of malignancy index.
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- Simple rules added with subjective assessment matched test performance of experts.
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- The logistic regression model 2 model can be used as an alternative if an expert is not available.
Introduction
Many
national guidelines concerning the management of ovarian cancer
currently advocate the risk of malignancy index (RMI) to characterise
ovarian pathology. However, other methods, such as subjective
assessment, International Ovarian Tumour Analysis (IOTA) simple
ultrasound-based rules (simple rules) and IOTA logistic regression model
2 (LR2) seem to be superior to the RMI.
Our
objective was to compare the diagnostic accuracy of subjective
assessment, simple rules, LR2 and RMI for differentiating benign from
malignant adnexal masses prior to surgery.
Materials and methods
MEDLINE,
EMBASE and CENTRAL were searched (January 1990–August 2015).
Eligibility criteria were prospective diagnostic studies designed to
preoperatively predict ovarian cancer in women with an adnexal mass.
Results
We
analysed 47 articles, enrolling 19,674 adnexal tumours; 13,953 (70.9%)
benign and 5721 (29.1%) malignant. Subjective assessment by experts
performed best with a pooled sensitivity of 0.93) and specificity of 0.89.
Simple rules (classifying inconclusives as malignant) (sensitivity 0.93 and specificity 0.80) and LR2
(sensitivity 0.93 and specificity 0.84 outperformed RMI (sensitivity 0.75,
specificity 0.92. A two-step strategy using simple
rules, when inconclusive added by subjective assessment, matched test
performance of subjective assessment by expert examiners (sensitivity
0.91and specificity 0.91.
Conclusions
A
two-step strategy of simple rules with subjective assessment for
inconclusive tumours yielded best results and matched test performance
of expert ultrasound examiners. The LR2 model can be used as an
alternative if an expert is not available.
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