Classifying adnexal lesions at ultrasound may help predict ovarian cancer in women
USA: By classifying adnexal lesions via classic- or nonclassic-appearing imaging features, ultrasound can help diagnose ovarian cancer in women, shows a recent study in the journal Radiology. The highest risk of cancer was found in isolated nonclassic lesions with blood flow in women aged more than 60 years.
There exists several US risk stratification for the assessment of adnexal lesions. These multiple-subcategory systems may be more multifaceted than required for isolated adnexal lesions in average-risk women.
Against the above background, Akshya Gupta, University of Rochester Medical Center, Rochester, NY, and colleagues aimed to explore whether a US-based classification scheme of classic versus nonclassic appearance can be utilized for appropriate triage of women at average risk of ovarian cancer without compromising diagnostic performance in a retrospective multicenter study.
The study included isolated ovarian lesions identified at the pelvic US performed between January 2011 and June 2014, reviewed between September 2019 and September 2020. In the absence of ascites or peritoneal implants, lesions were considered isolated. Lesion classification was done as classic or nonclassic based on sonographic appearance. Classic lesions included hemorrhagic cysts, simple cysts, dermoids, and endometriomas. Otherwise, lesions were considered nonclassic.
The researchers then recorded outcomes based on histopathologic results or clinical or imaging follow-up. Diagnostic performance and frequency of malignancy were calculated. χ2 test was used to compare the frequency of malignancy between age groups and the relationships between imaging features and malignancy were explored using Poisson regression.
A total of 970 isolated lesions in 878 women (mean age, 42 years ± 14 [SD]) were included.
Based on the study, the researchers reported the following findings:
- The malignancy rate for classic lesions was less than 1%. Of 970 lesions, 53 (6%) were malignant.
- The malignancy rate for nonclassic lesions was 32% (33 of 103) when blood flow was present and 8% (16 of 194) without blood flow.
- For women older than 60 years, the malignancy rate was 50% (10 of 20 lesions) when blood flow was present and 13% (five of 38) without blood flow.
- The sensitivity, specificity, positive predictive value, and negative predictive value of the classic-versus-nonclassic schema were 93% (49 of 53 lesions), 73% (669 of 917 lesions), 17% (49 of 297 lesions), and 99% (669 of 673 lesions), respectively, for detection of malignancy.
The authors wrote in their conclusion, "using a US classification schema of classic- or nonclassic-appearing adnexal lesions resulted in high sensitivity and specificity in the diagnosis of malignancy in ovarian cancer."
Reference:
The study titled, "Ovarian Cancer Detection in Average-Risk Women: Classic- versus Nonclassic-appearing Adnexal Lesions at US," was published in the journal Radiology.
DOI: https://doi.org/10.1148/radiol.212338
KEYWORDS: Radiology journal, RSNA, ovarian cancer, adnexal lesions, ultrasound, Akshya Gupta, diagnosis, triage, women, malignancy, risk, imaging, cancer
