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Risk of Ovarian Malignancy Algorithm and Pelvic Mass Score for the prediction of malignant ovarian tumors: a prospective comparative study

Mohamed A. Ali
Mohamed A. Ali
, 
Mohamed S. Sweed
Mohamed S. Sweed
, 
Eman A. NasrElDin
Eman A. NasrElDin
, 
Walaa E. Ahmed
Walaa E. Ahmed
 et 
Gihan E. ElHawwary
Gihan E. ElHawwary
   | 27 févr. 2024
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Article Category: Research paper
Publié en ligne: 27 févr. 2024
Pages: -
Reçu: 26 sept. 2022
Accepté: 21 nov. 2022
DOI: https://doi.org/10.15557/jou.2024.0001
Mots clés
© 2024 Mohamed A. Ali et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Flowchart of the study
Flowchart of the study

Fig. 2.

Case of mucinous cystadenoma
Case of mucinous cystadenoma

Fig. 3.

Case of mature cystic teratoma
Case of mature cystic teratoma

Fig. 4.

Case of endometrioid adenocarcinoma
Case of endometrioid adenocarcinoma

Fig. 5.

Case of papillary serous carcinoma
Case of papillary serous carcinoma

Fig. 6.

Case of undifferentiated carcinoma
Case of undifferentiated carcinoma

Fig. 7.

Comparison of the receiver-operating characteristic (ROC) curves for the differentiation between benign and malignant ovarian masses using various diagnostic indices and biomarkers
Comparison of the receiver-operating characteristic (ROC) curves for the differentiation between benign and malignant ovarian masses using various diagnostic indices and biomarkers

Prevalence of various histopathological types of benign lesions

Histopathological diagnosis N (%) Histopathological diagnosis N (%)
Endometriotic cyst 35 (25.9%) Hemorrhagic corpus luteum 4 (3%)
Mucinous cystadenoma 13 (9.6%) Simple follicular cyst 8 (5.9%)
Tubo-ovarian abscess 17 (12.6%) Fibroma 7 (5.2%)
Mature cystic teratoma 24 (17.8%) Serous cyst 10 (7.4%)
Serous cystadenoma 10 (7.4%) Follicular cyst 3 (2.2%)
Hemorrhagic follicular cyst 2 (1.5%) Fibrothecoma 2 (1.5%)

Receiver-operating characteristic (ROC) curve analysis for the value of various indices and biomarkers for differentiation between benign and malignant ovarian masses

Predictor
Index ROMA Sassone PMS CA 125 HE4 RI
AUC 0.91 0.80 0.93 0.86 0.81 0.72
95% CI 0.87 to 0.95 0.74 to 0.85 0.89 to 0.96 0.81 to 0.900 0.76 to 0.86 0.66 to 0.78
p-value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001
J index 0.8 0.47 0.74 0.61 0.64 0.46
Cut-off criterion >48.1 >9 >43.1 >130 >143 ≤0.56
Sensitivity 84.4 67.8 83.3 73.3 67.8 58.9
95% CI 75.3–91.2 57.1–77.2 74.0–90.4 63.0–82.1 57.1–77.2 48.0–69.2
Specificity 95.56 79.26 90.37 87.41 96.3 86.67
95% CI 90.6–98.4 71.4–85.8 84.1–94.8 80.6–92.5 91.6–98.8 79.7–91.9
+LR 19 3.27 8.65 5.82 18.3 4.42
−LR 0.16 0.41 0.18 0.31 0.33 0.47
+PV 92.7 68.5 85.2 79.5 92.4 74.6
95% CI 84.8–97.3 57.8–78.0 76.1–91.9 69.2–87.6 83.2–97.5 62.9–84.2
−PV 90.2 78.7 89.1 83.1 81.8 76
95% CI 84.1–94.5 70.8–85.2 82.6–93.7 75.9–88.9 74.9–87.4 68.4–82.5

Prevalence of various histopathological types of malignant lesions

Histopathological diagnosis N (%) Histopathological diagnosis N (%)
Endometrioid adenocarcinoma 29 (32.2%) Clear cell carcinoma 9 (10%)
Papillary serous carcinoma 17 (18.9%) Mucinous cystadenocarcinoma 5 (5.6%)
Papillary tubal serous carcinoma 1 (1.1%) Germ cell tumor 3 (3.3%)
Undifferentiated carcinoma 4 (4.4%) Clear cell + endometrioid adenocarcinoma 2 (2.2%)
Mixed epithelial tumor 4 (4.4%) Immature teratoma 2 (2.2%)
Granulosa cell tumor 2 (2.2%) Sclerosing stromal tumor 1 (1.1%)
Sertoli-Leydig tumor 1 (1.1%) Borderline serous tumor 5 (5.6%)
Borderline mucinous tumor 2 (2.2%) Lymphoma 1 (1.1%)
Krukenberg tumor 1 (1.1%) Pseudomyxoma peritonei 1 (1.1%)

Results of biomarker assays and estimated values of predictive indices in women with benign or malignant ovarian masses

Variable Benign (n = 135) Malignant (n = 90) p-value
HE4 (pmol/l) 72.8 (52.90–94.3) 369.6 (80.8–909.1) <0.0001
CA 125 (IU/ml) 25 (11.0–69.8) 341.5 (117.0–640.0) <0.0001
ROMA predicted probability (%) 17.5 (9.1–28.9) 87.1 (67.7–97.9) <0.0001
Sassone score 8 (6–9) 11 (9.0–12.0) <0.0001
PMS 18.1 (10.7–31.6) 106.7 (59.7–198.9) <0.0001

Sassone scoring system (cut-off value: 9)

US findings 1 2 3 4 5
Inner wall Smooth Irregularity <3 mm Papillary >3 mm Not applicable, mostly solid _____
Structure
Septa No septa Thin <3 mm _____ _____ _____
Wall thickness Thin <3 mm Thick >3 mm Not applicable, mostly solid _____ _____
Echogenicity Sonolucent Low echogenicity Low echogenicity with echogenic core Mixed echogenicity High echogenicity

Comparison of sensitivity of ROMA ≥12.5 (pre-menopausal) or ≥14.4 (post-menopausal) scores, Sassone score ≥9, and PMS ≥29 for the identification of malignant lesions

ROMA ROMA Sassone
Sass-one <12.5 or <14.4 ≥12.5 or ≥14.4 Σ PMS <12.5 or <14.4 ≥12.5 or ≥14.4 Σ PMS <9 ≥9 Σ
<9 2 16 18 (20%) <29 2 3 5 (5.6%) <29 1 4 5 (5.6%)
≥9 4 68 72 (80%) >29 4 81 85 (94.4%) >29 17 68 85 (94.4%)
Σ 6 (6.7%) 84 (93.3%) 90 Σ 6 (6.7%) 84 (93.3%) 90 Σ 18 (20%) 72 (80%) 90
Diff. 13.3% (95% CI, 2.8 to 19.7) Diff. 1.11% (95% CI, −4.9 to 6.2) Diff. 14.4% (95% CI, 3.8 to 20.8)
p-value 0.012 p-value 1.000 p-value 0.007
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