A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: The development of a new logistic regression model

Objective: The aim of this study was to assess the complementary use of ultrasonographic end points with the level of circulating CA 125 antigen by multivariate logistic regression analysis algorithms to distinguish malignant from benign adnexal masses before operation. Study Design: One hundred nin...

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Published in:American journal of obstetrics and gynecology 1999-07, Vol.181 (1), p.57-65
Main Authors: Timmerman, Dirk, Bourne, Thomas H., Tailor, Anil, Collins, William P., Verrelst, Herman, Vandenberghe, Kamiel, Vergote, Ignace
Format: Article
Language:English
Subjects:
Adnexal Diseases - diagnosis
Adnexal Diseases - diagnostic imaging
Adnexal Diseases - pathology
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
CA 125
CA-125 Antigen - blood
color Doppler imaging
Female
Female genital diseases
Gynecology. Andrology. Obstetrics
Humans
logistic regression
Medical sciences
Middle Aged
Neoplasm Staging
ovarian carcinoma
Pelvic Neoplasms - blood supply
Pelvic Neoplasms - diagnosis
Pelvic Neoplasms - diagnostic imaging
Pelvic Neoplasms - pathology
Preoperative Care
Prospective Studies
Regression Analysis
Sensitivity and Specificity
Tumors
ultrasonography
Ultrasonography, Doppler, Color
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Summary:Objective: The aim of this study was to assess the complementary use of ultrasonographic end points with the level of circulating CA 125 antigen by multivariate logistic regression analysis algorithms to distinguish malignant from benign adnexal masses before operation. Study Design: One hundred ninety-one patients aged 18 to 93 years with overt adnexal masses were examined by transvaginal ultrasonography with color Doppler imaging and 31 variables were recorded. The end points were the histologic classification of the tumor and the areas under the receiver-operator characteristic curves of alternative algorithms. Results: One hundred forty patients had benign tumors and 51 (26.7%) had malignant tumors: 31 primary invasive tumors (37% International Federation of Gynecology and Obstetrics stage I), 5 tumors of borderline malignancy (100% International Federation of Gynecology and Obstetrics stage I), and 15 tumors were metastatic and invasive. The most useful variables for the logistic regression analysis were the menopausal status, the serum CA 125 level, the presence of ≥1 papillary growth (>3 mm in length), and a color score indicative of tumor vascularity and blood flow. The optimized procedure had a sensitivity of 95.9% and a specificity of 87.1%. The area under the receiver-operator characteristic curve was significantly higher ( P < .01) than the corresponding values from the independent use of serum CA 125 levels or indexes of tumor form or vascularity. Conclusion: Regression analysis of a few complementary variables can be used to accurately discriminate between malignant and benign adnexal masses before operation. (Am J Obstet Gynecol 1999;181:57-65.)
ISSN:0002-9378
1097-6868
DOI:10.1016/S0002-9378(99)70436-9