Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 3 , ISSUE 1 ( January-March, 2009 ) > List of Articles

RESEARCH ARTICLE

Assessment of an Ultrasound-based Scoring System for Triaging Ovarian Tumors in Symptomatic Women

Juan Luis Alcázar, Pedro Royo, Rosendo Galván, José Ángel Mínguez, Manuel García Manero, Carmen Laparte, Guillermo López García

Keywords : Adnexal mass,ovarian cancer,complaints,ultrasound

Citation Information : Alcázar JL, Royo P, Galván R, Mínguez JÁ, Manero MG, Laparte C, García GL. Assessment of an Ultrasound-based Scoring System for Triaging Ovarian Tumors in Symptomatic Women. Donald School J Ultrasound Obstet Gynecol 2009; 3 (1):9-14.

DOI: 10.5005/jp-journals-10009-1003

License: CC BY-NC 4.0

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2009; The Author(s).


Abstract

Objective

To evaluate prospectively an ultrasound-based scoring system as a method for triaging symptomatic women presenting with an adnexal mass for surgical treatment.

Methods

151 symptomatic women scheduled for surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound prior to surgery. Patients were classified as low-risk or high-risk for malignancy according an ultrasound-based scoring system. Patients with low risk for malignancy were scheduled for laparoscopy and patients for high risk for malignancy were scheduled for laparotomy. Some patients with high-risk were scheduled for advanced oncologic laparoscopic surgery. Patients with low risk but tumor size > 10 cm were scheduled for laparotomy.

Results

82 women presented with pelvic pain, 8 had uterine bleeding and 61 referred symptoms suggestive for ovarian malignancy, such as abdominal swelling, bloating and abdominal discomfort. 75 (49.7%) masses were considered as “low-risk” and treated by laparoscopy in 58 cases and by laparotomy in 7 cases, because emergency or associated pathology (All tumors were benign). 76 (50.3%) masses were considered as “high-risk” and all treated by laparotomy (56 malignant and 4 benign tumors) or by advanced laparoscopy (16 malignant tumors). Ten (6.7%) tumors were considered as “low-risk” but scheduled for primary laparotomy because of size > 10 cm (9 benign and 1 malignant). Sensitivity, specificity, PPV and NPV for this scoring system were 98.6%, 94.9%, 94.7% and 98.7%, respectively. The scoring system were more sensitive than patient's complaints (98.6% vs 79.5%, p < 0.0001) and more specific than physical examination (94.9% vs 85.9%, p < 0.0001)

Conclusions

Ultrasound based triage of symptomatic women diagnosed, as having an adnexal mass is effective for selecting surgical approach.


PDF Share
  1. Laparoscopic management of adnexal masses: A gold standard? Curr Opin Obstet Gynecol 2002;14:423-28.
  2. Advanced ovarian cancer. An overview of multivariate analyses of prognostic variables with special reference to the role of cytoreductive surgery. Ann Oncol 1993;4:23-29.
  3. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer 2006;106:589-98.
  4. A population-based study of patterns of care for ovarian cancer: Who is seen by a gynecologic oncologist and who is not? Gynecol Oncol 2002;84:36-42.
  5. US characterization of ovarian masses: a metaanalysis. Radiology. 2000;217:803-11.
  6. The cystic adnexal mass: patient selection, surgical techniques and long-term follow-up. Curr Opin Obstet Gynecol 2001;13:389-97.
  7. A new scoring system to differentiate benign from malignant adnexal masses. Am J Obstet Gynecol 2003;188:685-92.
  8. Triage for surgical Management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system. Ultrasound Obstet Gynecol 2008;32:220-25.
  9. Development of an ovarian cancer symptom index: Possibilities for earlier detection. Cancer 2007;109:221-27.
  10. Combining a symptoms index with CA 125 to improve detection of ovarian cancer. Cancer 2008;113:484-89.
  11. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: A consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000;16:500-05.
  12. Transvaginal color Doppler sonography in adnexal massess: Which parameter performs best? Ultrasound Obstet Gynecol 1996; 8:114-19.
  13. International histological classification of tumors. No. 9, Histological typing of ovarian tumors, World Health Organization, Geneva 1973.
  14. Revised FIGO staging for gynecological cancer. Br J Obstet Gynecol 1989;96:889-92.
  15. Impact of a multiparameter, ultrasoundbased triage on surgical management of adnexal masses. Ultrasound Obstet Gynecol 2002;20:181-85.
  16. Ultrasonography and color Doppler-based triage for adnexal masses to provide the most appropriate surgical approach. Am J Obstet Gynecol 2005;192:401-16.
  17. Risk of malignancy index for referral of ovarian cancer cases to a tertiary center: does it identify the correct cases? Int J Gynecol Cancer 2006;16:30-34.
  18. Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery. Ultrasound Obstet Gynecol 2007;30:883-88.
  19. Triage of ovarian masses. Aust N Z J Obstet Gynaecol 2008;48:322-28.
  20. Limitations of the pelvic examination for evaluation of the female pelvic organs. Int J Gynaecol Obstet 2005;88:84-88.
  21. Management of adnexal mass. Evid Rep Technol Assess (Full Rep) 2006;130:1-145.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.