Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis.

Autor: Meys EM; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), GROW - School for Oncology and Developmental Biology, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. Electronic address: evelyne.meys@mumc.nl., Kaijser J; Department of Obstetrics and Gynaecology and Leuven Cancer Institute, University Hospital KU Leuven, Herestraat 49, Leuven 3000, Belgium. Electronic address: j.kaijser@ikazia.nl., Kruitwagen RF; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), GROW - School for Oncology and Developmental Biology, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. Electronic address: r.kruitwagen@mumc.nl., Slangen BF; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), GROW - School for Oncology and Developmental Biology, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. Electronic address: brigitte.slangen@mumc.nl., Van Calster B; Department of Development and Regeneration, KU Leuven, Herestraat 49, Leuven 3000, Belgium. Electronic address: ben.vancalster@med.kuleuven.be., Aertgeerts B; Department of General Practice, KU Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium. Electronic address: bert.aertgeerts@med.kuleuven.be., Verbakel JY; Department of General Practice, KU Leuven, Kapucijnenvoer 33, Leuven 3000, Belgium; Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK. Electronic address: jan.verbakel@med.kuleuven.be., Timmerman D; Department of Obstetrics and Gynaecology and Leuven Cancer Institute, University Hospital KU Leuven, Herestraat 49, Leuven 3000, Belgium. Electronic address: dirk.timmerman@uzleuven.be., Van Gorp T; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), GROW - School for Oncology and Developmental Biology, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. Electronic address: Toon.van.gorp@mumc.nl.
Jazyk: angličtina
Zdroj: European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2016 May; Vol. 58, pp. 17-29. Date of Electronic Publication: 2016 Feb 27.
DOI: 10.1016/j.ejca.2016.01.007
Abstrakt: 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 (95% confidence interval [CI] 0.92-0.95) and specificity of 0.89 (95% CI 0.86-0.92). Simple rules (classifying inconclusives as malignant) (sensitivity 0.93 [95% CI 0.91-0.95] and specificity 0.80 [95% CI 0.77-0.82]) and LR2 (sensitivity 0.93 [95% CI 0.89-0.95] and specificity 0.84 [95% CI 0.78-0.89]) outperformed RMI (sensitivity 0.75 [95% CI 0.72-0.79], specificity 0.92 [95% CI 0.88-0.94]). A two-step strategy using simple rules, when inconclusive added by subjective assessment, matched test performance of subjective assessment by expert examiners (sensitivity 0.91 [95% CI 0.89-0.93] and specificity 0.91 [95% CI 0.87-0.94]).
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.
(Copyright © 2016 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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