scholarly journals Diagnostic Accuracy and Appropriate Cut Off Value of Risk of Malignancy Index in Preoperative Discrimination Between Malignant and Benign Ovarian Tumors: Prospective Cross-sectional Study

2021 ◽  
Author(s):  
bezza Kedida Dabi ◽  
Fanta Asefa Disasa ◽  
Ayantu Kebede Olika
Keyword(s):  
Diagnostic Accuracy ◽  
Menopausal Status ◽  
Cross Sectional Study ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Benign Tumors ◽  
Cross Sectional ◽  
Malignant Ovarian Tumor ◽  
Ultrasound Score ◽  
Benign Ovarian Tumors

Abstract BackgroundRisk of malignancy index (RMI) is scoring system which was introduced to differentiate between benign and malignant ovarian tumor. It incorporates CA-125, ultrasound score and menopausal status for prediction of ovarian malignancies in preoperative period. There is no universal screening method to discriminate between benign and malignant adnexal masses yet. So, this study was conducted to determine the diagnostic accuracy of RMI and determine best cut off value for RMI.MethodsProspective cross-sectional study was carried out among women with ovarian mass admitted to Gynecology ward and operated from September 1, 2019 to June 30, 2020.Data analysis was carried out using SPSS version 26. CA-125 level, menopausal status and ultrasound score were used to calculate RMI. Finally, RMI score was compared to histopathology result used as gold standard.ResultsNinity nine patients were enrolled in this study. Prevalence of benign ovarian tumors were 61.6% (61/99) and that of malignant ovarian tumors were 38.4% (38/99). The mean age for benign tumors was 30±9yrs and the mean age for malignant tumors was 50.6±10.8yrs. Among benign tumors, serous cystadenoma was the most common (36%), followed by dermoid cyst (32.9%), mucinous cyst adenoma (14.8%). The most common malignant ovarian tumor was serous cyst adenocarcinoma (63.2%), followed by mucinous cystadenocarcinoma (23.8%) and dysgerminoma (5.3%). Overall, using RMI score cut off value 220 has good sensitivity (84.2%), specificity (77%), PPV (69.5%), NPV (88.7%) and diagnostic accuracy (79.8%) for discriminating between benign and malignant ovarian tumors.ConclusionFrom this study there were high proportion of women with RMI>=220 in malignant ovarian tumors group. The study shows that there is significant role of RMI in prediction of ovarian malignancy thus helping in deciding which patients need referral to a center where gynecologic oncologists are available. It is good practice to use it in developing countries including our country because of its simplicity, safety and applicability in initial evaluations of patients with adnexal mass.

scholarly journals Modified Risk of Malignancy Index (RMI 5) in ovarian tumor

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rijuta Joshi ◽  
Gehanath Baral
Keyword(s):  
Ovarian Tumor ◽  
Malignant Tumors ◽  
Statistical Significance ◽  
Menopausal Status ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Ca 125 ◽  
Benign Tumors ◽  
Cross Sectional ◽  
Ultrasound Score

Aims: To evaluate the role of modified RMI (RMI 5) in pre-operative evaluation of ovarian tumor. Methods: It was a prospective cross sectional study done in Paropakar Maternity and Women’s Hospital from May to August 2018. During the study, 72 women with ovarian tumor were analyzed. RMI5 was calculated using the ultrasound score, Doppler score, menopausal status and CA125. Cut-off of 200 was used for malignancy discrimination. Chi square test was used to calculate the statistical significance which was set at 0.05. Receiver Operator Characteristics curves for RMI and its individual parameters were plotted using SPSS. Results: There were 72 ovarian tumors operated in four months and mean age was36 years with 10 (14%) at post-menopause. The mean value of RMI 5 was 38 for benign tumors, 80 for borderline tumors and 899 for malignant tumors. The area under curve for RMI 5 was 0.993 for cut-off of 200. The diagnostic accuracy of RMI 5 was 94.4 which was similar to that of Doppler score 2 (94.7) while it was much higher than that of the rest of the parameters (CA-125: 72, ultrasound score: 87 and postmenopausal status: 88.9). Conclusions: RMI 5 is better for malignancy prediction of ovarian masses instead of individual parameters like menopausal status, CA125 and ultrasound score.

scholarly journals Relationship between Serum Tumor Markers, CA-125, CEA, CA19-9, LDH, and βHCG with Histopathology and Age in Women with Ovarian Tumors

2020 ◽  
Vol 5 (4) ◽  
pp. 167-171
Author(s):  
Nilajkumar D Bagde ◽  
Madhuri N Bagde ◽  
Zamir A Lone
Keyword(s):  
Tumor Markers ◽  
Cross Sectional Study ◽  
Serum Markers ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Benign Tumors ◽  
Histopathological Analysis ◽  
Cross Sectional ◽  
Serum Tumor Markers

Introduction: Ovarian tumors pose a diagnostic predicament as it is difficult to differentiate benign from malignant without a histopathology report. Appropriate tumor markers may serve as diagnostic aid to better decision making in the management of these cases. We attempted to determine the relationship between age, serum markers, and histopathological sub types of ovarian tumors to help distinguish benign from malignant tumors.Methods: A retrospective cross sectional study of all cases with ovarian tumors that had available histopathology reports and tumor marker levels was done at a single centre. Variables examined were age, histopathology report and serum tumor markers CA-125, CEA, CA19-9, LDH, and βHCG. Results: Histopathological analysis revealed 26% teratomas, 28% cystadenomas, 14% corpus luteal cysts, 26% carcinomas and 6% endometriomas. CA-125 was the only marker that was significantly raised in malignant versus benign tumors (p=0.008) and increased with increasing age. All women with raised CEA reports had teratomas, and none with cancers had a raised CEA. CA19-9, LDH and βHCG were not significantly different in benign versus malignant tumors.Conclusions: CA-125 may be used as an adjuvant diagnostic tool for ovarian cancer in older women. The role of CEA as a marker for teratomas needs further evaluation.

scholarly journals Role of human epididymis protein 4 for detection of ovarian carcinoma in adnexal masses: A pilot study

2016 ◽  
Author(s):  
Nidhi Bansal ◽  
A. Suneja ◽  
K. Guleria ◽  
N. B. Vaid ◽  
K. Mishra ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cross Sectional Study ◽  
Ca 125 ◽  
Serum Samples ◽  
Cross Sectional ◽  
Adnexal Masses ◽  
Good Discriminator ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Benign Tumours

Introduction: HE4 is a novel tumour biomarker used for early diagnosis of ovarian cancer. This study evaluated the diagnostic accuracy of HE4 alone and in combination with CA125, risk of malignancy index (RMI), risk of malignancy algorithm (ROMA). Methods: It was a cross sectional study conducted recruiting 88 women with adnexal masses who were planned for surgery. After baseline work up and ultrasound examination, serum samples were collected for estimation of CA 125 and HE4 levels. Serum HE4 levels were estimated using ELISA kit. RMI and ROMA score were calculated and diagnostic accuracy of HE4, CA 125, RMI, ROMA and their combination were compared. Cut off for HE4 and ROMA score were calculated using ROC curve. Results: Of 88 subjects, 66 were analyzed with 19 malignant (including 5 LMP) and 47 benign cases. The median value of HE4 among malignant cases was found to be significantly higher than among the benign cases. PPV and NPV of HE4 at a cut off 130.8 pMol/ml was 85.7% and 77.9% respectively. Highest PPV (88.9%) with acceptable NPV (80.7%) was found with ROMA followed by HE4 (PPV 85.7%; NPV 77.97%), RMI (PPV 76.92%; NPV 83%) and CA125 (PPV 52%; NPV 80.85%). Conclusion: HE4 levels were lower in Indian population both in malignant and benign tumours as compared to other studies. HE4 is a good discriminator and gives best accuracy when it is combined with CA125 in a logistic algorithm, ROMA.

scholarly journals Preoperative Measurement of Serum C-Reactive Protein: Is it Useful in the Differential Diagnosis of Adnexal Masses?

2017 ◽  
Vol 32 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Adriana Yoshida ◽  
Sophie F. Derchain ◽  
Denise R. Pitta ◽  
Nathália Crozatti ◽  
Liliana A.L.A. Andrade ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Sensitivity And Specificity ◽  
Menopausal Status ◽  
Ovarian Tumors ◽  
Cancer Center ◽  
Benign Tumors ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Adnexal Masses ◽  
Reactive Protein

Background Serum biomarkers may help to discriminate malignant from benign adnexal masses with equivocal features on imaging. Adequate discrimination of such tumors is crucial for referring patients to either a specialized cancer center or a nonspecialized gynecology service. Aim We aimed to investigate whether the preoperative level of serum C-reactive protein (CRP), alone or combined with CA125 and menopausal status in the Ovarian Score (OVS), is useful in the prediction of malignancy in women with ovarian tumors. Methods This cross-sectional study included 293 patients who underwent surgery in a tertiary cancer center. Receiver operating characteristic (ROC) areas under the curves (AUC) for CRP, CA125 and OVS were calculated in different scenarios, as well as their sensitivity and specificity, using standard cutoff points (for CRP, 10 mg/L; for CA125, 35 U/mL). Results CA125 and the OVS performed significantly better than CRP alone in the differentiation of benign disease from epithelial ovarian cancer (EOC) (AUC = 0.86 for CA125, 0.79 for OVS, and 0.73 for CRP). OVS and CRP alone were superior to CA125 only in the differentiation of borderline ovarian tumors from advanced stages of EOC and non-EOC. Sensitivity and specificity were 52.5% and 83%, respectively, for CRP, 77.9% and 66.7% for CA125, and 71.3% and 67.8% for OVS. Conclusions OVS is as good as CA125 in the differentiation of benign tumors from ovarian cancer. The addition of CA125 and menopausal status to CRP enhanced the relatively low discriminatory power of isolated CRP.

scholarly journals Diagnostic Added-Value of Serum CA-125 on the IOTA Simple Rules and Derivation of Practical Combined Prediction Models (IOTA SR X CA-125)

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 173
Author(s):  
Phichayut Phinyo ◽  
Jayanton Patumanond ◽  
Panprapha Saenrungmuaeng ◽  
Watcharin Chirdchim ◽  
Tanyong Pipanmekaporn ◽  
...  
Keyword(s):  
Prediction Models ◽  
Characteristic Curve ◽  
Secondary Analysis ◽  
Ovarian Tumors ◽  
Added Value ◽  
Ca 125 ◽  
Discriminative Ability ◽  
Cross Sectional ◽  
Simple Rules ◽  
Benign Ovarian Tumors

Background: This study aimed to evaluate the diagnostic added-value of serum CA-125 to the International Ovarian Tumor Analysis (IOTA) Simple Rules in order to facilitate differentiation between malignant and benign ovarian tumors before surgery. Methods: A secondary analysis of a cross-sectional cohort of women scheduled for surgery in Maharaj Nakorn Chiang Mai Hospital between April 2010 and March 2018 was carried out. Demographic and clinical data were prospectively collected. Histopathologic diagnosis was used as the reference standard. Logistic regression was used for development of the model. Evaluation of the diagnostic added-value was based on the increment of the area under the receiver operating characteristic curve (AuROC). Results: One hundred and forty-five women (30.3%) out of a total of 479 with adnexal masses had malignant ovarian tumors. The model that included information from the IOTA Simple Rules and serum CA-125 was significantly more superior to the model that used only information from the IOTA Simple Rules (AuROC 0.95 vs. 0.89, p < 0.001 for pre-menopause and AuROC 0.98 vs 0.83, p < 0.001 for post-menopause). Conclusions: The IOTA SR X CA-125 model showed high discriminative ability and is potentially useful as a decision tool for guiding patient referrals to oncologic specialists.

scholarly journals Diagnostic Accuracy of Risk of Malignancy Indices in Ovarian Tumor

2020 ◽  
Vol 18 (2) ◽  
pp. 253-258
Author(s):  
Gehanath Baral ◽  
Rijuta Joshi ◽  
Benju Pandit
Keyword(s):  
Ovarian Cancer ◽  
Diagnostic Accuracy ◽  
Ovarian Tumor ◽  
Predictive Accuracy ◽  
Cross Sectional Study ◽  
Ca 125 ◽  
Cross Sectional ◽  
Predictive Values ◽  
Doppler Study ◽  
Risk Of Malignancy

Background: Screening test for ovarian cancer has not been developed yet but several tools exist to predict it. The aim is to find out the relative accuracy of commonly practiced versions of Risk of Malignancy Indices to predict ovarian malignancy pre-operatively.Methods: Intention to treat cross sectional study at Paropakar Maternity and Women’s Hospital in Kathmandu during last six months of year 2018. Cases with ovarian mass were taken pre-operatively with serum tumor markers, ultrasound and tumor Doppler study report. Pregnancy and diagnosed malignancy were excluded. Histopathology report traced post-operatively. All five versions of Risk of Malignancy Indices were analyzed by their predictive efficiency and different cut-off value of CA-125.Results: 116 cases of ovarian tumor from 14 to 76 years (mean=35.2±11.7) were studied. There were 8.6% (n=10) malignant pathology; and isolated high vascular flow and solid component may predict malignancy (p=0.000). Up to 12 multiples of normal CA-125 value could not demonstrate clear predictive value for malignancy (p=0.061). By sensitivity, specificity, diagnostic accuracy and predictive values were similar for Risk of Malignancy Indices-1 and RMI-5 as well as Risk of Malignancy Indices-2 and Risk of Malignancy Indices-3. Cut-off of 250 is efficient by >90% and best at 300. Sensitivity of all Risk of Malignancy Indices versions were similar at cut-off level of 200, 250 and 300.Conclusions: Isolated value of CA-125 and size of tumor are not useful. All Risk of Malignancy Indices versions are reasonably good. Risk of Malignancy Indices value of 250 or more is the best predictive cut-off. Risk of Malignancy Indices-1 and Risk of Malignancy Indices-5 as well as Risk of Malignancy Indices-2 and Risk of Malignancy Indices-3 have similar predictive accuracy. Doppler study is not mandatory.Keywords: Cut-off value; diagnostic accuracy; ovarian cancer; RMI

HE4 can Help Discriminate Women with Malignant Ovarian Tumors only if CA125 Levels are Elevated

2013 ◽  
Vol 28 (4) ◽  
pp. 377-386 ◽  
Author(s):  
Denise da Rocha Pitta ◽  
Luis Otávio Sarian ◽  
Elisabete Aparecida Campos ◽  
Liliana Lucci De Angelo Andrade ◽  
Luis Felipe Sallum ◽  
...  
Keyword(s):  
Permutation Test ◽  
Malignant Tumors ◽  
Roc Curves ◽  
Cross Sectional Study ◽  
Serum Markers ◽  
Ovarian Tumors ◽  
The Other ◽  
Benign Tumors ◽  
Cross Sectional ◽  
Increased Risk

Objective To evaluate the performance of mesothelin, CA125, HE4 and ROMA index in the detection of malignant ovarian tumors. Study Design This is a cross-sectional study including 199 women with adnexal masses (67 with malignant tumors and 132 with benign tumors) and 150 healthy women (controls). We used a recursive multivariate partitioning algorithm to assess the contribution of each of the serum markers and the ROMA index to the discrimination of women with malignant tumors. Also, the areas under the ROC curves (AUC) for each of the serum markers and for the ROMA index were compared using the Venkatraman's projection-permutation test. Results In the recursive model, CA125 had the best performance in discriminating women with malignant tumors. In women with normal-range CA125 levels, none of the other markers contributed to the discrimination of women with malignant tumors. In women with elevated CA125 levels, elevated HE4 levels were associated with an increased risk of harboring a malignant tumor. The AUC for mesothelin was smaller than that for all the other curves, and both the ROMA index and CA125 had better AUC than HE4. Conclusion In women with normal CA125 levels, neither mesothelin nor HE4 contributed to discriminate women with malignant ovarian tumors; however, for women with elevated CA125 levels HE4 may help discriminating those who have a malignant ovarian tumor.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

scholarly journals Emirati Women’s Knowledge about the Menopause and Menopausal Hormone Therapy

2020 ◽  
Vol 17 (13) ◽  
pp. 4875
Author(s):  
Linda Smail ◽  
Ghufran A. Jassim ◽  
Khawla I. Sharaf
Keyword(s):  
Hormone Therapy ◽  
Heart Diseases ◽  
Menopausal Status ◽  
Cross Sectional Study ◽  
Menopausal Hormone Therapy ◽  
Cross Sectional ◽  
Reproductive Characteristics ◽  
The Mean ◽  
Women's Knowledge ◽  
Women’S Knowledge

The aim of this study was to investigate the knowledge of Emirati women aged 30–64 about menopause, menopausal hormone therapy (MHT), and their associated health risks, and additionally, to determine the relationships between Emirati women’s knowledge about menopause and their sociodemographic and reproductive characteristics. A community-based cross-sectional study was conducted of 497 Emirati women visiting five primary healthcare centers in Dubai. Data were collected using a questionnaire composed of sociodemographic and reproductive characteristics, menopause knowledge scale (MKS), and menopause symptoms knowledge and MHT practice. The mean menopause symptoms knowledge percentage was 41%, with a standard deviation of 21%. There were significant differences in the mean knowledge percentage among categories of education level (p < 0.001) and employment (p = 0.003). No significant differences in the knowledge percentages were found among categories of menopausal status. “Pregnancy cannot occur after menopause” was the statement with the highest knowledge percentage (83.3%), while the lowest knowledge percentages were “risk of cardiovascular diseases increases with menopause’’ (23.1%), “MHT increases risk of breast cancer’’ (22.1%), and “MHT decreases risk of colon cancer’’ (13.9%). The knowledge of Emirati women about menopause, MHT, and related heart diseases was very low; therefore, an education campaign about menopause and MHT risks is needed to improve their knowledge for better coping with the symptoms.

Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis

2010 ◽  
Vol 70 (3) ◽  
pp. 434-439 ◽  
Author(s):  
Eugenio de Miguel ◽  
Santiago Muñoz-Fernández ◽  
Concepción Castillo ◽  
Tatiana Cobo-Ibáñez ◽  
Emilio Martín-Mola
Keyword(s):  
New York ◽  
Diagnostic Accuracy ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Controlled Study ◽  
Diagnostic Classification ◽  
Hla B27 ◽  
Cross Sectional ◽  
Ultrasound Score

ObjectiveTo determine the sensitivity and specificity of enthesis ultrasound for the diagnostic classification of early spondyloarthritis.MethodsA cross-sectional, blinded and controlled study. Standardised bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)) was performed. Accepted diagnostic classification criteria were used as the gold standard. Validity was analysed by receiver operating characteristic (ROC) curves. Values of p<0.05 were considered significant.Results113 early spondyloarthritis patients were included (58 women/55 men), 57 non-inflammatory control individuals (29 women/28 men) and 24 inflammatory control individuals (11 women/13 men). The evolution time of spondyloarthritis was 10.9±7.1 months. At least some grade of sacroiliitis on x-ray was present in 59 patients, but only five fulfilled the radiographic sacroiliitis New York criteria. Human leucocyte antigen B27 (HLA-B27) was positive in 42% of patients. No statistical differences were found for the enthesis score among diagnostic spondyloarthritis subtypes form of presentation (axial, peripheral or mixed) or HLA-B27 positivity. The MASEI score achieved statistical significance for gender. The ultrasound score was 23.36±11.40 (mean±SD) in spondyloarthritis patients and 12.26±6.85 and 16.04±9.94 in the non-inflammatory and inflammatory control groups (p<0.001), respectively. The ROC area under the curve was 0.82, and a cut-off point of ≥20 points achieved a likelihood ratio of 5.30 and a specificity of 89.47%.ConclusionsEntheses are affected early in spondyloarthritis, and the incidence of involvement is higher in men and independent of the spondyloarthritis diagnostic subtype, HLA-B27 status or presentation pattern. The enthesis ultrasound score seems to have diagnostic accuracy and may be useful for improving the diagnostic accuracy of early spondyloarthritis.

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