Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer

Sadowski, Elizabeth A.; Paroder, Viktoriya; Patel-Lippmann, Krupa; Robbins, Jessica B.; Barroilhet, Lisa; Maddox, Elizabeth; McMahon, Timothy T.; Sampene, Emmanuel; Wasnik, Ashish P.; Blaty, Alexander D.; Maturen, Katherine E.

doi:10.1148/radiol.2018172271

Cited by 57 publications

(34 citation statements)

References 39 publications

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“…1 In this setting, ultrasound (US) is considered the first-line imaging approach for evaluating AM; however, about 20% of AM are incompletely differentiated after US assessment. 2 AM can be divided into three categories based on US examination: benign, malignant, and indeterminate. 3 Indeterminate AM is a complex mass, which cannot be put into either category, even after color Doppler evaluation, or for which the site of origin cannot be determined.…”

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confidence: 99%

“…THE CLINICAL SUSPICION OF ADNEXAL MASSES (AM) is one of the most frequent indications for gynecologic imaging 1 . In this setting, ultrasound (US) is considered the first‐line imaging approach for evaluating AM; however, about 20% of AM are incompletely differentiated after US assessment 2 . AM can be divided into three categories based on US examination: benign, malignant, and indeterminate 3 .…”

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confidence: 99%

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Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses

Basha

Abdel-Rahman

Metwally

et al. 2020

Magnetic Resonance Imaging

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Background: The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for accurate imaging evaluation before treatment. Purpose: To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. Study Type: A prospective multicenter study. Population: In all, 531 women (mean age, 44 AE 11.2 years; range, 21-79 years) with 572 sonographically indeterminate AM. Field Strength/Sequence: 1.5T/precontrast T 1-weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T 2-WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm 2 ; and dynamic contrast-enhanced perfusion T 1-WI liver acquisition with volume acceleration (LAVA). Assessment: All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow-up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy. Statistical Tests: Four-fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve. Results: In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861).

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confidence: 99%

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confidence: 99%

Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses

Basha

Abdel-Rahman

Metwally

et al. 2020

Magnetic Resonance Imaging

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“…The current standard of care for a suspected adnexal mass is imaging, typically performed via transvaginal ultrasonography. Imaging may clearly reveal the mass to be benign or malignant based on its physical features, but there are many cases in which the mass is indeterminate [3]. In these cases, in an asymptomatic patient, follow-up imaging after a period of time is recommended in order to determine if the mass is persistent, stable or has resolved.…”

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Adnexal Mass Risk Assessment: A Multivariate Index Assay for Malignancy Risk Stratification

Zhang

Bullock²

2019

Future Oncol.

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Aims: Adnexal mass risk assessment (AMRA) stratifies patients with adnexal masses, identifying the relatively small number of malignancies from benigns which might take a ‘watchful waiting’ approach. Methods: AMRA uses seven biomarkers and derived from women with adnexal masses scheduled for surgery. Estimated clinical performance was calculated using fixed prevalence. Results: At 5% prevalence, the high-risk group, 7.9% total, captured 75.9% of invasive malignancies at a positive predictive value of 35.8%. High risk/intermediate risk combined had a sensitivity of 89.7 and 95.6% for pre- and post-menopausal cancers, respectively. The low-risk group, 67.8% total, had an negative predictive value of 99.0%. Conclusion: With highly differentiating risk stratification capability across histological subtypes and stages, AMRA is potentially applicable to patients with adnexal masses to assist deciding whether immediate surgery is recommended.

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“…However, US has varying specificities (51%-97%) for a definitive diagnosis. Adnexal cystic masses that cannot be confidently characterized as benign or malignant at US, such as large lesions or lesions with internal solid component without Doppler flow, are sonographically indeterminate (110,111). Adnexal lesions that are indeterminate at US may be further evaluated with MRI to help exclude malignancy (106,107,109,110,(112)(113)(114).…”

Section: Imaging Appearance Of Early Ovarian Cancermentioning

confidence: 99%

BRCAMutation Carriers: Breast and Ovarian Cancer Screening Guidelines and Imaging Considerations

Elezaby¹,

Lees

Maturen³

et al. 2019

Radiology

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reast cancer is the most common cancer in women, and is the second leading cause of cancer deaths. The age and incidence-adjusted estimates for new breast cancer cases in the United States for 2018 are 266 120 (15.3% of all new cancers), with 40 920 breast cancer deaths (6.7% of all cancer deaths) (1). Ovarian cancer is the fifth most common cancer in women and the fifth leading cause of cancer deaths. The estimates for new ovarian cancer cases in the United States for 2018 are 22 240 (1.3% of all new cancers), with 14 070 ovarian cancer deaths (2.3% of all cancer deaths) (2). Most breast and ovarian cancers occur sporadically. However, some women are predisposed to higher rates of breast and ovarian cancers secondary to an underlying genetic mutation, which are often referred to as hereditary breast and ovarian cancer susceptibility gene mutations.Family history is a well-known risk factor for breast and ovarian cancer, but there is a distinction between hereditary and familial cancer risks. Familial cancers occur in certain families with statistically greater frequency than in the general population. They typically do not exhibit a specific inheritance pattern and have no specific age of onset. Hereditary cancers most commonly occur as a result of genetic mutations. The majority of these gene mutations have an autosomal dominant transmission pattern (ie, first-degree relatives of an affected individual have a 50% risk of having the same gene mutation). These mutations are germline mutations that are not sex linked and can be transmitted equally from either parent. Affected individuals are at higher risk for bilateral disease, multifocal disease, and cancer onset at an earlier age, as well as for the uncommon clustering of cancers, including pancreatic cancer, melanoma, cholangiocarcinoma, and prostate cancer (3,4).Approximately 5%-10% of all breast cancers and up to 15% of all ovarian cancers are associated with an inheritable genetic mutation (5-8). The most common genetic mutations implicated in hereditary breast and ovarian cancers have been mapped to the BRCA1 (chromosome 17q21) and BRCA2 (chromosome 13q12.3) genes (9,10). The purpose of this article is to review the current screening guidelines for breast and ovarian cancers in patients who test positive for BRCA mutation and to briefly review the imaging features that are suspicious for early breast and ovarian cancers. Prevalence and Cancer RiskThe prevalence of the BRCA genetic mutation in the general population is relatively low (one in 400). However, certain populations have a higher incidence, particularly those with Ashkenazi Jewish ancestry (one in 40) due to

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Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer

Cited by 57 publications

References 39 publications

Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses

Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses

Adnexal Mass Risk Assessment: A Multivariate Index Assay for Malignancy Risk Stratification

BRCAMutation Carriers: Breast and Ovarian Cancer Screening Guidelines and Imaging Considerations

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