The diagnostic efficacy of Gynecology Imaging Reporting and Data System (GI-RADS): single-center prospective cross-sectional study

Abstract

Background: To assess the validity and accuracy of GI-RADS classification in the prediction of malignancy and in triaging the management protocol in ovarian lesions.Results: One hundred fifty-six ovarian lesions were detected in the examined 116 women. The prevalence of malignant tumors was 44%. Overall GI-RADS classification rates were as follows: 41 cases (26.3%) were classified as GI-RADS 1, 26 cases (16 .7%) as GI-RADS 2, 34 cases (21.8%) as GI-RADS 3, 14 cases (8.9%) as GI-RADS 4, and 41 cases (26.3%) as GI-RADS 5. No follow-up was done in GI-RADS 1 patients. A final diagnosis of all GI-RADS 2 ovarian masses such as functional cyst (n = 10), hemorrhagic cysts (n = 8), corpus luteal cysts (n = 6), and some GI-RADS 3 as simple cysts (n = 10) was made by spontaneous resolution of these masses at follow-up after 6 weeks. Fifteen cases of GI-RADS 3 as mature teratoma, serous and mucinous cystadenoma, endometrioma, and ovarian torsion and all GI-RADS 4 and 5 underwent laparoscopic or surgical removal of the ovarian mass with histopathological examination. The diagnostic performance of the GI-RADS in predicting the risk of malignancy in ovarian masses was as follows: 98.11% sensitivity, 95.15% specificity, 91.2% positive predictive value (PPV), 99.2% negative predictive value (NPV), and 20.2 positive likelihood ratio, and the overall accuracy was 96.2% (area under receiver operating curve (AUC) = 0.96, P < 0.001).Conclusion: GI-RADS classification performs well as a reporting system of the ovarian masses with high diagnostic performance in the prediction of malignancy, and it seems to be a helpful tool in triaging management in patients with ovarian masses.

Sonographic and Doppler predictors of malignancy in ovarian lesions

“…In our study, color Doppler allows mapping of the blood flow within the mass and shows neovascularity in 88.7% of malignant lesions and central blood flow in 73.6% of these lesions, but 98% of the benign ovarian lesions show peripheral or absent blood flow; these results correlated well with the study done by Khurana et al [10] who reported that the detection of the blood flow has consistently related to the malignant ovarian lesions as 97.5% neovascularity could be seen in the malignant ovarian lesions. Also, our results agreed with the results of the study that was done by Barroilhet et al [4] who demonstrated that the central blood flow concerning with malignancy and the absence of blood flow or peripheral blood flow almost suggest the benignity and rolled out the malignancy as the central blood flow in their study was identified in 75.9% of the malignant ovarian lesions.…”

“…These results were concordant with the result of the studies done by Brown et al [15], Valentin et al [16], and Herrmann et al [17], which demonstrated that the non-hyperechoic solid component feature has long been recognized as strongly associated with malignancy in both gross pathologic and sonographic feature. Also, Khurana et al [10] reported that the papillary projections was a predictor of malignancy.…”

“…US plays an important role in the identification and characterization of ovarian lesions. Thus, several studies have been conducted in the world to evaluate the role of the gray-scale and Doppler US in the characterization of benign and malignant ovarian lesions [10,11], but the results have been conflicting. We found that the age was the most important clinical risk factor for ovarian cancer as we noted from the multivariate regression test with 1.45 odds ratio, and also the risk of ovarian cancer increases in postmenopausal women than in premenopausal women, as between the 53 malignant ovarian lesions, 35 patients (66%) were in the post menopause; however, 71.8% of the benign lesions were in the premenopausal status.…”

“…The following diagnostic algorithm was used: Any mass has the following criteria: volume ≥ 10 cm 3 , non-hyperechoic solid component, papillary projection, septal thickness ≥ 3 mm, wall thickness ≥ 3 mm, mass with central blood flow and RI < 0.6, and PI < 1.6 were categorized as suspicious for malignancy [10].…”

“…Various mathematical models, scoring systems, and software programs that based on sonographic findings were proposed for differentiation between benign and malignant ovarian tumors [9], but until now, there is no scoring system that has been accepted as gold standard for predicting the ovarian lesions at risk. Color and spectral Doppler are the subject of great debate about their efficacy in differentiation between benign and malignant ovarian lesions [10]. Previous studies have shown that this technique may be useful as a second step technique or when the US features are inconclusive [11], while others concluded that it adds little additional information [12].…”