Improving diagnostic strategies for ovarian cancer in Filipino women using ultrasound imaging and a multivariate index assay |
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Affiliation: | 1. Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines;2. Department of Obstetrics and Gynecology, University of the Philippines – Philippine General Hospital, Taft Avenue, Manila, Philippines;3. Department of Pathology, College of Medicine, University of the Philippines Manila, Manila, Philippines;4. Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Philippines;5. College of Medicine, University of the Philippines Manila, Manila, Philippines |
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Abstract: | ObjectiveTo evaluate the clinical performance and overall utility of imaging and biomarker assays in discriminating between benign and malignant ovarian masses in a Filipino population.MethodsThis is a prospective cohort study among Filipino women undergoing assessment for an ovarian mass in a tertiary center. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation, multivariate index assay (MIA2G), and surgery for an adnexal mass. Ovarian tumors were classified as high-risk for malignancy based on the International Ovarian Tumour Analysis (IOTA) – Logistic Regression 2 (LR2) score. The ovarian imaging and biomarker results were correlated with the reference standard: histological findings.ResultsAmong the 379 women with adnexal masses enrolled in this study, 291 were evaluable with ultrasound imaging, biomarker assays, and histopathological results. The risk of malignancy was higher for women classified as high-risk based on IOTA-LR2 (≥10%). The sensitivity, specificity, and diagnostic accuracy for the prediction of malignancy were 81.2%, 81%, and 0.81 (95% CI: 0.77–0.86) for IOTA-LR2; 77.5%, 66.7%, and 0.72 (95% CI: 0.67–0.77) for CA-125; and 91.3%, 41.2%, and 0.66 (95% CI: 0.62–0.71) for MIA2G. A combination of IOTA-LR2 and MIA2G significantly influenced the diagnostic performance and the result. When MIA2G was combined with IOTA-LR2 in parallel, the sensitivity (94.2%) and NPV (87.7%) increased, but the specificity (37.3%) decreased. When combined with IOTA-LR2 in series, there were fewer false positives, which resulted in improved specificity (85%).ConclusionThis study determined the utility of ovarian imaging and a second-generation multivariate index assay in predicting the risk of ovarian malignancy. IOTA-LR2 and MIA2G were useful in classifying patients with a high risk for ovarian malignancy. |
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Keywords: | Ovarian mass Screening strategies Ultrasound Multivariate index assays Serial testing IOTA–LR2 CA-125 IOTA-LR2 Score" },{" #name" :" keyword" ," $" :{" id" :" key0045" }," $$" :[{" #name" :" text" ," _" :" International Ovarian Tumour Analysis –Logistic Regression 2 Score MIA2G" },{" #name" :" keyword" ," $" :{" id" :" key0055" }," $$" :[{" #name" :" text" ," _" :" Second-Generation Multivariate Index Assay CA-125" },{" #name" :" keyword" ," $" :{" id" :" key0065" }," $$" :[{" #name" :" text" ," _" :" Cancer antigen 125 RMI" },{" #name" :" keyword" ," $" :{" id" :" key0075" }," $$" :[{" #name" :" text" ," _" :" Risk of Malignancy Index MIA" },{" #name" :" keyword" ," $" :{" id" :" key0085" }," $$" :[{" #name" :" text" ," _" :" Multivariate Index Assay ACOG" },{" #name" :" keyword" ," $" :{" id" :" key0095" }," $$" :[{" #name" :" text" ," _" :" American College of Obstetricians and Gynecologists PPV" },{" #name" :" keyword" ," $" :{" id" :" key0105" }," $$" :[{" #name" :" text" ," _" :" Positive Predictive Value NPV" },{" #name" :" keyword" ," $" :{" id" :" key0115" }," $$" :[{" #name" :" text" ," _" :" Negative Predictive Value UPMREB" },{" #name" :" keyword" ," $" :{" id" :" key0125" }," $$" :[{" #name" :" text" ," _" :" University of the Philippines Manila Research Ethics Board PHRR" },{" #name" :" keyword" ," $" :{" id" :" key0135" }," $$" :[{" #name" :" text" ," _" :" Philippine Health Research Registry |
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