Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours

prospective multicentre diagnostic study.

Ben Van Calster, Kirsten Van Hoorde, Lil Valentin, Antonia C. Testa, Daniela Fischerova, Caroline Van Holsbeke, Luca Savelli, Dorella Franchi, Elisabeth Epstein, Jeroen Kaijser, Vanya Van Belle, Artur Czekierdowski, Stefano Guerriero, Robert Fruscio, Chiara Lanzani, Felice Scala, Tom Bourne, Dirk Timmerman, Ovarian Tumour Analysis Group International Ovarian Tumour Analysis Group

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours. Observational diagnostic study using prospectively collected clinical and ultrasound data. 24 ultrasound centres in 10 countries. Women with an ovarian (including para-ovarian and tubal) mass and who underwent a standardised ultrasound examination before surgery. The model was developed on 3506 patients recruited between 1999 and 2007, temporally validated on 2403 patients recruited between 2009 and 2012, and then updated on all 5909 patients. Histological classification and surgical staging of the mass. The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. The ADNEX model discriminates well between benign and malignant tumours and offers fair to excellent discrimination between four types of ovarian malignancy. The use of ADNEX has the potential to improve triage and management decisions and so reduce morbidity and mortality associated with adnexal pathology.

Original languageEnglish
JournalBritish Medical Journal
Volume349
DOIs
Publication statusPublished - 2014

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Ovarian Neoplasms
Multicenter Studies
Area Under Curve
Neoplasms
Triage
Ascites
Acoustics
ROC Curve
Calibration
Observational Studies
Cysts
Pathology
Morbidity
Mortality
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours : prospective multicentre diagnostic study. / Van Calster, Ben; Van Hoorde, Kirsten; Valentin, Lil; Testa, Antonia C.; Fischerova, Daniela; Van Holsbeke, Caroline; Savelli, Luca; Franchi, Dorella; Epstein, Elisabeth; Kaijser, Jeroen; Van Belle, Vanya; Czekierdowski, Artur; Guerriero, Stefano; Fruscio, Robert; Lanzani, Chiara; Scala, Felice; Bourne, Tom; Timmerman, Dirk; International Ovarian Tumour Analysis Group, Ovarian Tumour Analysis Group.

In: British Medical Journal, Vol. 349, 2014.

Research output: Contribution to journalArticle

Van Calster, B, Van Hoorde, K, Valentin, L, Testa, AC, Fischerova, D, Van Holsbeke, C, Savelli, L, Franchi, D, Epstein, E, Kaijser, J, Van Belle, V, Czekierdowski, A, Guerriero, S, Fruscio, R, Lanzani, C, Scala, F, Bourne, T, Timmerman, D & International Ovarian Tumour Analysis Group, OTAG 2014, 'Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study.', British Medical Journal, vol. 349. https://doi.org/10.1136/bmj.g5920
Van Calster, Ben ; Van Hoorde, Kirsten ; Valentin, Lil ; Testa, Antonia C. ; Fischerova, Daniela ; Van Holsbeke, Caroline ; Savelli, Luca ; Franchi, Dorella ; Epstein, Elisabeth ; Kaijser, Jeroen ; Van Belle, Vanya ; Czekierdowski, Artur ; Guerriero, Stefano ; Fruscio, Robert ; Lanzani, Chiara ; Scala, Felice ; Bourne, Tom ; Timmerman, Dirk ; International Ovarian Tumour Analysis Group, Ovarian Tumour Analysis Group. / Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours : prospective multicentre diagnostic study. In: British Medical Journal. 2014 ; Vol. 349.
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abstract = "To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours. Observational diagnostic study using prospectively collected clinical and ultrasound data. 24 ultrasound centres in 10 countries. Women with an ovarian (including para-ovarian and tubal) mass and who underwent a standardised ultrasound examination before surgery. The model was developed on 3506 patients recruited between 1999 and 2007, temporally validated on 2403 patients recruited between 2009 and 2012, and then updated on all 5909 patients. Histological classification and surgical staging of the mass. The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. The ADNEX model discriminates well between benign and malignant tumours and offers fair to excellent discrimination between four types of ovarian malignancy. The use of ADNEX has the potential to improve triage and management decisions and so reduce morbidity and mortality associated with adnexal pathology.",
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AU - Savelli, Luca

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AU - Lanzani, Chiara

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