Study on the diagnostic efficacy of ADNEX model in differentiating metastatic and primary ovarian cancer

doi:10.16150/j.1671-2870.2023.06.010

Abstract

Abstract:

Objective: To study the clinical value of the International Ovarian Tumor Analysis(IOTA) ADNEX(the Assessment of Differential NEopasia in the adneXa) model in differentiating metastatic ovarian cancer from primary ovarian cancer. Methods: Patients who underwent transvaginal ultrasonography and operation in our hospital from March 2016 to April 2021 were selected. Preoperative ultrasound examination was performed, and the model prediction results were recorded. Based on the postoperative pathological results， the sensitivity, specificity and area under receiver operating characteristic (ROC) curve of the ADNEX model with and without CA125 in distinguishing metastatic and primary ovarian cancer was calculated. Results: A total of 197 patients with ovarian cancer were enrolled, including 153 patients with primary ovarian cancer (36 patients with stage Ⅰ ovarian cancer, 117 patients with stage Ⅰ-Ⅳ ovarian cancer) and 44 patients with metastatic ovarian cancer. The area under the ROC curve of ADNEX model without CA125 in differentiating metastatic and primary ovarian cancer was 0.621 (95% confidence interval 0.534-0.708), with a sensitivity of 93.2% and a specificity of 31.4%.The area under the ROC curve of ADNEX model with CA125 was 0.810 (95% confidence interval 0.747-0.872), with a sensitivity of 79.5% and a specificity of 69.3%. The difference between the two was statistically significant (P<0.001). Conclusions: ADNEX model has good clinical value in the differentiation of metastatic and primary ovarian cancer. Use of CA125 in ADNEX can improve the diagnostic efficiency of the model.

Key words: Ovarian cancer, metastatic, IOTA, ADNEX model, Ultrasound diagnosis

CLC Number:

R447
R737.31

NI Zhongxin, CHEN Hui. Study on the diagnostic efficacy of ADNEX model in differentiating metastatic and primary ovarian cancer[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(06): 573-578.

Figures/Tables 6

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References 26

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Histological type	n (%)
Primary ovarian malignant	153 (77.66)
Serous carcinoma	105 (53.30)
Clear cell carcinoma	15 (7.61)
Ovarian endometrioid carcinoma	15 (7.61)
Carcinosarcoma	3 (1.52)
Mucinous carcinoma	6 (3.05)
Neuroendocrine carcinomas	2 (1.02)
Immature teratomas	2 (1.02)
Granular cell tumor	2 (1.02)
Dysgerminomas	1 (0.51)
Malignant Brenner tumor	1 (0.51)
Ovarian endometrioid carcinoma + clear cell carcinoma	1 (0.51)
Ovarian metastasis	44 (22.34)

Variables	Overall	OC Stages Ⅰ	OC Stages Ⅱ-Ⅳ	Ovarian metastasis	P
Overall [n (%)]	197 (100%)	36 (18.27)	117 (59.39)	44 (22.34)	-
Age [years, median (IQR)]	55.00(48.00-63.00)	56.50(47.00-63.00)	58.00(51.00-64.00)	50.00(38.75-56.50)	<0.001
Menopause [n (%)]					0.014
Yes	126 (63.96)	24 (66.67)	82 (70.09)	20 (45.45)
No	71 (36.04)	12 (33.33)	35 (29.91)	24 (54.55)
CA125 [U/mL, median (IQR)]	210.60(39.10-883.30)	59.30(15.08-311.68)	596.20(122.20-2162.80)	37.95(13.25-102.68)	<0.001
Maximum diameter of lesion, mm, median (IQR)	77.00(51.00-111.00)	91.00(70.00-148.00)	70.00(44.00-100.00)	80.50(57.50-117.75)	0.017
Solid tissue present [n (%)]	195 (98.98)	35 (97.22)	117 (100.00)	43 (97.73)	0.164
Maximum diameter of largest solid component, if present, mm, median (IQR)	56.00(37.00-82.00)	50.00(33.00-63.50)	52.00(34.00-85.00)	68.00(51.50-90.50)	0.038
Papillary projections present [n (%)]					0.260
0	161 (81.73)	26 (72.22)	95 (81.20)	40 (90.91)
1	7 (3.55)	1 (2.78)	5 (4.27)	1 (2.27)
2	3 (1.52)	0 (0.00)	3 (2.56)	0 (0.00)
≥3	26 (13.20)	9 (25.00)	14 (11.97)	3 (6.82)
More than 10 locules [n (%)]	33 (16.75)	7 (19.44)	15 (12.82)	11 (25.00)	0.163
Ascites [n (%)]	48 (24.37)	3 (8.33)	41 (35.04)	4 (9.09)	<0.001

Discrimination	AUC (95%CI)		P
Discrimination	ADNEX model with CA125	ADNEX model without CA125	P
Primary OC vs metastasis	0.810 (0.747-0.872)	0.621 (0.534-0.708)	<0.001
Stage Ⅰ OC vs stages Ⅱ-Ⅳ OC	0.826 (0.745-0.907)	0.771 (0.687-0.854)	0.156
Stage Ⅰ OC vs metastasis	0.620 (0.486-0.754)	0.654 (0.524-0.784)	0.033
Stages Ⅱ-Ⅳ OC vs metastasis	0.890 (0.839-0.940)	0.710 (0.624-0.796)	<0.001

Discrimination	ADNEX model	Sensitivity (95%CI)	Specificity (95%CI)	PPV (95%CI)	NPV (95%CI)	LR+ (95%CI)	LR- (95%CI)	Optimal cutoff value
Primary OC vs metastasis	With CA125	0.795 (0.676-0.915)	0.693 (0.620-0.766)	0.427 (0.320-0.534)	0.922 (0.873-0.971)	2.589 (1.955-3.430)	0.295 (0.163-0.534)	0.140
Primary OC vs metastasis	Without CA125	0.932 (0.857-1.000)	0.314 (0.240- 0.387)	0.281 (0.208- 0.354)	0.941 (0.877-1.006)	1.358 (1.188-1.552)	0.217 (0.071-0.664)	0.110
Stage Ⅰ OC vs stages Ⅱ-Ⅳ OC	With CA125	0.701 (0.618-0.784)	0.833 (0.712- 0.955)	0.932 (0.879-0.984)	0.462 (0.340-0.583)	4.205 (2.006-8.813)	0.359 (0.262-0.491)	0.840
Stage Ⅰ OC vs stages Ⅱ-Ⅳ OC	Without CA125	0.821 (0.751-0.890)	0.639 (0.482-0.796)	0.881 (0.820-0.942)	0.523 (0.375-0.670)	2.272 (1.459-3.538)	0.281 (0.178-0.444)	0.691
Stage Ⅰ OC vs metastasis	With CA125	0.727 (0.596-0.859)	0.639 (0.482-0.796)	0.711 (0.579-0.844)	0.657 (0.500-0.814)	2.014 (1.258-3.225)	0.427 (0.248-0.734)	0.381
Stage Ⅰ OC vs metastasis	Without CA125	0.841 (0.733-0.949)	0.556 (0.393-0.718)	0.698 (0.575-0.822)	0.741 (0.575-0.906)	1.892 (1.285-2.787)	0.286 (0.137-0.600)	0.297
Stages Ⅱ-Ⅳ OC vs metastasis	With CA125	0.841 (0.733-0.949)	0.803 (0.731-0.875)	0.617 (0.494-0.740)	0.931 (0.881-0.980)	4.278 (2.901-6.307)	0.198 (0.100-0.393)	0.239
Stages Ⅱ-Ⅳ OC vs metastasis	Without CA125	0.795 (0.676-0.915)	0.607 (0.518-0.695)	0.432 (0.324-0.540)	0.887 (0.818-0.957)	2.023 (1.544-2.651)	0.337 (0.185-0.615)	0.208

ADNEX model	Cutoff value	Sensitivity (95%CI)	Specificity (95%CI)	PPV(95%CI)	NPV(95%CI)	LR+(95%CI)	LR-(95%CI)
With CA125	0.10	0.886 (0.793-0.980)	0.549 (0.470-0.628)	0.361 (0.271-0.452)	0.944 (0.896-0.992)	1.965 (1.602-2.411)	0.207 (0.090-0.478)
	0.15	0.750 (0.622-0.878)	0.706 (0.634-0.778)	0.423 (0.313-0.533)	0.908 (0.856-0.960)	2.550 (1.891-3.438)	0.354 (0.210-0.597)
	0.20	0.614 (0.470-0.758)	0.810 (0.748-0.873)	0.482 (0.351-0.613)	0.879 (0.826-0.933)	3.237 (2.164-4.844)	0.477 (0.326-0.697)
	0.25	0.477 (0.330-0.625)	0.876 (0.824-0.928)	0.525 (0.370-0.680)	0.854 (0.798-0.909)	3.843 (2.280-6.479)	0.597 (0.447-0.797)
Without CA125	0.10	0.932 (0.857-1.000)	0.288 (0.216-0.359)	0.273 (0.202-0.345)	0.936 (0.866-1.006)	1.308 (1.150-1.487)	0.237 (0.077-0.727)
	0.15	0.727 (0.596-0.859)	0.477 (0.398-0.556)	0.286 (0.202-0.369)	0.859 (0.785-0.933)	1.391 (1.099-1.761)	0.572 (0.343-0.952)
	0.20	0.250 (0.122-0.378)	0.778 (0.712-0.844)	0.244 (0.119-0.370)	0.783 (0.717-0.848)	1.125 (0.623-2.032)	0.964 (0.797-1.167)
	0.25	0.045 (0.000- 0.107)	0.967 (0.939-0.995)	0.286 (0.000-0.620)	0.779 (0.720-0.838)	1.391 (0.279-6.925)	0.987 (0.919-1.059)