Evaluation of the Diagnostic Value of the Ultrasound ADNEX Model for Benign and Malignant Ovarian Tumors

Figures & data

Figure 1 ADNEX calculation results.

Table 1 Clinical Indicators and Ultrasonic Manifestations of Ovarian Tumor Patients Were Summarized According to Pathological Stages

Characteristic	Benign Tumor (n = 119)	Malignant Tumor (n = 105)					p-value
		Borderline Tumor (n = 20)	Stage I (n =14)	Stage II–IV (n =60)	Metastatic Tumor (n = 11)	Total (n =105)
Age (years)	44(32–53)	50(41–61)	52(49–57)	54(49–61)	55(50–65)	53(49–61)	<0.001^a
CA125 (U/mL)	20(13–44)	37(12–221)	138(32–333)	547(230–1536)	107(21–264)	264(46–726)	<0.001^a
Maximal diameter of the lesion(mm)	72(47–103)	97(67–138)	118(70–138)	116(91–148)	83(58–117)	110(71–144)	<0.001^a
Maximal diameter of the solid tissue(mm)	0(0–13)	25(11–31)	33(18–55)	86(60–109)	58(41–90)	60(32–93)	<0.001^a
Papillary projections present	11(9.2)	11(55.0)	4(28.6)	25(41.7)	0(0.0)	40(38.1)	<0.001^b
0	108(90.8)	9(45.0)	10(71.4)	35(58.3)	11(100.0)	65(61.9)
1	3(2.5)	6(30.0)	0(0.0)	14(23.3)	0(0.0)	20(19.0)
2	5(4.2)	2(10.0)	1(7.1)	2(3.3)	0(0.0)	5(4.8)
3	1(0.8)	1(5.0)	1(7.1)	3(5.0)	0(0.0)	5(4.8)
>3	2(1.7)	2(10.0)	2(14.3)	6(10.0)	0(0.0)	10(9.5)
>10 cyst locules	3(2.5)	3(15.0)	3(21.4)	5(8.3)	1(9.1)	12(11.4)	<0.01^b
Acoustic shadows	12(10.1)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	<0.01^b
Ascites	5(4.2)	3(15.0)	4(28.6)	34(56.7)	6(54.5)	47(44.8)	<0.001^b

Notes: The data is presented as a median (quartile interval) or n (%). p-values of benign and malignant groups were calculated by: ^aMann–Whitney U-test; ^bChi-square test.

Table 2 Histopathological Findings of 224 Patients with Ovarian Tumor

Histological Type	n (%)
Benign tumor	119 (53.1)
Serous cystadenoma	32 (14.3)
Mature cystic teratoma	25 (11.2)
Simple cyst	18 (8.0)
Mucinous cystadenoma	14 (6.3)
Endometrioma	14 (6.3)
Theca cell tumor	5 (2.2)
Struma ovary	2 (0.9)
Other benign ovarian tumors	9 (4.0)
Borderline tumor	20 (8.9)
Serous cystadenoma	13 (5.8)
Mucinous cystadenoma	7 (3.1)
Primary malignant tumor	74 (33.0)
Serous cystadenoma	59 (26.3)
Clear-cell carcinoma	6 (2.7)
Mucinous adenocarcinoma	3 (1.3)
Endometrioid adenocarcinoma	3 (1.3)
Carcinosarcoma	3 (1.3)
Metastatic tumor	11 (4.9)

Table 3 Comparison of Diagnostic Performance of ADNEX Models with and Without CA 125

ADNEX Models	AUC (95% CI)	Sensitivity (95% CI) (%)	Specificity (95% CI) (%)	PPV (95% CI) (%)	NPV (95% CI) (%)	LR+ (95% CI)	LR- (95% CI)	DOR	Optimal Cut-Off Value (%)	p-value*
With CA 125	0.94 (0.90–0.97)	86.7 (78.6–92.5)	91.6 (85.1–95.9)	90.1 (83.3–94.3)	88.6 (82.7–92.7)	10.31 (5.67–18.75)	0.15 (0.09–0.24)	68.73	46.7	0.20
Without CA 125	0.93 (0.89–0.96)	89.5 (82.0–94.7)	85.7 (78.1–91.5)	84.7 (78.0–89.6)	90.3 (84.1–94.2)	6.27 (4.02–9.78)	0.12 (0.07–0.22)	52.25	44.3

Notes: Diagnostic performance of International Ovarian Tumor Analysis ADNEX model in discriminating between benign and malignant tumors, according to whether CA 125 level is included in model. *DeLong’s test was used to compare the AUC values of ADNEX model with and without CA 125 measurements.

Abbreviations: AUC, area under the receiver operating characteristic curve; PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR-, negative likelihood ratio; DOR, diagnostic odds ratio.

Figure 2 The diagnostic performance of the ADNEX model with (1) and without (2) CA 125.

Table 4 Diagnostic Performance of the ADNEX Model with CA 125 at Different Cut-Off Values

Cut-Off Value	Sensitivity (95% CI) (%)	Specificity (95% CI) (%)	PPV (95% CI) (%)	NPV (95% CI) (%)	LR+ (95% CI)	LR- (95% CI)	DOR
5%	95.2 (89.2–98.4)	60.5 (51.1–69.3)	68.0 (62.9–72.7)	93.5 (85.8–97.2)	2.41 (1.92–3.02)	0.08 (0.03–0.19)	30.13
10%	94.3 (88.0–97.9)	74.0 (65.1–81.6)	76.2 (70.2–81.3)	93.6 (87.0–97.0)	3.62 (2.66–4.92)	0.08 (0.04–0.17)	45.25
20%	92.4 (85.5–96.7)	79.0 (70.6–85.9)	79.5 (73.2–84.7)	92.2 (85.7–95.8)	4.40 (3.09–6.26)	0.10 (0.05–0.19)	44.00
30%	89.5 (82.0–94.7)	80.7 (72.4–87.3)	80.3 (73.8–85.6)	89.7 (83.2–93.9)	4.63 (3.19–6.73)	0.13 (0.07–0.23)	35.62
46.7%	86.7 (78.6–92.5)	91.6 (85.1–95.9)	90.1 (83.3–94.3)	88.6 (82.7–92.7)	10.31 (5.67–18.75)	0.15 (0.09–0.24)	68.73

Notes: Diagnostic performance of International Ovarian Tumor Analysis ADNEX model with CA 125 in discriminating between benign and malignant tumors at progressive cut-offs for overall risk of malignancy. Overal: Sum of risk for four subtypes of ovarian malignancy.

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR-, negative likelihood ratio; DOR, diagnostic odds ratio.

Table 5 Comparison Between ADNEX Model Stage and Pathological Stage

ADNEX Models	Pathological Stage
	Benign Tumor	Borderline Tumor	Stage I	Stage II–IV	Metastatic Tumor
Benign tumor	88	4	2	0	0
Borderline tumor	22	12	5	3	1
Stage I	3	1	4	2	1
Stage II–IV	6	2	3	51	4
Metastatic tumor	0	1	0	4	5

Table 6 Comparison of the Diagnostic Performance of the ADNEX Model for Different Subtypes of Ovarian Tumors

ADNEX Models	Sensitivity (95% CI) (%)	Specificity (95% CI)(%)	PPV (95% CI) (%)	NPV (95% CI) (%)	Diagnose Accordance Rate (95% CI) (%)
Benign tumor	74.0(65.1–81.6)	94.3(88.0–97.9)	93.6(87.0–97.0)	76.2(70.2–81.3)	83.5(78.0–88.1)
Borderline tumor	60.0(36.1–80.9)	84.8(79.1–89.4)	27.9(19.3–38.6)	95.6(92.6–97.4)	82.6(77.0–87.3)
Stage I	28.6(8.4–58.1)	96.7(93.3–98.7)	36.4(15.9–63.3)	95.3(93.6–96.6)	92.4(88.1–95.5)
Stage II–IV	85.0(73.4–92.9)	90.9(85.4–94.8)	77.3(67.5–84.8)	94.3(90.0–96.8)	89.3(84.5–93.0)
Metastatic tumor	45.5(16.7–76.6)	97.7(94.6–99.2)	50.0(25.3–74.7)	97.2(95.3–98.3)	95.1(91.4–97.5)

Abbreviations: PPV, positive predictive value; NPV, negative predictive value.