DOI QR코드

DOI QR Code

Ovarian Masses: Is Multi-detector Computed Tomography a Reliable Imaging Modality?

  • Khattak, Yasir Jamil (The Aga Khan University Hospital) ;
  • Hafeez, Saima (The Aga Khan University Hospital) ;
  • Alam, Tariq (The Aga Khan University Hospital) ;
  • Beg, Madiha (The Aga Khan University Hospital) ;
  • Awais, Mohammad (The Aga Khan University Hospital) ;
  • Masroor, Imrana (The Aga Khan University Hospital)
  • Published : 2013.04.30

Abstract

Background: Ovarian cancer continues to pose a major challenge to physicians and radiologists. It is the third most common gynecologic malignancy and estimated to be fifth leading cancer cause of death in women, constituting 23% of all gynecological malignancies. Multi-detector computed tomography (MDCT) appears to offer an excellent modality in diagnosing ovarian cancer based on combination of its availability, meticulous technique, efficacy and familiarity of radiologists and physicians. The aim of this study was to compute sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of 64-slice MDCT in classifying ovarian masses; 95% confidence intervals were reported. Materials and Methods: We prospectively designed a cross-sectional analytical study to collect data from July 2010 to August 2011 from a tertiary care hospital in Karachi, Pakistan. A sample of 105 women aged between 15-80 years referred for 64-MDCT of abdomen and pelvis with clinical suspicion of malignant ovarian cancer, irrespective of stage of disease, were enrolled by non-probability purposive sampling. All patients who were already known cases of histologically proven ovarian carcinoma and having some contraindication to radiation or iodinated contrast media were excluded. Results: Our prospective study reports sensitivity, specificity; positive and negative predictive values with 95%CI and accuracy were computed. Kappa was calculated to report agreement among the two radiologists. For reader A, MDCT was found to have 92% (0.83, 0.97) sensitivity and 86.7% (0.68, 0.96) specificity, while PPV and NPV were 94.5% (0.86, 0.98) and 86.7% (0.63, 0.92), respectively. Accuracy reported by reader A was 90.5%. For reader B, sensitivity, specificity, PPV and NPV were 94.6% (0.86, 0.98) 90% (0.72, 0.97) 96% (0.88, 0.99) and 87.1% (0.69, 0.95) respectively. Accuracy computed by reader B was 93.3%. Excellent agreement was found between the two radiologists with a significant kappa value of 0.887. Conclusion: Based on our study results, we conclude MDCT is a reliable imaging modality in diagnosis of ovarian masses accurately with insignificant interobserver variability.

Keywords

Malignant;sensitivity and specificity;computed tomography;ultrasound;confidence intervals;Pakistan

References

  1. Parkin DM, Bray F, Ferlay J, Pisani P (2005). Global cancer statistics, 2002. CA Cancer J Clin, 55, 74-108 https://doi.org/10.3322/canjclin.55.2.74
  2. Parrish FJ (2007). Volume CT: state-of-the-art-reporting. Am J Roentgenol, 189, 528-34. https://doi.org/10.2214/AJR.07.2426
  3. Sengupta PS, Shanks JH, Buckley CH (2000). Requirement for expert histopathological assessment of ovarian cancer and borderline tumors. Br J Cancer, 82, 760-2. https://doi.org/10.1054/bjoc.1999.0994
  4. Silverberg E, Boring CC, Squires TS (1990). Cancer statistics. Cancer, 40, 9-26.
  5. Spencer JA (2005). A multidisciplinary approach to ovarian cancer at diagnosis. Br J Radiol, 78, 94-102. https://doi.org/10.1259/bjr/29280555
  6. Tanwani AK (2005). Prevalence and pattern of ovarian lesions. Ann Pak Inst Med Sci, 1, 211-4.
  7. Taylor K, Schwartz P (1994). Screening for ovarian cancer. Radiology, 192, 1-10. https://doi.org/10.1148/radiology.192.1.8208918
  8. Tempany CM, Zou KH, Silverman SG, Brown DL, Kurtz AB (2000). Staging of advanced ovarian cancer: comparison of imaging modalities--report from the radiological diagnostic oncology group. Radiology, 215, 761-7. https://doi.org/10.1148/radiology.215.3.r00jn25761
  9. Teneriello MG, Park RC (1995). Early detection of ovarian cancer. CA Cancer J Clin, 45, 71-87. https://doi.org/10.3322/canjclin.45.2.71
  10. Tsili AC, Tsampoulas C, Argyropoulou M, et al (2008). Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexal masses. Eur Radiol, 18, 1049-57. https://doi.org/10.1007/s00330-007-0842-4
  11. Tsili AC, Tsampoulas C, Argyropoulou M, et al (2008). Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexal masses. Eur Radiol, 18, 1049-57 https://doi.org/10.1007/s00330-007-0842-4
  12. Woodward PJ, Hosseinzadeh K, Saenger JS (2004). Radiologic staging of ovarian carcinoma with pathologic correlation. Radiographics, 24, 225-46 https://doi.org/10.1148/rg.241035178
  13. Droegumueller W (1994). Screening for ovarian carcinoma: hopeful and wishful thinking. Am J Obstet Gynecol, 170, 1095-8. https://doi.org/10.1016/S0002-9378(94)70103-2
  14. Ferozabadi RD, Zarchi MK, Mansurian HR, Mogliadam BR, Teimoori S (2000). Evaluation of diagnostic value of CT scan, physical examination and ultrasound based on the pathological findings in patients with pelvic masses. Asian Pac J Cancer Prev, 12, 1745-7.
  15. Gatreh-Samani F, Tarzamni MK, Olad-Sahebmadarek E, Dastranj A, Afrough A (2011). Accuracy of 64-multidetector computed tomography in diagnosis of adnexal tumors. J Ovarian Res, 4, 15 https://doi.org/10.1186/1757-2215-4-15
  16. Herrmann UI Jr, Locher GW, Goldhirsh A (1987). Sonographic patterns of ovarian tumors: prediction of malignancy. Obstet Gynecol, 69, 777-81.
  17. Jacobs I, Bast RC Jr (1989). The CA 125 tumor-associated antigen: a review of the literature. Hum Reprod, 4, 1-12. https://doi.org/10.1093/humrep/4.suppl_1.1
  18. Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H (2005). Indeterminate ovarian mass at ultrasound: incremental value of second imaging test for characterization-meta analysis and Bayesian analysis. Radiology. 236, 85-94. https://doi.org/10.1148/radiol.2361041618
  19. Kombacher P, Hamm B, Becker R, et al (1992). Tumors of the adnexa: a comparison of magnetic resonance tomography, endosonography and the histological findings [Original article in German, English version available]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr, 156, 303-8. https://doi.org/10.1055/s-2008-1032890
  20. Koonings PP, Campbell K, Mishell DR Jr, Grimes DA (1989). Relative frequency of primary ovarian neoplasms: a 10-year review. Obstet Gynecol, 74, 921-6.
  21. Kurtz AB, Tsimikas JV, Tempany CM, Hamper UM, Arger PH et al (1999). Diagnosis and staging of ovarian cancer: comparative values of doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis-report of the radiology diagnostic oncology group. Radiology, 212, 19-27 https://doi.org/10.1148/radiology.212.1.r99jl3619
  22. Landis SH, Murray T, Bolden S, Wingo PA (1998). Cancer statistics. Cancer, 47, 6-29.
  23. Mugel T, Ghossain M, Buy JN, Malbec L, Vadrot D (1993). Value of CT scan and MRI in primary tumors of the ovary. J Chir (Paris), 130, 486-91.
  24. Nagell JR, Higgins RV, Donaldson E (1990). Transvaginal sonography as a screening method for ovarian cancer: a report of the first 1000 cases screened. Cancer, 65, 573-7. https://doi.org/10.1002/1097-0142(19900201)65:3<573::AID-CNCR2820650331>3.0.CO;2-4
  25. Osmers R (1996). Sonographic evaluation of ovarian mass and its therapeutical implications. Ultrasound Obstet Gynecol, 175, 428-34.
  26. Outwater EK, Dunton C (1995). Imaging of the ovary and adnexa: clinical issues and applications of MR imaging. Radiology, 194, 1-18. https://doi.org/10.1148/radiology.194.1.7997533
  27. Adel El-Badrawy, Eman O, Ashraf K, Mohamed A, Adel H (2011). 64 Multidetector CT with multiplanar reformation in evaluation of bilateral ovarian masses. Egypt J Radiology and Nuclear Medicine, 42, 147-5 https://doi.org/10.1016/j.ejrnm.2011.06.003
  28. Buy JN, Ghossain MA, Sciot C, Bazot M, Guinet C (1991). Epithelial tumors of the ovary: CT findings and correlation with US. Radiolog, 178, 811-8.