Accuracy of Pelvic Mass Score in Pre-operative Determination of Malignancy in Adnexal Masses

Abstract

Introduction: Suspicious adnexal masses are common clinical problems in gynaecological practice. A reliable diagnostic tool for the early detection of the ovarian malignancy is essential. Aim: To validate a new scoring system –Pelvic Mass Score (PMS) in predicting the nature of the adnexal mass pre-operatively. Materials and Methods: A prospective observational study was carried out in 100 consenting women with an undiagnosed adnexal mass requiring operative intervention. Among them 62 patients had mass with a feeding vessel in which the Doppler velocimetry study values were available. The PMS was determined in these 62 patients. A score of 29 or more was taken as suggestive of malignancy. The results were compared with the histopathological diagnosis to confirm malignancy. The chi-square test was applied to test the significance. Results: Among the 62 patients with vascular mass, 31 had histopathological diagnosis of malignancy. The statistical analysis of the data with PMS with 29 as cut-off revealed 100% sensitivity and 100% Negative Predictive Value (NPV) as there was no false negative case detected. But the specificity and Positive Predictive Value (PPV) was poor; 45.2% and 64.6% respectively. Based on the Receiver Operating Characteristic (ROC) curve, if we redefine cut-off as 69, specificity increases to 80.6% with a sensitivity of 90.3%, the PPV and NPV being 82.35 and 89.29 respectively. Conclusion: The present study concludes that, in suspicious vascular adnexal masses PMS can be used as a reliable diagnostic score to predict malignancy if we redefine the existing cut-off of 29 to 69.

Keywords

• ovarian cancer
• tumour vascularity
• ultrasound scoring system