Kemal SANDAL, Mesut POLAT, Murat YASSA, Taner GÜNAY, Gamze YETİM ERDEM, Kadir GÜZİN

Adneksiyal Kitlelerde "Risk of Malignancy Index" Versiyonları ile "Assesment of Different Neoplasias in the Adnexa" (ADNEX) Skorlama Sisteminin Karşılaştırılması

Amaç: Adneksiyal kitlelerin preoperatif olarak malignite riskinin değerlendirilmesi, operasyonun yapılacağı merkeze ve ekibe karar verilmesi açısından önem arzetmektedir. Bu durum hastanın postoperatif prognozu ile doğrudan ilişkilidir. Bu çalışmada adneksiyal kitlelerin preoperatif değerlendirmesinde mevcut olan malignite riski belirleme modellerinden Risk of Malignancy İndex(RMI) versiyonlarının ve Assessment of Different Neoplasias in the Adnexa (ADNEX) modelinin malignite öngörüsündeki başarı oranlarının incelenmesi amaçlanmıştır. Gereçler ve Yöntem: Tersiyer eğitim araştırma hastanesinde Eylül 2014-Haziran 2016 tarihleri arasında adneksiyel kitle nedeniyle opere tüm hastalar retrospektif olarak değerlendirildi, ultrasonografi, klinik bilgi ve Ca 125 verileri ile RMI I-II-III-IV skorları ve ADNEX model malignite risk yüzdeleri hesaplandı, sonuçlar patolojik tanılar ile değerlendirildi. Bulgular: 191 vakanın verileri değerlendirildiğinde RMI I (>200) duyarlılık %66 özgüllük %88.4 PPV %68.6, NPV %87.1, RMI II (>200) duyarlılık %75.5, özgüllük %78.3, PPV %57.1, NPV %89.3, RMI III(>200) duyarlılık %66, özgüllük %88.4, PPV %68.6, NPV %87.1, RMI IV (>450) duyarlılık %67.9, özgüllük %90.6, PPV %73.5, NPV %88 olarak izlendi. ADNEX model için çalışmada 3 farklı malignite sınır değeri uygulanmıştır. Malignite riskinde %5’lik sınır değer kullanıldığında duyarlılık %98.1, özgüllük %46.4, PPV %41.3, NPV%98.5, %10’luk sınır değer kullanıldığında duyarlılık %94,3, özgüllük %63, PPV %49.5, NPV%96.7, %15’lik sınır değer kullanıldığında duyarlılık %94.3, özgüllük %72.5, PPV %56.8 NPV%97.1 olarak saptandı. Sonuç: ADNEX modeli duyarlılık ve özgüllük sonuçları literatür ile benzer olarak izlenmiştir. RMI versiyonlarının sonuçları literatürle karşılaştırıldığında duyarlılık açısından literatüre göre daha düşük, özgüllük verileri literatür ile benzer izlenmiştir. Duyarlılık sonuçlarında ADNEX modeli RMI versiyonlarına göre oldukça yüksek değerlere ulaşmakla birlikte özgüllük açısından daha kısıtlı olduğu izlenmiştir. Sonuçların doğrulanması için longitudinal çalışmalara ihtiyaç vardır.

Comparision of "Risk of Malignancy Indices" and "Assesment of Different Neoplasia in the Adnexa" (ADNEX) Model as Preoperative Malignancy Evaluation Methods for Adnexal Masses

Objective: Preoperative evaluation of adnexial masses is crucial for decision processes of preoperative preparation. It is also directly related to prognosis. In this study, we aimed to evaluate the performances of versions of Risk of Malignancy Index (RMI) and Assesment of Different Neoplasias in the Adnexa (ADNEX) model for diagnosis of malignancy. Material and Methods: We retrospectively evaluated patients who applied with adnexial mass to our tertiary gynecolocial center between 1st of September, 2014 and 30th of July, 2016. Of 206 patients, 15 were excluded due to missing CA 125 and ultrasonograpic measurement and recurrent ovarian cancer diagnoses. 191 patients were included into the study. Demographic, ultrasonographic data and CA-125 values were all recorded and RMI I to IV scores and malignancy risk percents for ADNEX model were calculated. Three cut-off values for malignancy probabilites (5%, 10%, and 15%) were applied for ADNEX model. Results were compared to postoperative pathological diagnoses. Results: Sensitivity (SEN), specifity (SPE), positive predictive value (PPV), and negative predictive value (NPV) were 66%, 88.4%, 68.6%, and 87.1% for RMI I, 75.5%, 78.3%, 57.1%, and 89.3% for RMI II, 66%, 88.4%, 68.6%, and 87.1% for RMI III, and 67.9%, 90.6%, 73.5 and 88% for RMI IV. For ADNEX model, SEN, SPE, PPV, and NPV values were 98.1%, 46.4%, 41.3%, and 98.5% for cut-off value of 5%, 94.3%, 63%, 49,5%, and 96.7% for cut-off value of 10%, and 94.3%, 72.5%, 56.8%, and 97.1% for cut-off value of 15%. Conclusion: Results of versions of RMI were similar to those in the literature in terms of specifity, but lower in terms of sensitivity. Sensitivity and specifity values for ADNEX model were similar to those of the literature. Although sensitivity of ADNEX model were higher than those of versions of RMI, specifity values were lower. Future prospective studies could be performed to evaluate diagnostic perfomances of those indices and to develop newer indices in terms of better SEN and SPE.

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