Obstet Gynecol Sci.  2022 Jan;65(1):1-13. 10.5468/ogs.21212.

Ultrasonographic ovarian mass scoring system for predicting malignancy in pregnant women with ovarian mass

• Lee SJ
• Oh HR
• Na S
• Hwang HS
• Lee SM

• KMID: 2524680
• DOI: http://doi.org/10.5468/ogs.21212

Abstract

During routine antenatal ultrasound examinations, an ovarian mass can be found incidentally. In clinical practice, the differential diagnosis between benign and malignant ovarian masses is essential for planning further management. Ultrasound imaging has become the most popular diagnostic tool during pregnancy, with the recent development of ultrasonography. In non-pregnant women, several methods have been used to predict malignant ovarian masses before surgery. The International Ovarian Tumor Analysis (IOTA) group reported several scoring systems, such as the IOTA simple rules, IOTA logistic regression models, and IOTA assessment of different NEoplasias in the adneXa. Other researchers have also evaluated the malignancy of ovarian masses before surgery using scoring systems such as the Sassone score, pelvic mass score, DePriest score, Lerner score, and Ovarian-Adnexal Reporting and Data System. These researchers suggested specific features of ovarian masses that can be used for differential diagnosis, including size, proportion of solid tissue, papillary projections, inner wall structure, locules, wall thickness, septa, echogenicity, acoustic shadows, and presence of ascites. Although these factors can also be measured in pregnant women using ultrasound, only a few studies have applied ovarian scoring systems in pregnant women. In this article, we reviewed various scoring systems for predicting malignant tumors of the ovary and determined whether they can be applied to pregnant women.

Keyword

Ovarian cysts; Ovarian cancer; Diagnostic imaging; Ultransonography; Pregnant women

Reference

References

1. Mohaghegh P, Rockall AG. Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques. Radiographics. 2012; 32:1751–73.

2. Goh WA, Rincon M, Bohrer J, Tolosa JE, Sohaey R, Riaño R, et al. Persistent ovarian masses and pregnancy outcomes. J Matern Fetal Neonatal Med. 2013; 26:1090–3.

3. Condous G, Khalid A, Okaro E, Bourne T. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol. 2004; 24:62–6.

4. Glanc P, Salem S, Farine D. Adnexal masses in the pregnant patient: a diagnostic and management challenge. Ultrasound Q. 2008; 24:225–40.

5. Hogston P, Lilford RJ. Ultrasound study of ovarian cysts in pregnancy: prevalence and significance. Br J Obstet Gynaecol. 1986; 93:625–8.

6. Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999; 93:585–9.

7. Araujo KG, Jales RM, Pereira PN, Yoshida A, de Angelo Andrade L, Sarian LO, et al. Performance of the IOTA ADNEX model in preoperative discrimination of adnexal masses in a gynecological oncology center. Ultrasound Obstet Gynecol. 2017; 49:778–83.

8. Rossi A, Braghin C, Soldano F, Isola M, Capodicasa V, Londero AP, et al. A proposal for a new scoring system to evaluate pelvic masses: pelvic masses score (PMS). Eur J Obstet Gynecol Reprod Biol. 2011; 157:84–8.

9. Al-Musalhi K, Al-Kindi M, Ramadhan F, Al-Rawahi T, Al-Hatali K, Mula-Abed WA. Validity of cancer antigen-125 (CA-125) and risk of malignancy index (RMI) in the diagnosis of ovarian cancer. Oman Med J. 2015; 30:428–34.

10. Kaijser J. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies. Facts Views Vis Obgyn. 2015; 7:42–59.

11. Campbell S. Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening. Ultrasound Obstet Gynecol. 2012; 40:245–54.

12. Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016; 214:424–37.

13. Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 2008; 31:681–90.

14. Timmerman D, Testa AC, Bourne T, Ferrazzi E, Ameye L, Konstantinovic ML, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol. 2005; 23:8794–801.

15. Nunes N, Ambler G, Foo X, Widschwendter M, Jurkovic D. Prospective evaluation of IOTA logistic regression models LR1 and LR2 in comparison with subjective pattern recognition for diagnosis of ovarian cancer in an outpatient setting. Ultrasound Obstet Gynecol. 2018; 51:829–35.

16. Van Calster B, Van Hoorde K, Froyman W, Kaijser J, Wynants L, Landolfo C, et al. Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors. Facts Views Vis Obgyn. 2015; 7:32–41.

17. Sassone AM, Timor-Tritsch IE, Artner A, Westhoff C, Warren WB. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol. 1991; 78:70–6.

18. DePriest PD, Shenson D, Fried A, Hunter JE, Andrews SJ, Gallion HH, et al. A morphology index based on sonographic findings in ovarian cancer. Gynecol Oncol. 1993; 51:7–11.

19. El Sokkary HHAH. The efficacy of ultrasonographic morphological index using Depriest score in ovarian cancer prediction. Int J Reprod Contracept Obstet Gynecol. 2016; 5:4200–5.

20. Lerner JP, Timor-Tritsch IE, Federman A, Abramovich G. Transvaginal ultrasonographic characterization of ovarian masses with an improved, weighted scoring system. Am J Obstet Gynecol. 1994; 170(1 Pt 1):81–5.

21. Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020; 294:168–85.

22. Cao L, Wei M, Liu Y, Fu J, Zhang H, Huang J, et al. Validation of American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US): analysis on 1054 adnexal masses. Gynecol Oncol. 2021; 162:107–12.

23. Zanetta G, Mariani E, Lissoni A, Ceruti P, Trio D, Strobelt N, et al. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG. 2003; 110:578–83.

24. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol. 2016; 128:e210–26.

25. Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol. 1999; 181:19–24.

26. Czekierdowski A, Stachowicz N, Smoleń A, Kluz T, Łoziński T, Miturski A, et al. Sonographic assessment of complex ultrasound morphology adnexal tumors in pregnant women with the use of IOTA simple rules risk and ADNEX scoring systems. Diagnostics (Basel). 2021; 11:414.

27. Lee SJ, Kim YH, Lee MY, Ko HS, Oh SY, Seol HJ, et al. Ultrasonographic evaluation of ovarian mass for predicting malignancy in pregnant women. Gynecol Oncol. 2021; 163:385–91.

28. Platek DN, Henderson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol. 1995; 173:1236–40.

29. Bromley B, Benacerraf B. Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med. 1997; 16:447–52. quiz 453–4.

30. Sunoo CS, Terada KY, Kamemoto LE, Hale RW. Adnexal masses in pregnancy: occurrence by ethnic group. Obstet Gynecol. 1990; 75:38–40.

31. Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005; 105(5 Pt 1):1098–103.

32. Surampudi K, Nirmalan PK, Gundabattula SR, Chandran JB. Management of adnexal masses in pregnancy: our experience from a tertiary referral perinatal centre in South India. Arch Gynecol Obstet. 2015; 291:53–8.

33. Balci O, Gezginc K, Karatayli R, Acar A, Celik C, Colakoglu MC. Management and outcomes of adnexal masses during pregnancy: a 6-year experience. J Obstet Gynaecol Res. 2008; 34:524–8.

34. Yacobozzi M, Nguyen D, Rakita D. Adnexal masses in pregnancy. Semin Ultrasound CT MR. 2012; 33:55–64.

35. Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv. 2006; 61:463–70.

36. Giuntoli RL 2nd, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol. 2006; 49:492–505.

37. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol. 2011; 205:97–102.

38. Spitzer M, Kaushal N, Benjamin F. Maternal CA-125 levels in pregnancy and the puerperium. J Reprod Med. 1998; 43:387–92.

39. Han SN, Lotgerink A, Gziri MM, Van Calsteren K, Hanssens M, Amant F. Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review. BMC Med. 2012; 10:86.

40. Wang Z, Zhou F, Xiao X, Ying C. Serum levels of human epididymis protein 4 are more stable than cancer antigen 125 in early and mid-term pregnancy. J Obstet Gynaecol Res. 2018; 44:2053–8.

41. Gasiorowska E, Kluz T, Lipski D, Warchoł W, Tykarski A, Nowak-Markwitz E. Human epididymis protein 4 (HE4) reference limits in Polish population of healthy women, pregnant women, and women with benign ovarian tumors. Dis Markers. 2019; 2019:3890906.

42. Uslu B, Dogan S, Özdem S, Şimşek T. Serum concentrations of HE4 and Ca125 in uncomplicated pregnancies: a longitudinal study. J Obstet Gynaecol. 2020; 40:70–6.

43. Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol. 2011; 155:119–24.

44. Grigoriadis C, Eleftheriades M, Panoskaltsis T, Bacanu AM, Vitoratos N, Kondi-Pafiti A, et al. Ovarian cancer diagnosed during pregnancy: clinicopathological characteristics and management. G Chir. 2014; 35:69–72.

45. Usui R, Minakami H, Kosuge S, Iwasaki R, Ohwada M, Sato I. A retrospective survey of clinical, pathologic, and prognostic features of adnexal masses operated on during pregnancy. J Obstet Gynaecol Res. 2000; 26:89–93.

46. Mascilini F, Savelli L, Scifo MC, Exacoustos C, Timor-Tritsch IE, De Blasis I, et al. Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis. Ultrasound Obstet Gynecol. 2017; 50:116–23.