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Fine needle aspiration cytology in diagnosis of pelvic adnexal masses
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FC4.10.02 USING LOGISTIC REGRESSION MODEL TO PREDICT OVARIAN MALIGNANCY: WHICH PARAMETER PERFORMS BEST? H. Marret (l), R. Ecochard (2), F. Golfier (3), D. Raudrant (3) (1) Dept. OBIGYN, Bretonneau University Hospital, Tours Cedex, France (2) Dept. of Medial computing and Biostatistics, Lacassagne center University, Lyon, France (3) Dept. OBIGYN, Hhtel Dieu University Hospital, Lyon, France Objective: Multivariate logistic regression analysis was used to improve the preoperative diagnosis of ovarian malignancy using color doppler energy, Gray-scale sonographic parameters and CA125 serum level. Methods: One hundred and forty three adnexal masses were studied with transvaginal B-mode ultrasonography and color doppler energy. We had included each ultrasonographic variable (tumor size, wall thickness, septal structure, echogenicity, papillary projection, density (solid or not)). Intratumoral blood flow velocity waveforms were obtained to determine resistance index and location of the tumor vascularity. Menopausal status and serum CA 125 levels were also entered as categorical variables. Results: Eighteen adnexal masses (12.7%) were malignant or low malignant potential ovarian tumors. Multivariate analysis showed that papillary projection of the tumor wall and blood flow central location, were the only factors to be independent predictors of malignancy. All other parameters were not independent factors. Sensitivity, specificity, predictive positive value and negative predictive value were 94%, 84%, 46% and 99% respectively, with a cut off value of 25% probability of malignancy. Only one ovarian cancer but 16% of the benign masses were misclassified. Conclusion: Sonographic analysis using color doppler energy and morphologic parameters is a simple but not perfect method to discriminate benign and malignant ovarian tumors. In our experience the parameters that performed best were papillary projections and blood flow location.
FC4.10.03 CLINICAL EVALUATION OF COMPUTER AIDED MULTIVARIATE PATTERN ANALYSIS SYSTEM II (CAMPAS OV II) FOR DISCRIMINATING MALIGNANT FROM BENIGN OVARIAN MASSES (BOM) E. S. Kobayashi, K. Oura, M. Yasuda, K. Ochiai, T. Tanaka, Dept. of OBIGYN, Jikei University, School of Medicine, Tokyo Japan. Objectives: We previously reported that CAMPAS using biomarkers was developed and a prospective clinical study of CAMPAS OV II was performed (ASCO ABST #261,1994). In this study, we confirm the usefulness of CAMPAS OV II retrospectively after clinical application. Study Methods: Between Oct. 1994 and March 1999 CAMPAS OV II was applied to patients with ovarian masses (POM) for discriminating malignant ovarian tumors (MOT) form BOM. Serum samples were collected from 2876 POM at outpatient department (OPD) of the Jikei university hospital and simultaneously measured level of CA 125, Immunosupressive acidic protein, tissue polypeptide antigen, alkaline phosphatase, albumin and Fe for analysis by CAMPAS. Results: 680 out of 2876 POM were operated on, and the other 2196 POM are being followed at OPD. The results of CAMPAS OV II were compared with the histopathological diagnosis in operated POM. The sensitivity of CAMPAS OV II was 96.7%(89/92) for MOT and 33.3% (6118) for tumors of borderline malignancy. The specificity was 90.2% (5141570) for all BOM and 82.6% (1331161) for endometrial cyst. Of the 36 stage I MOT, 32 cases had a positive result with CAMPAS OV II and the sensitivity was 88.9% (32136). Totally, the accuracy of CAMPAS OV II was 91.1% (6031662). Conclusions: It was confirmed that CAMPAS OV II is an effective diagnostic method for discriminating malignancy including early stage cases from BOM at general OPD.
THURSDAY,
SEPTEMBER
FC4.10.04 A NEW HISTOPATHOLOGIC GRADING SYSTEM FOR OVARIAN CARCINOMA Y. Shimizu (l), K. Hasumi (l), S. Kamoi (2), S. Amada (3), S.G. Silverberg (4) (1) Dept. OBIGYN, Cancer Institute Hospital, Tokyo, Japan. (2) Dept. OBIGYN, Nihon Medical School, Tokyo, Japan (3) Dept. OBIGYN, Kyushu University Hospital, Fukuoka, Japan. (4) Dept. Pathology, University Maryland Med. Syst., Baltimore, Maryland, USA. Objectives: To assess whether a new histopathologic grading system, which was previously proposed by authors, works as a prognostic factor for ovarian carcinoma (OC). Study Methods: For the above purpose, clinicopatholigical analyses were made on 538 consecutive patients with OC treated in a uniform manner between 1980 and 1994 with surgery and platinum-based chemotherapy. All sides were reviewed and the tumors graded as follows: architectural pattern (predominant): glandular=l, papillary=2, and solid=3; nuclear pleomorphism: slight=l, moderate=2, and marked=3; mitotic figures 110 high power fields: O-9=1, lo-24=2, and 25s=3; total score 3-5=Grade 1, 6 or 7=Grade 2, and 8 or 9= Grade 3. Results: The new tumor grade significantly correlated with survival in both early (FIG0 stage I/II) and advanced (III/IV) OC except clear cell carcinoma (CCC). Results for CCC approached but did not reach statistical significance. By multivariate analysis, only this tumor grade and performance status (PS) were significant in early stage OC. For advanced OC, the new tumor grade also was significant, as were PS, residual tumor size, response to chemotherapy, and mutinous (unfavorable) or transitional cell (favorable) histologic type. FIG0 grade (based primarily on architectural features) did not work as a significant prognostic factor in either early or advanced stage OC. Conclusion: The present study confirmed the clinical utility of the new grading system for all clinical stages and histologic types except CCC.
FC4.10.05 FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF PELVIC ADNEXAL MASSES S. Goval, J. Kalra, S. Gopalan, Dept. OBIGYN, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Objectives: The aim of the study was to determine the accuracy of fine needle aspiration cytology (FNAC) m evaluation of the nature of pelvic adnexal masses. Study Methods: Sixty-one women with a clinical diagnosis of adnexal mass were recruited in this prospective blinded study. FNAC was carried out with or without ultrasound guidance and a cytological diagnosis was made. Exploratory laparotomy and excision of adnexal mass was done in 43 women to confirm the diagnosis histologically. FNAC diagnosis was correlated with the final histological diagnosis using McNemar’s Chi Square test. Results: The age of the women ranged from 15 to 76 years with 37.7% of them being postmenopausal. FNAC was carried out transabdominally in 93% of the cases with sonography guidance in 41%. Inadequate aspiration material was obtained in 5 women. Histological confirmation of diagnosis after excision of the adnexal mass in 43 women showed FNAC to have a sensitivity and specificity of 87.5% and 100% respectively for prediction of malignancy with an overall accuracy of 94.7%. FNAC was also able to diagnose specifically the type of malignant pathology accurately. Benign lesions such as endometriosis, dermoid and inflammatory masses were also accurately diagnosed in all cases. Conclusions: FNAC is a simple and safe procedure for evaluation of an adnexal mass with an excellent accuracy of diagnosis when done under ultrasound guidance and this can be beneficial in planning the management of and adnexal mass particularly in younger women.
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FC4.10.02 USING LOGISTIC REGRESSION MODEL TO PREDICT OVARIAN MALIGNANCY: WHICH PARAMETER PERFORMS BEST? H. Marret (l), R. Ecochard (2), F. Golfier (3), D. Raudrant (3) (1) Dept. OBIGYN, Bretonneau University Hospital, Tours Cedex, France (2) Dept. of Medial computing and Biostatistics, Lacassagne center University, Lyon, France (3) Dept. OBIGYN, Hhtel Dieu University Hospital, Lyon, France Objective: Multivariate logistic regression analysis was used to improve the preoperative diagnosis of ovarian malignancy using color doppler energy, Gray-scale sonographic parameters and CA125 serum level. Methods: One hundred and forty three adnexal masses were studied with transvaginal B-mode ultrasonography and color doppler energy. We had included each ultrasonographic variable (tumor size, wall thickness, septal structure, echogenicity, papillary projection, density (solid or not)). Intratumoral blood flow velocity waveforms were obtained to determine resistance index and location of the tumor vascularity. Menopausal status and serum CA 125 levels were also entered as categorical variables. Results: Eighteen adnexal masses (12.7%) were malignant or low malignant potential ovarian tumors. Multivariate analysis showed that papillary projection of the tumor wall and blood flow central location, were the only factors to be independent predictors of malignancy. All other parameters were not independent factors. Sensitivity, specificity, predictive positive value and negative predictive value were 94%, 84%, 46% and 99% respectively, with a cut off value of 25% probability of malignancy. Only one ovarian cancer but 16% of the benign masses were misclassified. Conclusion: Sonographic analysis using color doppler energy and morphologic parameters is a simple but not perfect method to discriminate benign and malignant ovarian tumors. In our experience the parameters that performed best were papillary projections and blood flow location.
FC4.10.03 CLINICAL EVALUATION OF COMPUTER AIDED MULTIVARIATE PATTERN ANALYSIS SYSTEM II (CAMPAS OV II) FOR DISCRIMINATING MALIGNANT FROM BENIGN OVARIAN MASSES (BOM) E. S. Kobayashi, K. Oura, M. Yasuda, K. Ochiai, T. Tanaka, Dept. of OBIGYN, Jikei University, School of Medicine, Tokyo Japan. Objectives: We previously reported that CAMPAS using biomarkers was developed and a prospective clinical study of CAMPAS OV II was performed (ASCO ABST #261,1994). In this study, we confirm the usefulness of CAMPAS OV II retrospectively after clinical application. Study Methods: Between Oct. 1994 and March 1999 CAMPAS OV II was applied to patients with ovarian masses (POM) for discriminating malignant ovarian tumors (MOT) form BOM. Serum samples were collected from 2876 POM at outpatient department (OPD) of the Jikei university hospital and simultaneously measured level of CA 125, Immunosupressive acidic protein, tissue polypeptide antigen, alkaline phosphatase, albumin and Fe for analysis by CAMPAS. Results: 680 out of 2876 POM were operated on, and the other 2196 POM are being followed at OPD. The results of CAMPAS OV II were compared with the histopathological diagnosis in operated POM. The sensitivity of CAMPAS OV II was 96.7%(89/92) for MOT and 33.3% (6118) for tumors of borderline malignancy. The specificity was 90.2% (5141570) for all BOM and 82.6% (1331161) for endometrial cyst. Of the 36 stage I MOT, 32 cases had a positive result with CAMPAS OV II and the sensitivity was 88.9% (32136). Totally, the accuracy of CAMPAS OV II was 91.1% (6031662). Conclusions: It was confirmed that CAMPAS OV II is an effective diagnostic method for discriminating malignancy including early stage cases from BOM at general OPD.
THURSDAY,
SEPTEMBER
FC4.10.04 A NEW HISTOPATHOLOGIC GRADING SYSTEM FOR OVARIAN CARCINOMA Y. Shimizu (l), K. Hasumi (l), S. Kamoi (2), S. Amada (3), S.G. Silverberg (4) (1) Dept. OBIGYN, Cancer Institute Hospital, Tokyo, Japan. (2) Dept. OBIGYN, Nihon Medical School, Tokyo, Japan (3) Dept. OBIGYN, Kyushu University Hospital, Fukuoka, Japan. (4) Dept. Pathology, University Maryland Med. Syst., Baltimore, Maryland, USA. Objectives: To assess whether a new histopathologic grading system, which was previously proposed by authors, works as a prognostic factor for ovarian carcinoma (OC). Study Methods: For the above purpose, clinicopatholigical analyses were made on 538 consecutive patients with OC treated in a uniform manner between 1980 and 1994 with surgery and platinum-based chemotherapy. All sides were reviewed and the tumors graded as follows: architectural pattern (predominant): glandular=l, papillary=2, and solid=3; nuclear pleomorphism: slight=l, moderate=2, and marked=3; mitotic figures 110 high power fields: O-9=1, lo-24=2, and 25s=3; total score 3-5=Grade 1, 6 or 7=Grade 2, and 8 or 9= Grade 3. Results: The new tumor grade significantly correlated with survival in both early (FIG0 stage I/II) and advanced (III/IV) OC except clear cell carcinoma (CCC). Results for CCC approached but did not reach statistical significance. By multivariate analysis, only this tumor grade and performance status (PS) were significant in early stage OC. For advanced OC, the new tumor grade also was significant, as were PS, residual tumor size, response to chemotherapy, and mutinous (unfavorable) or transitional cell (favorable) histologic type. FIG0 grade (based primarily on architectural features) did not work as a significant prognostic factor in either early or advanced stage OC. Conclusion: The present study confirmed the clinical utility of the new grading system for all clinical stages and histologic types except CCC.
FC4.10.05 FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF PELVIC ADNEXAL MASSES S. Goval, J. Kalra, S. Gopalan, Dept. OBIGYN, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Objectives: The aim of the study was to determine the accuracy of fine needle aspiration cytology (FNAC) m evaluation of the nature of pelvic adnexal masses. Study Methods: Sixty-one women with a clinical diagnosis of adnexal mass were recruited in this prospective blinded study. FNAC was carried out with or without ultrasound guidance and a cytological diagnosis was made. Exploratory laparotomy and excision of adnexal mass was done in 43 women to confirm the diagnosis histologically. FNAC diagnosis was correlated with the final histological diagnosis using McNemar’s Chi Square test. Results: The age of the women ranged from 15 to 76 years with 37.7% of them being postmenopausal. FNAC was carried out transabdominally in 93% of the cases with sonography guidance in 41%. Inadequate aspiration material was obtained in 5 women. Histological confirmation of diagnosis after excision of the adnexal mass in 43 women showed FNAC to have a sensitivity and specificity of 87.5% and 100% respectively for prediction of malignancy with an overall accuracy of 94.7%. FNAC was also able to diagnose specifically the type of malignant pathology accurately. Benign lesions such as endometriosis, dermoid and inflammatory masses were also accurately diagnosed in all cases. Conclusions: FNAC is a simple and safe procedure for evaluation of an adnexal mass with an excellent accuracy of diagnosis when done under ultrasound guidance and this can be beneficial in planning the management of and adnexal mass particularly in younger women.
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