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The Accuracy of Risk Scores in Predicting Ovarian Malignancy: A Systematic Review

Geomini, Peggy MD, PhD; Kruitwagen, Roy MD, PhD; Bremer, Gérard L. MD, PhD; Cnossen, Jeltsje MD, PhD; Mol, Ben W.J. PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e318195ad17

OBJECTIVE: To perform a systematic review of the literature on the accuracy of prediction models in the preoperative assessment of adnexal masses.

DATA SOURCES: Studies were identified through the MEDLINE and EMBASE databases from inception to March 2008. The MEDLINE search was performed using the keywords [“ovarian neoplasms”[MeSH] NOT “therapeutics”[MeSH] AND “model”] and [“ovarian neoplasms”[MeSH] NOT “therapeutics”[MeSH] AND “prediction”]. The Embase search was performed using the keywords [ovary tumor AND prediction], [ovary tumor AND Mathematical model], and [ovary tumor AND statistical model].

METHODS OF STUDY SELECTION: The search detected 1,161 publications; from the cross-references, another 116 studies were identified. Language restrictions were not applied. Eligible studies contained data on the accuracy of models predicting the risk of malignancy in ovarian masses. Models were required to combine at least two parameters.

TABULATION, INTEGRATION, AND RESULTS: Two independent reviewers selected studies and extracted study characteristics, study quality, and test accuracy. There were 109 accuracy studies that met the selection criteria. Accuracy data were used to form two-by-two contingency tables of the results of the risk score compared with definitive histology. We used bivariate meta-analysis to estimate pooled sensitivities and specificities and to fit summary receiver operating characteristic curves.

Studies included in our analysis reported on 83 different prediction models. The model developed by Sassone was the most evaluated prediction model. All models has acceptable sensitivity and specificity. However, the Risk of Malignancy Index I and the Risk of Malignancy Index II, which use the product of the serum CA 125 level, an ultrasound scan result, and the menopausal state, were the best predictors. When 200 was used as the cutoff level, the pooled estimate for sensitivity was 78% for a specificity of 87%.

CONCLUSION: Based on our review, the Risk of Malignancy Index should be the prediction model of choice in the preoperative assessment of the adnexal mass.

In Brief

Based on a systematic review, the Risk of Malignancy Index is useful in the preoperative assessment of the adnexal mass.

Author Information

From the 1Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; 2the Department of Obstetrics and Gynecology, Academic Hospital Maastricht, The Netherlands; 3the Department of Obstetrics and Gynecology, Maasland Hospital, Sittard, The Netherlands; and 4the Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.

Corresponding author: Peggy Geomini, Department of Obstetrics and Gynecology, Maxima Medical Centre, PO Box 7777, 5500 MB Veldhoven, The Netherlands; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.