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Prospective Validation of a Standardized Ultrasonography-Based Ovarian Cancer Risk Assessment System

Suh-Burgmann, Elizabeth, MD; Flanagan, Tracy, MD; Osinski, Todd, MD; Alavi, Mubarika, MS; Herrinton, Lisa, PhD

doi: 10.1097/AOG.0000000000002939
Contents: Cancer: Original Research

OBJECTIVE: To evaluate the performance of a system that standardizes ovarian cancer risk assessment and reporting on ultrasonography.

METHODS: We conducted a prospective community-based cohort study of average-risk women undergoing ultrasonography in 2016 using a reporting system that requires adnexal masses to be categorized as 1, 2, 3, or X based on standardized ultrasound criteria including size, presence of solid components, and vascularity assessed by Doppler. With a median follow-up of 18 months, the risk of ovarian cancer or borderline tumor diagnosis for each category was determined.

RESULTS: Among 43,606 women undergoing ultrasonography, 6,838 (16%) had an abnormal adnexal mass reported: 70% were category 1, 21% category 2, 3.7% category 3, and 5.4% category X. Among these women, 89 (1.3%) were subsequently diagnosed with ovarian cancer and 59 (0.9%) with borderline tumors. The risks of ovarian cancer diagnosis associated with masses reported as categories 1, 2, 3, and X were 0.2% (95% CI 0.05–0.3%), 1.3% (95% CI 0.7–1.9%), 6.0% (95% CI 3.0–8.9%), and 13.0% (95% CI 9.5–16.4%), respectively; risks of either ovarian cancer or borderline tumor were 0.4% (95% CI 0.2–0.6%), 2.3% (95% CI 1.6–3.1%), 10.4% (95% CI 6.6–14.1%), and 18.9% (95% CI 14.9–23.0%) respectively. Among 36,768 (84%) women with normal or benign adnexal findings reported, 38 women were diagnosed with ovarian cancer, for a risk of 0.1% (95% CI 0.07–0.14%).

CONCLUSION: In a community-based setting with low ovarian cancer prevalence, our standardized reporting system differentiated adnexal masses into four categories with distinct levels of risk with 9–10% of women having higher risk masses and 70% of women having masses associated with a risk of cancer similar to that of normal ultrasound findings. The system supports risk-based management by providing clinicians a more consistent assessment of risk based on ultrasound characteristics.

In a community-based population, standardized ovarian cancer risk assessment using ultrasonography differentiated adnexal masses into categories associated with distinct levels of risk.

Division of Gynecologic Oncology, Regional Women’s Health, and Regional Imaging, The Permanente Medical Group, Walnut Creek, and the Division of Research, Kaiser Permanente Northern California, Oakland, California.

Corresponding author: Elizabeth Suh-Burgmann, MD, Division of Gynecologic Oncology, The Permanente Medical Group, 1425 South Main Street, Walnut Creek, CA 94596; email:

Supported by the Kaiser Permanente Northern California Physician Researcher Program.

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

The authors thank Margaret Lynch, MD, Mariana Caponigro, MD, Nina Lee, MD, Jaysheel Mehta, MD, Ruth Goldenberg, MD, Eleanor Ormsby, MD, Cliff Sweet, MD, and David Shen Lee, MD, for their contribution to the establishment of the structured reporting templates, and thank Doug Corley, MD, David Vinson, MD, Joseph Presti, MD, Matthew Solomon, MD, Robert Chang, MD, and Daniel Li, MD, for critical review of the manuscript.

Peer review history is available at

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.