MRI Accuracy in Diagnosing Sonographically Indeterminate Masses Taking Histopathology as Standard

Authors

  • Iram Iqbal Department of Radiology, SIMS, Lahore.
  • M. Awais Farooq Department of Radiology, Mayo Hospital/KEMU, Lahore.
  • Sadaf Arooj Department of Radiology, Jinnah Hospital/AIMC, Lahore.
  • Yasir Qavi Department of Radiology, SIMS, Lahore.
  • Rukhsana Nasim Department of Radiology, General Hospital/PGMI/AMC, Lahore.
  • Sehrish Zafar Department of Radiology, SIMS, Lahore.

DOI:

https://doi.org/10.47489/szmc.v38i2.480

Keywords:

Adnexal masses, Magnetic resonance imaging, Sonographically indeterminate

Abstract

Introduction: Approximately 25% of ultrasound-detected adnexal masses pose clinical challenges, being indeterminately categorized as benign or malignant. Characterizing them is pivotal for deciding surgery or pelvic MRI.

Aims and Objectives: To validate the accuracy of MRI for diagnosing sonographically indeterminate masses using biopsy as the gold standard.

Place and Duration of study: A validation cross-sectional study was performed at the Department of Radiology, Mayo Hospital, Lahore, for a period of six months i.e. from December 2019 to June 2020.

Material and Methods: Non-probability consecutive sampling was employed to select 289 patients (12-60 years) with sonographically indeterminate adnexal masses. All those patients who were unwilling to participate or had MRI contraindications like metallic inserts, pacemakers, and claustrophobia were excluded from the study. Data was collected using the proforma as approved by IRB. All patients underwent MR imaging on a 1.5-T GE unit, and MRI accuracy was calculated. The analysis of data was performed using SPSS 25.0 version software, p-value ? 0.05 was taken as significant.

Results: MRI sensitivity, specificity, PPV, NPV, FP, FN, and diagnostic accuracy in sonographically inconclusive adnexal lesions were 94.25%, 85.22%, 90.61%, 90.74%, 3.46%, 5.88% and 90.66%, respectively, referencing histopathology.

Conclusion: The study concludes MRI as a noninvasive, accurate modality for distinguishing benign and malignant adnexal masses. While IOTA Simple Rules can't categorize all masses, around 20% with inconclusive results may need alternative evaluation, like skilled ultrasound examination& MRI. It significantly enhances preoperative differentiation, aiding surgeons in making informed decisions regarding treatment approaches.

References

Carvalho JP, Moretti-Marques R, Silva Filho AL. Adnexal mass: diagnosis and management. Febrasgo Position Statement. 2020. DOI: https://doi.org/10.1055/s-0040-1715547

Hermens AJ, Kluivers KB, Janssen LM, et al. Adnexal masses in children, adolescents and women of reproductive age in the Netherlands: A nationwide population-based cohort study. Gynecol Oncol.2016;143(1):93-97.

http://dx.doi.org/10.1016/j.ygyno.2016.07.096

Syed S, Khurshid N, Batool I, et al. Adnexal Masses in Adolescents and Young Women: An Analysis Of 56 Clinical Cases. J Med Insights. 2021;11(1):[14- 18].

Adusumilli S, Hussain HK, Caoili EM, Weadock WJ, Murray JP, Johnson TD, Chen Q, Desjardins B. MRI of sonographically indeterminate adnexal masses. American journal of roentgenology. 2006 Sep;187(3):732-40.

Bhatti S, Bilal A, Abideen ZU, et al. Role of Ultrasonography in Diagnosing Adnexal Masses: Cross-Sectional Study. Pak J Med Sci. 2020;14(4):917-18.

Vázquez-Manjarrez SE, Rico-Rodriguez OC, Guzman-Martinez N, et al. Imaging and diagnostic approach of the adnexal mass: what the oncologist should know. Chin ClinOncol. 2020;9(5):69. doi: 10.21037/cco-20-37

Basha MA, Metwally MI, Gamil SA, et al. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. EurRadiol. 2021 Feb;31(2):674-684. doi: 10.1007/s00330-020-07143-7. Epub 2020 Aug 18.

PMID: 32809166.

Hiett AK, Sonek JD, Guy M, et al. Performance of IOTA Simple Rules, Simple Rules risk assessment, ADNEX model and O-RADS in differentiating between benign and malignant adnexal lesions in North American women. Ultrasound Obstet Gynecol. 2022 May;59(5):668-676. doi: 10.1002/uog.24777. Epub 2022 Apr 8. PMID: 34533862.

Macori F, Elfeky M, Knipe H, et al. IOTA-ADNEX model. Reference article, Radiopaedia.org (Accessed on 30 Jan 2024) https://doi.org/10.53347/rID-96294

Afzal S, RehmanYousaf K, Iqbal I. Evaluation of Risk Malignancy Index (RMI) As Diagnostic Tool to Distinguish Between Malignant and Benign Adnexal Masses, while Taking Histopathology as Gold Standard. Esculapio - JSIMS [Internet]. 2023 Jul. 24 [cited 2024 Feb. 10];15(3):246-9. Available from: https://esculapio.pk/journal/index.php/journal- files/article/view/423

Disasa FA, Olika AK. Diagnostic Accuracy and Appropriate Cut Off Value of Risk of Malignancy Index in Preoperative Discrimination Between Malignant and Benign Ovarian Tumors: Prospective Crosssectional Study. 2021

Andreotti RF, Timmerman D, Strachowski LM, 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 Jan;294(1):168-185. doi: 10.1148/radiol.2019191150. Epub 2019 Nov 5.

PMID: 31687921.

Foti PV, Attinà G, Spadola S, et al. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging. 2016 Feb;7(1):21-41. doi: 10.1007/s13244-015-0455-4. Epub 2015 Dec

PMID: 26671276; PMCID: PMC4729709.

Kumar S, Singh R, Kumar R, et al. Magnetic Resonance Imaging of Sonographically Indeterminate Adnexal Masses: A Reliable Diagnostic Tool to Detect Benign and Malignant Lesion. International journal of scientific study. 2017;5(1):200-5.

Cavaco-Gomes J, Moreira CJ, Rocha A, et al. Investigation and management of adnexal masses in pregnancy. Scientifica. 2016;2016.

DeSouza NM, Rockall A, Freeman S. Functional MR Imaging in Gynecologic Cancer. Magnetic Resonance Imaging Clinics of North America 2016;24:205-222.

Sohaib SA, Mills TD, Sahdev A. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 2005; 60(3):340–348

Garg A, Manchanda A, Batra R. 14 Benign Adnexal Disease. Comprehensive Textbook of Diagnostic Radiology: Four Volume Set. 2021 Mar 31:233.

Sohaib SA, Reznek RH (2007) MR imaging in ovarian cancer. Cancer Imaging 1(7 Spec No A):S119–29

Valentini AL, Gui B, Miccò M, et al. Benign and Suspicious Ovarian Masses-MR Imaging Criteria for Characterization: Pictorial Review. J Oncol. 2012;2012:481806. doi: 10.1155/2012/481806. Epub

Mar 22. PMID: 22536238; PMCID: PMC3321462.

Singh T, Prabhakar N, Singla V, Bagga R, Khandelwal N. Spectrum of magnetic resonance imaging findings in ovarian torsion. Pol J Radiol. 2018 Dec 18;83:e588-e599. doi:

5114/pjr.2018.81157. PMID: 30800198; PMCID: PMC6384404.

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Published

2024-04-29

How to Cite

1.
Iqbal I, M. Awais Farooq, Sadaf Arooj, Qavi Y, Rukhsana Nasim, Sehrish Zafar. MRI Accuracy in Diagnosing Sonographically Indeterminate Masses Taking Histopathology as Standard. Proceedings S.Z.M.C [Internet]. 2024 Apr. 29 [cited 2024 May 18];38(2):79-84. Available from: https://proceedings-szmc.org.pk/index.php/szmc/article/view/480