Preoperative Evaluation of the ADNEX Model for the Prediction of the Ovarian Cancer Risk of Adnexal Masses at Siriraj Hospital

2021 ◽  
pp. 1-7
Author(s):  
Vitcha Poonyakanok ◽  
Prasong Tanmahasamut ◽  
Atthapon Jaishuen ◽  
Thanyarat Wongwananuruk ◽  
Chutimon Asumpinwong ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Characteristic Curve ◽  
Preoperative Evaluation ◽  
Survival Rates ◽  
Benign Tumors ◽  
Diagnostic Study ◽  
Ovarian Cancer Risk ◽  
Cutoff Value ◽  
Adnexal Masses ◽  
Siriraj Hospital

Introduction: Distinguishing benign adnexal masses from malignant tumors plays an important role in preoperative planning and improving patients’ survival rates. The International Ovarian Tumor Analysis (IOTA) group developed a model termed the Assessment of Different NEoplasias in the adneXa (ADNEX). Objective: Our objective was to evaluate the performance of the ADNEX model in distinguishing between benign and malignant tumors at a cutoff value of 10%. Methods: This was a prospective diagnostic study. 357 patients with an adnexal mass who were scheduled for surgery at Siriraj Hospital were included from May 1, 2018, to May 30, 2019. All patients were undergoing ultrasonography, and serum CA125 was measured. Data were calculated by the ADNEX model via an IOTA ADNEX calculator. Results: Of the 357 patients, 296 had benign tumors and 61 had malignant tumors. The area under the receiver operating characteristic curve for using the ADNEX model was 0.975 (95% confidence interval, 0.953–0.988). At a 10% cutoff, the sensitivity was 98.4% and specificity was 87.2%. The best cutoff value was at 16.6% in our population. Conclusions: The performance of the ADNEX model in differentiating benign and malignant tumors was excellent.

Inclusion of CA-125 Does Not Improve Mathematical Models Developed to Distinguish Between Benign and Malignant Adnexal Tumors

2007 ◽  
Vol 25 (27) ◽  
pp. 4194-4200 ◽  
Author(s):  
Dirk Timmerman ◽  
Ben Van Calster ◽  
Davor Jurkovic ◽  
Lil Valentin ◽  
Antonia C. Testa ◽  
...  
Keyword(s):  
Mathematical Models ◽  
Malignant Tumors ◽  
Color Doppler ◽  
Characteristic Curve ◽  
Premenopausal Women ◽  
Color Doppler Imaging ◽  
Doppler Imaging ◽  
Ca 125 ◽  
Benign Tumors ◽  
Adnexal Masses

Purpose To test the value of serum CA-125 measurements alone or as part of a multimodal strategy to distinguish between malignant and benign ovarian tumors before surgery based on a large prospective multicenter study (International Ovarian Tumor Analysis). Patients and Methods Patients with at least one persistent ovarian mass preoperatively underwent transvaginal ultrasonography using gray scale imaging to assess tumor morphology and color Doppler imaging to obtain indices of blood flow. Results Data from 809 patients recruited from nine centers were included in the analysis; 567 patients (70%) had benign tumors and 242 (30%) had malignant tumors—of these 152 were primary invasive (62.8%), 52 were borderline malignant (21.5%), and 38 were metastatic (15.7%). A logistic regression model including CA-125 (M2) resulted in an area under the receiver operating characteristic curve (AUC) of 0.934 and did not outperform a published (M1) without serum CA-125 information (AUC, 0.936). Specifically designed new models including CA-125 for premenopausal women (M3) and for postmenopausal women (M4) did not perform significantly better than the model without CA-125 (M1; AUC, 0.891 v AUC, 0.911 and AUC, 0.975 v AUC, 0.949, respectively). In postmenopausal patients, serum CA-125 alone (AUC, 0.920) and the risk of malignancy index (AUC, 0.924) performed very well. Results were very similar when the models were prospectively tested on a group of 345 new patients with adnexal masses of whom 126 had malignant tumors (37%). Conclusion Adding information on CA-125 to clinical information and ultrasound information does not improve discrimination of mathematical models between benign and malignant adnexal masses.

Diagnostic approach using the expression profiling of the P53 tumor suppressor gene and its related proteins in ovarian epithelial tumors

2005 ◽  
Vol 15 (3) ◽  
pp. 453-461 ◽  
Author(s):  
H. Lee ◽  
G. Park ◽  
J. H. Jung ◽  
W. S. Ahn ◽  
J. M. Lee ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Malignant Tumors ◽  
Cyclin E ◽  
Receiver Operating Curve ◽  
Benign Tumors ◽  
Cutoff Value ◽  
Borderline Tumors ◽  
Expression Levels ◽  
Epithelial Tumors ◽  
Ovarian Epithelial Tumors

The initial aim of this study was to examine the expression profiles of P53 and its upstream genes, downstream genes, and cell cycle regulators to determine whether these markers are useful for making a differential diagnosis among the benign, borderline, and malignant ovarian epithelial tumors. Between borderline and malignant tumors, the increased expression levels of P53, Bax, Cyclin E, and cyclin-dependent kinase-2 as well as the decreased expression levels of growth arrest and DNA damage (GADD45) and murine double minute-2 (MDM2) were significantly associated with malignancy (P < 0.01, each). Using the receiver operating curve (ROC), the most reliable cutoff value of the added-up staining scores of those markers was 4.5 with 79% sensitivity and 89% specificity for malignancy. Between benign and borderline tumors, the P21 and Bax expression levels were significantly higher in borderline tumors, whereas the Bcl-2 expression level was much higher in benign tumors (P < 0.01, each). Using the ROC, the cutoff value of the added-up staining scores used to discriminate between the two groups was 2.5 with 70% sensitivity and 74% specificity for borderline tumors. Thus, for the differential diagnosis between borderline and malignant tumors, the cutoff value 4.5 of the cumulative staining scores can be used. However, the cutoff value 2.5 for discrimination between benign and borderline tumors may not be useful because of its relatively low sensitivity and specificity. In addition, the P53, GADD45, Cyclin E, and MDM2 expression levels in malignant ovarian tumors might be useful for determining the histologic grade and type.

scholarly journals Radiomics Models for the Preoperative Prediction of Pelvic and Sacral Tumor Types: A Single-Center Retrospective Study of 795 Cases

2021 ◽  
Vol 11 ◽  
Author(s):  
Ping Yin ◽  
Xin Zhi ◽  
Chao Sun ◽  
Sicong Wang ◽  
Xia Liu ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Malignant Tumors ◽  
Characteristic Curve ◽  
Benign Tumors ◽  
Giant Cell Tumors ◽  
Neurogenic Tumors ◽  
Sacral Tumor ◽  
Sacral Tumors ◽  
Tumor Types ◽  
Class Models

PurposeTo assess the performance of random forest (RF)-based radiomics approaches based on 3D computed tomography (CT) and clinical features to predict the types of pelvic and sacral tumors.Materials and MethodsA total of 795 patients with pathologically confirmed pelvic and sacral tumors were analyzed, including metastatic tumors (n = 181), chordomas (n = 85), giant cell tumors (n =120), chondrosarcoma (n = 127), osteosarcoma (n = 106), neurogenic tumors (n = 95), and Ewing’s sarcoma (n = 81). After semi-automatic segmentation, 1316 hand-crafted radiomics features of each patient were extracted. Four radiomics models (RMs) and four clinical-RMs were built to identify these seven types of tumors. The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) were used to evaluate different models.ResultsIn total, 795 patients (432 males, 363 females; mean age of 42.1 ± 17.8 years) were consisted of 215 benign tumors and 580 malignant tumors. The sex, age, history of malignancy and tumor location had significant differences between benign and malignant tumors (P &lt; 0.05). For the two-class models, clinical-RM2 (AUC = 0.928, ACC = 0.877) performed better than clinical-RM1 (AUC = 0.899, ACC = 0.854). For the three-class models, the proposed clinical-RM3 achieved AUCs between 0.923 (for chordoma) and 0.964 (for sarcoma), while the AUCs of the clinical-RM4 ranged from 0.799 (for osteosarcoma) to 0.869 (for chondrosarcoma) in the validation set.ConclusionsThe RF-based clinical-radiomics models provided high discriminatory performance in predicting pelvic and sacral tumor types, which could be used for clinical decision-making.

scholarly journals MET-05 PRELIMINARY REPORT OF RADIOTHERAPY FOR BRAIN METASTASES FROM GASTRO-INTESTINAL CANCERS USING MASK SYSTEM OF LEKSELL GAMMA KNIFE ICON

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii35-ii36
Author(s):  
Takuya Kawabe ◽  
Manabu Sato
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Benign Tumors ◽  
Survival Times ◽  
Single Session ◽  
Tumor Number ◽  
Eloquent Area

Abstract OBJECT Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated. METHODS We retrospectively analyzed 50 patients (71 times) with brain metastases from gastro-intestinal cancers who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2019 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. The most common origin was colon (19 patients), followed by rectum (11), stomach (7), esophagus (5) and others (8). RESULTS 13 cases were treated in a single session, 53 with fractionation, and five with multiple sessions. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-) for malignant tumors, and 2.7Gy x 10Fr for benign tumors. Median tumor number was two (1–40) and median tumor size was 8.1 (0.03–67.5) ml. Median survival times after Icon treatment was 13.5 months and local control rate after 6-month Icon treatment was 80%. CONCLUSIONS Although these results are limited to short periods, survival rates, local control rates and qualitative survival rated in patients unsuitable for stereotactic radiosurgery, such as those with large, recurrent, and eloquent site lesions, were within the acceptable ranges.

scholarly journals Differential expression and processing of secretogranin II in relation to the status of pheochromocytoma: implications for the production of the tumoral marker EM66

2012 ◽  
Vol 48 (2) ◽  
pp. 115-127 ◽  
Author(s):  
J Guillemot ◽  
E Thouënnon ◽  
M Guérin ◽  
V Vallet-Erdtmann ◽  
A Ravni ◽  
...  
Keyword(s):  
Western Blot ◽  
Molecular Mechanisms ◽  
Malignant Tumors ◽  
Characteristic Curve ◽  
Benign Tumors ◽  
Secretogranin Ii ◽  
Low Concentrations ◽  
The Status ◽  
Responsive Element ◽  
Plasma Marker

We have previously demonstrated that measurement of tissue concentrations of the secretogranin II (SgII or SCG2 as listed in the HUGO database)-derived peptide EM66 may help to discriminate between benign and malignant pheochromocytomas and that EM66 represents a sensitive plasma marker of pheochromocytomas. Here, we investigated the gene expression and protein production of SgII in 13 normal adrenal glands, and 35 benign and 16 malignant pheochromocytomas with the goal to examine the molecular mechanisms leading to the marked variations in the expression of EM66 in tumoral chromaffin tissue. EM66 peptide levels were 16-fold higher in benign than in malignant pheochromocytomas and had an area under the receiver-operating characteristic curve of 0.95 for the distinction of benign and malignant tumors. Q-PCR experiments indicated that the SgII gene was significantly underexpressed in malignant tumors compared with benign tumors. Western blot analysis using antisera directed against SgII and SgII-derived fragments revealed lower SgII protein and SgII-processing products in malignant tumors. Western blot also showed that low p-cAMP-responsive element-binding (CREB) concentrations seemed to be associated with the malignant status. In addition, the prohormone convertase PC1 and PC2 genes and proteins were overexpressed in benign pheochromocytomas compared with malignant pheochromocytomas. Low concentrations of EM66 found in malignant tumors are associated with reduced expression and production of SgII and SgII-derived peptides that could be ascribed to a decrease in SgII gene transcription, probably linked to p-CREB down-regulation, and to lower PC levels. These findings highlight the mechanisms leading to lower concentrations of EM66 in malignant pheochromocytoma and strengthen the notion that this peptide is a suitable marker of this neuroendocrine tumor.

Early results of real-time qualitative sonoelastography in the evaluation of parotid gland masses: A study with histopathological correlation

2013 ◽  
Vol 54 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Irfan Celebi ◽  
Abdullah S Mahmutoglu
Keyword(s):  
Parotid Gland ◽  
Cell Carcinoma ◽  
Real Time ◽  
Malignant Tumors ◽  
Characteristic Curve ◽  
Kappa Statistic ◽  
Benign Tumors ◽  
Low Grade ◽  
Primary Role ◽  
Early Results

Background Sonoelastography has been used to differentiate malignant from benign lesions in numerous types of tissues including breast, prostate, liver, blood vessels, thyroid, musculoskeletal structures, and salivary glands. Purpose To evaluate the efficacy and application of real-time qualitative sonoelastography in the differentiation of benign and malignant focal parotid gland lesions. Material and Methods A total of 75 patients (36 boys/men, 39 girls/women; age range, 10–83 years) with 81 lesions were evaluated prospectively by sonoelastography performed and interpreted by two expert radiologists. The results of these experts classification and scoring of lesions according to relative stiffness of the mass were compared with each other and with histopathological findings. The interpretation of sonoelastography scores of 1–4 were as follows: 1, soft; 2, mostly soft; 3, mostly stiff; and 4, stiff. Results The kappa statistic of 0.508 (P <, 0.001) indicated moderate agreement between the two radiologists. The sonoelastography scores correctly diagnosed 30 of 49 benign tumors (sensitivity, 61.2%) and 19 of 32 malignant tumors (specificity, 59.4%). The area under the receiver-operating characteristic curve was 0.603. The diagnostic value of sonoelastography for evaluating pleomorphic adenomas, Warthin tumors, adenoid cystic carcinoma, and high-grade tumors was low, whereas the diagnostic rates for low-grade tumors such as mucoepidermoid carcinoma, acinic cell carcinoma, and metastases of basal cell carcinoma were better with sonoelastography. Conclusion Although sonoelastography seems to be promising in the differentiating of low-grade malignancies, the primary role of radiology is currently limited to determination of localization, size, and morphology of parotid tumors.

Meningioma Radiosurgery: Tumor Control, Outcomes, and Complications among 190 Consecutive Patients

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1029-1038 ◽  
Author(s):  
Scott L. Stafford ◽  
Bruce E. Pollock ◽  
Robert L. Foote ◽  
Michael J. Link ◽  
Deborah A. Gorman ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
External Beam Radiotherapy ◽  
Survival Rates ◽  
Internal Carotid Artery Stenosis ◽  
Benign Tumors ◽  
Tumor Control ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Tumor Margin ◽  
Cause Specific Survival

ABSTRACT OBJECTIVE To determine local control (LC) and complication rates for patients with intracranial meningiomas who underwent radiosurgery. METHODS One hundred ninety consecutive patients with 206 meningiomas underwent radiosurgery between 1990 and 1998. One hundred forty-seven tumors (77%) involved the cranial base. The median age at the time of radiosurgery was 58 years (range, 20–90 yr). There were 126 female patients (66%). One hundred twelve patients (59%) had undergone one or more previous operations (median, 1; range, 1–5). Twenty-two patients (12%) had either atypical (n = 13) or malignant (n = 9) tumors. The median prescription isodose volume was 8.2 cm3 (range, 0.5–50.5 cm3), and the median tumor margin dose was 16 Gy (range, 12–36 Gy). The median imaging and clinical follow-up periods were 40 and 47 months, respectively. RESULTS Overall survival rates for the entire cohort at 5 and 7 years were 82 and 82%, respectively; cause-specific survival rates at 5 and 7 years were 94 and 92%, respectively. The cause-specific survival rates at 5 years for patients with benign, atypical, and malignant tumors were 100, 76, and 0%, respectively (P &lt; 0.0001). The 5-year LC rate was 89%, with 114 tumors (56%) decreasing in size. LC rates were correlated with tumor histological features (P &lt; 0.0001); patients with benign tumors exhibited a 5-year LC rate of 93%, compared with 68 and 0% for patients with atypical or malignant meningiomas, respectively. No correlation was observed between radiation dose and LC rate. Twenty-four patients (13%) experienced treatment-related complications, including cranial nerve deficits (8%), symptomatic parenchymal changes (3%), internal carotid artery stenosis (1%), and symptomatic cyst formation (1%). Only six patients (3%) exhibited decreases in functional status that were directly related to radiosurgery. Tumor volume, tumor margin dose, or previous radiotherapy was not associated with the development of radiation-related complications. CONCLUSION Radiosurgery is an effective management strategy for many patients with meningiomas. Patients with atypical or malignant tumors exhibit high recurrence rates despite the use of radiosurgery, and these patients continue to exhibit worse cause-specific survival rates despite aggressive treatment, including surgery, external-beam radiotherapy, and radiosurgery. Further study is needed to determine the tumor control and complication rates 10 years or more after meningioma radiosurgery.

scholarly journals Significance of Coagulation and Fibrinolysis Markers for Benign and Malignant Soft Tissue Tumors

2020 ◽  
Author(s):  
Kunihiro Asanuma ◽  
Tomoki Nakamura ◽  
Tomohito Hagi ◽  
Takayuki Okamoto ◽  
Kouji Kita ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Malignant Tumors ◽  
Characteristic Curve ◽  
Soft Tissue Tumors ◽  
Clinicopathological Parameters ◽  
Diagnostic Tools ◽  
Benign Tumors ◽  
Benign Soft Tissue Tumors ◽  
Significant Difference ◽  
Coagulation And Fibrinolysis

Abstract Background: The intimate relationship between coagulation and fibrinolysis in malignant tumors is a well-known phenomena, with the malignant phenotype enhancing coagulation and fibrinolysis. We hypothesized that soft tissue sarcoma (STS) affects the expression of coagulation and fibrinolysis markers, which could be used to distinguish STS from benign soft tissue tumors. We analyzed the correlations between plasma levels of D-dimer (DD), plasmin-α2 plasmin inhibitor complex (PIC), soluble fibrin (SF), and thrombin-antithrombin III complex (TAT) in benign soft tissue tumors and STS to elucidate whether these markers can be used to predict STS.Methods: Plasma DD, PIC, SF and TAT levels in primary soft tissue tumors (benign, 67, STS 68) were measured before biopsy or treatment. The marker levels were analyzed and compared to various clinicopathological parameters.Results: In malignancy (STS), the average DD, PIC and SF levels were significantly higher than in benign tumors. Multivariate logistic analysis of continuous variables indicated that only PIC exhibited a significant difference (OR: 24.5, 95%CI: 3.55-170, p=0.0012). Receiver operating characteristic curve analysis produced area under the curve values for DD: 0.691, PIC: 0.784, SF: 0.734 and TAT: 0.588. Youden’s index was used to establish thresholds of 0.37 (DD), 0.80 (PIC), 0.90 (SF) and 0.82 (TAT). Threshold values for PIC and SF indicated high specificity (0.881, 0.791) and high positive predictive value (0.818, 0.745), respectively The highest accuracy value among the markers was observed for PIC (0.704). Significant differences in multivariate analysis of binary variables were demonstrated by categorizing low and high groups based on their threshold, PIC (≥0.80) (OR: 3.36, 95%CI: 1.19-9.43, p=0.0212) and SF (≥0.90) (OR: 2.63, 95%CI: 1.04-6.66, p=0.0404) . Conclusions: Of the coagulation and fibrinolysis markers studied, increased PIC levels were related to STS and over 0.80 PIC was the most suitable for the prediction of STS, which, along with other diagnostic tools, represents a helpful subsidiary tool for the prediction of STS.

scholarly journals Ovarian Masses-Applicable IOTA ADNEX Model versus Morphological Findings for Accurate Diagnosis and Treatment

2021 ◽  
Vol 11 (22) ◽  
pp. 10789
Author(s):  
Tudor Butureanu ◽  
Demetra Socolov ◽  
Daniela Roxana Matasariu ◽  
Alexandra Ursache ◽  
Ana-Maria Apetrei ◽  
...  
Keyword(s):  
At Risk ◽  
Surgical Treatment ◽  
Ovarian Tumor ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Adnexal Masses ◽  
Borderline Tumors ◽  
Benign Ovarian Tumor ◽  
Significant Difference ◽  
Ovarian Masses

A common problem in gynecological practice is the differential diagnosis of the ovarian masses. The clinician must apply the IOTA (International Ovarian Tumor Analysis) ADNEX (Assessment of Different Neoplasia in the Adnexa) model criteria to evaluate the risk of benign, borderline or malignant tumors. The aim of this study was to verify if the IOTA ADNEX model is a practical tool to be used before surgery and if there is a significant difference between IOTA ADNEX criteria and histological findings. A prospective single center study was performed between January 2017 and December 2019 in Obstetrics and Gynecology Hospital “Cuza-Voda”, Iasi, Romania. The study included 230 patients between 17 and 74 years old diagnosed with persistent adnexal masses. We applied the IOTA ADNEX model protocol predicting the risk of benign, borderline or malignant masses. The golden standard remains the histological diagnosis of the surgically removed mass. The patients that had been diagnosed using ultrasonography with persistent adnexal masses between 30 and 291 mm were operated on in our clinic. In our study. the majority of patients had benign ovarian tumor mass, these being 223 (96.96%) patients, from whom, according to IOTA ADNEX protocol, the correspondence was: 91.8–99.7% at risk of benign tumors, 0.3–4.5% at risk of borderline tumors and 0.3–8.2% at risk of malignant masses. Unexpected findings were obtained from the malignant group that included five patients (2.17%) with the following correspondence: 96.1–99% at risk of benign tumors, 0.6–2.4% at risk of borderline tumors and 1–3.9% at risk of malignant masses. After applying the IOTA ADNEX model criteria, the patients with a suspicion of malignant disease were correctly guided towards surgical treatment in an oncological center. In our hospital, surgical treatment was only proposed to those patients with high suspicion of benign masses.

scholarly journals Which Parameters could be Useful for Predicting Malignancy in Solid Adnexal Masses?

2009 ◽  
Vol 3 (1) ◽  
pp. 1-5
Author(s):  
Juan Luis Alcázar ◽  
Pedro Royo ◽  
Laura Pineda
Keyword(s):  
Blood Flow ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Malignant Tumors ◽  
Univariate Analysis ◽  
Menopausal Status ◽  
Ca 125 ◽  
Benign Tumors ◽  
Adnexal Masses

Abstract To determine which clinical, biochemical and other sonographic parameters could be useful to predict malignancy in sonographically solid adnexal masses. Methods Clinical (age, menopausal status, complaints and physical examination), biochemical (serum CA-125 levels) and other sonographic features (tumor volume, ascites, bilaterality, blood flow location and velocimetric pattern) from 163 women diagnosed as having a solid adnexal mass on B-mode gray-scale ultrasound were reviewed for this retrospective study. All patients had undergone surgery and mass removal. Definitive histologic diagnosis was available in all cases. All parameters were compared to final histological diagnosis (benign or malignant) in univariate statistical analysis. Then a stepwise forward logistic regression analysis was performed to identify those features that independently predict malignancy. Results A total of 173 masses were analyzed. Patients mean age was 52.4 years (range: 15 to 84 years) 117 masses were malignant and 56 were benign. After univariate analysis all parameters showed statistical differences between benign and malignant tumors. After logistic regression analysis only central blood flow (odd ratio: 64.2, 95% CI: 17.07 to 242.03) and presence of ascites (odd ratio: 32.77, 95% CI: 5.38 to 199.72) were identified as independent predictors of malignancy. The presence of one of these two features correlated to malignancy in 98.6% of cases. The absence of both was found in 82.1% of benign tumors. Conclusions The presence or absence of ascites or central blood flow may be helpful for discriminating benign from malignant solid adnexal masses.

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