الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 100 |  |  |
| | | from | 100 | | |
Abstract
SUMMARY
Ovarian cancer is fatal cancer among gynecological malignancies. Ovarian cancer remains the fifth leading cause of cancer-related death.
In Egypt, ovarian cancer represented 2.2% of all incident cancers and accounted for 4.4% of all newly diagnosed female cancers.
Adnexal masses are clinical and imaging-wise common problem. Adnexal masses represent a wide variety of causes, and so, they can signify a diagnostic dilemma. Imaging is a cornerstone in the diagnosis of Adnexal masses, from the early detection to categorization. Pelvic ultrasound is still the most frequently used imaging method for detecting and characterizing Adnexal masses.
Accurate prognosis of the type of adnexal mass detected during ultrasound evaluation remains the most important issue in ovarian tumors classification. Prognostic ultraso¬und models should precisely indicate tumor type because incorrect classification may lead to an underestimation of the risk of ovarian mass malignancy. Delayed referral of a woman with suspected adnexal tumor to gynecologic on¬cology specialist is related to several factors, and the lack of widely-accepted and effective preoperative risk assessment strategies remains one of the most important issues.
In this study, we aimed to evaluate the diagnostic performance of the Gynecology Imaging Reporting and Data System (GI-RADS) as regards its ability to preoperatively evaluate adnexal masses considering the histopathological definitive diagnosis the reference.
This prospective study was conducted and performed on 100 women with pelvic pain due to accidently discovered adnexal mass attending to Fayoum general hospital outpatient clinic and medical insurance hospital in Fayoum starting from June 2021 till January 2023.
The current research study revealed Mean age and BMI (kg/m2)was 46.4±10.3 years and 27.1±2.3 respectively. Majority of cases were multiparous (89.0%). More than two thirds were premenopausal (69.0%). Family history of ovarian and breast cancer was in 8.0% and 3.0% respectively. Past history of breast cancer was in 3.0% of cases.
The current study results revealed that the most frequent GI-RADs grade was III (65.0%), followed by IV (20.0%), then II (9.0%) and V (6.0%). The final diagnosis by histopathology revealed that malignancy rate was found in 23.0% of cases, while benign was found in 77.0%. Furthermore,the most frequent histopathology finding was Serous cystadenoma (20.0%), followed by Endometrioma (19.0%), then Serous cystadenocarcinoma (16.0%).
Our study results revealed that Age, BMI and Postmenopausal state wereadnexal masses significantly higher in cases with malignancy (p value= 0.002, 0.037, 0.012). while, Multiparous, Family history of ovarian cancer, Family history of breast cancer and Past history of breast cancer were more frequent in cases with malignancy, the difference were statistically non-significant.
As regardsGI-RADS grades, our study results revealed that GI-RADS grades were classified as follows; grade II was 9 cases (none was malignant), grade III was 65 cases (3 were malignant), grade IV was 22 cases (14 were malignant) and grade V was 6 cases (all were malignant) with significantly different among histopathology findings regarding GI-RADS grades and GI-RADS grades IV and V were significantly more frequent in cases with malignancy.
Consequently, our study results reported that there was significant high agreement between GI-RADS diagnosis and final histopathology diagnosis.
Our current study results reported that Dermoid was the most frequent false positive findings (50.0%), followed by Serous cystadenoma (33.3%), then Endometrioma (16.7%). Serous cystadenocarcinoma was the most frequent false negative findings, followed by Mucinous cystadenocarcinoma (33.3%).
As regards predicting adnexal mass malignancy, our study results revealed that the combination of IV-V GI-RADS had high specificity (92.2%) and sensitivity (87%) and negative predictive value (95.9%), but moderate other diagnostic characteristics in predicting adnexal mass malignancy.
We concluded that our results support the high reliability of GIRADS classification system for diagnosis of AMs by US. Additionally, the GI-RADS criteria are easy to learn and work at least as well as IOTA.
GI-RADS classification performs well and valid as a reporting system of the ovarian masses with high diagnostic performance in prediction of malignancy, and it seems to be a helpful tool in triaging patient’s management and clinical decision making. The goal of the GIRADS classification should be explained to the referring clinicians before the application of the treatment as it can improve patient care.
We recommend applying GI-RADS as a useful and reliable tool to improve the diagnostic ability of ultrasound to differentiate adnexal masses and malignant tumors. It is an effective method to settle the inconsistency among different ultrasound operators.