THE EFFICACY OF A SONOGRAPHIC MORPHOLOGY INDEX IN IDENTIFYING OVARIAN-CANCER - A MULTIINSTITUTIONAL INVESTIGATION

Transvaginal sonography (TVS) has been shown to be the most effective means to screen for ovarian cancer. TVS is associated with a high sens itivity and specificity. However, the positive predictive value associ ated with TVS in the diagnosis of malignancy is low. A morphologic sco ring index for use with TVS has been used at the University of Kentuck y since 1991. The current study was performed to more fully evaluate t he efficacy and interobserver variation in ultrasonographic morphology index scores attributed to ovarian tumors. Ultrasound records of 213 patients from five participating centers were reviewed by three indepe ndent observers. Morphology index scores were assigned to each tumor i n a blinded fashion. The morphology index scores were then compared wi th the final histopathologic findings. One hundred sixty-nine patients had benign tumors and 44 patients had ovarian malignancies. The mean morphology index scores were significantly higher in malignant ovarian tumors (MI 7.3 +/- 1.9) than in benign ovarian tumors (MI 3.3 +/- 1.8 ). Statistical evaluation of the morphology index scores revealed a se nsitivity of 89% and a positive predictive value of 46%. Interobserver variation was lowest in assessing ovarian volume and higher in the ev aluation of wall structure and septal structure. A multilogistic regre ssion model was used to evaluate the predictive power of each componen t of the morphology index. The use of a morphology index is an effecti ve and cost-efficient method of increasing the positive predictive val ue of TVS screening for ovarian cancer. Use of this index in large num bers of patients will generate data which should help refine appropria te structural scoring categories and reduce interobserver variation. ( C) Academic Press, Inc.