Tables at a glance

Table 1

Table 2

Table 3

Table 4

Table 5

Figures at a glance

Comments

Figure 1

Table 1

Ultrasound image	Size (cm)	Follow-up	Surgery (cm)
GI-RADS1
Normal	-	No	No
GI-RADS2
Functional	> 5	6w/3m/6m/1y	According to symptoms
GI-RADS3
Premenopausal
Teratoma	3-4		>4
Endometrioma	3-5	6w/3m/6m/1y	>5
Simple cyst	>3		>10
Postmenopausal
Teratoma	<3		>3
Endometrioma	<3	6w/3m/6m/1y	>3
Simple cyst	>2.2		>10
GI-RADS4
1-2 findings suggestive of malignancy	<3 premenopausal	6w/3m/6m/1y	>3
GI-RADS5
>3 findings suggestive of malignancy			All cyst

Table 1: Management protocol for adnexal masses according to GI-RADS classification and hormonal status

Table 2

Sonographic characteristics

N (%)

Size**

4.6 (2.3)

GI-RADS
-     2
-     3
-     4
-     5

38 (24.7)
79 (51.3)
25 (16.2)
12 (7.8)

Diferents GI-RADS 3

Endometrioma
Teratoma
Simple cyst

36 (45.6)
14 (17.7)
29 (36.7)

Malignancy findings

Solid areas
Ascites
Tinck septations
Thinck papillary projections
Vascularization on color or power Doppler

19 (12.3)
5 (3.2)
18 (11.7)
11 (7.1)
20 (13)

Sonographic changes

1st follow-up (6 weeks-3 months) o Persistence

Spontaneus resolution
Change in adnexal mass

2nd follow-up (6 months)

Persistence
Spontaneus resolution
Change in adnexal mass

120 (81.9)
22 (14.8)
4 (2.7)

77 (67.8)
11 (9.6)
25 (21.7)

Table 2: Sonographic characteristics
** Data expressed in cms as median values (interquartile range, RIQ)

Table 3

Histologic results	N (%)
Simple cyst Teratoma Immature teratoma Endometrioma Cystadenoma Carcinoma Borderline Dysgerminoma Myoma Fibroma Sarcoma	2 (3.9) 6 (11.6) 1( 2) 8 (15.7) 16 (31,4) 12 (23.5) 2 (3.9) 1 (2) 1(2) 1(2) 1 (2)
Carcinomas: Serous Endometrioid Mucinous	8 (66.7) 3 (25) 1 (8.3)
Diferentation grade: Grade 1 Grade 2 Grado 3	2 (15.4) 4 (30.8) 7 (53.8)

Table 3: Histologic results

Table 4

Variable	Surgery N (%)	No surgery N (%)	p
Age*	48.1 (17.1)	41.6 (12.1)	0.017
Menopausal	21 (41.2)	18 (17.5)	0.001
Size(cm)**	5.9 (3.9)	4.2 (1.7)	<0.0001
HE4 negative	42 (82.4)	99 (96.1)	0.010
Ca125	32 (78)	55 (88.7)	0.144
GI-RADS - 2 - 3 - 4 - 5	5 (9.8) 21 (41.2) 14 (27.5) 11 (21.6)	33 (32) 58 (56.3) 11 (10.7) 1 (1)	<0.0001

Table 4: Comparison of study groups: surgical vs no surgical intervention
D* Data expressed as mean (SD) ** Data expressed as median (RIQ)

Table 5

	Sensitivity % (95%CI)	Specificity % (95%CI)	VPP % (95%CI)	VPN % (95%CI)
HE4 GLOBAL ROC 76.6%
- PC 70	70.6 (46-95.2)	88.3 (82.6-94.1)	42.9 (22.7-63)	96 (92.2-99.8)
- PC 82	70.6 (46-95.2)	92 (87.1-96.9)	52.2 (29.6-74.8)	96.2 (92.5-99.8)
- PC 100	58.8 (32.5-85.2)	95.6 (91.8-99.4)	62.5 (35.6-89.3)	94,9 (90,9-98,9)
- PC 130	47.1 (20.4-73.7)	96.3 (92.8-99.9)	61.5 (31.2-91.8)	93.6 (89.2-98)
HE4 PREMENOPAUSAL ROC 66.1%
- PC 70	60 (7,1-100)	82.7 (87.4-98)	27.3 (0-58.1)	98.1 (95-100)
- PC 82	60 (7.1-100)	94.5 (89.8-99.2)	33.3 (0-69.7)	98.1 (95-100)
- PC 100	40 (0-92,9)	97.3 (93.8-100)	40 (0-92.9)	97.3 (93.8-100)
- PC 130	40 (0-92,9)	98.2 (95.2-100)	50 (0-100)	97.3 (93.8-100)
HE4 POSMENOPAUSAL ROC 77.2%
- PC 70	75 (46.3-100)	70.4 (51.3-89.5)	52.9 (26.3-79.6)	86.4 (69.7-100)
- PC 70	75 (46.3- 100)	81.5 (65-98)	64.3 (35,6-93)	88 (73.3-100)
- PC 82	75 (46.3- 100)	81.5 (65-98)	64.3 (35,6-93)	88 (73.3-100)
- PC 100	66.7 (35.8-97.5)	88.9 (75.2-100)	72.7 (41.9-100)	85.7 (71-100)
- PC 130	50 (17.5-82.5)	88.9 (75.2-100)	66.7 (30.3-100)	80 (64-96)
Ca125	26.7 (0.9-52.4)	84.1 (75.9-92.3)	22.2 (0.2-44.2)	87.1 (79.3-94.8)
GIRADS - Global	88.2 (70-100)	83.9 (22.4-90.4)	40,5 (23.4-57.7)	98.3 (95.5-100)
- Premen	100 (90-100)	85.4 (78.4-92.5)	23,8 (3.2-44.4)	100 (99.5-100)
- Posmen	83.3 (58.1-100)	77.8 (60.2-95.3)	62.5 (35.6-89.3)	91.3 (77.6-100)

Table 5: Calculation of Sensitivity (S), Specificity (E), VPP and VPN of tumor and ultrasound markers

FIGURE 1

Figure 1: Monitoring and therapeutic decision of adnexal masses according