adneksial kitlelerde malignite araştırması · ultrasound obstet gynecol 2013; 41: 9–20...
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Adneksial kitlelerde malignite araştırması
Dr. Tevfik Yoldemir
Marmara Üniversitesi Kadın Hastalıkları ve Doğum A.D.
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Kistin iç duvarı kistin içeriği
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Uniloküler kist / uniloküler solid kist
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Multiloküler kist/ multiloküler solid kist
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Solid tumor (tüm kitlenin >%80)
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Septum / papiller çıkıntı
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Douglas boşluğunda sıvı
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Siyah beyaz skala - morfoloji
Ultrasound Obstet Gynecol 2007; 30: 874–882
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Siyah beyaz + Doppler
Ultrasound Obstet Gynecol 2007; 30: 874–882
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Damar yapısı
Ultrasound Obstet Gynecol 2007; 30: 874–882
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Cut-off değerler
Gynecologic Oncology 127 (2012) 379–383
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Risk of Malignancy Index (RMI)• RMI = U x M x serum CA125
U = 0, görüntüleme skoru 0 ise
U = 1, görüntüleme skoru 1 ise
U = 3, görüntüleme skoru 2-5 ise
M = 1 eğer premenopozal ise
M = 3 eğer postmenapozal ise
1 puan : multilokular kist, solid nodul, bilateral kist, asit, ve uzak metastaz.
http://www.hutchon.net/RMIcalc2.htm
Am J Obstet Gynecol 2010;203:228.e1-6.
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Risk of Ovarian Malignancy Algorithm(ROMA)
• Premenapozal: Öngörü indeksi PI
= -12.0+2.38 x LN(HE4)+0.0626 x LN(CA125)
• Postmenapozal: PI
= -8.09+1.04 x LN(HE4)+0.732 x LN(CA125)
• Tahmin edilen olasılık
= exp(PI) ⁄ [1+exp(PI)]
http://xema-medica.com/eng/calc/
Am J Obstet Gynecol 2010;203:228.e1-6.
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ROMA v RMI - Selim v Malign
Am J Obstet Gynecol 2010;203:228.e1-6.
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ROMA v RMI
Am J Obstet Gynecol 2010;203:228.e1-6.
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multivariate index assay(MIA, OVA1)
• CA125II, transferin, transthyretin (prealbumin), apolipoprotein A1, beta-2-microglobulin.
• OvaCalc software (Vermillion, Inc., Austin, TX)
• Yüksek risk
– MIA skoru ≥5.0 (premenapozal)
– ≥4.4 (postmenapozal)
Am J Obstet Gynecol 2013;209:581.e1-8.
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Dearking modifiye-ACOG kılavuz rehberi (Jinekolog onkolog danışmak için)
• Premenapozal
– 1. Yüksek CA125 (>67 unite/mL)
– 2. Asit
– 3. Abdominal veya uzak metastaz
• Postmenopozal
– 1. Yüksek CA125 (>35 unite/mL)
– 2. nodular veya fikse pelvik kitle
– 3. Asit
– 4. Abdominal veya uzak metastaz Am J Obstet Gynecol 2013;209:581.e1-8.
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Klinik v CA125 v mACOGg v MIA
Am J Obstet Gynecol 2013;209:581.e1-8.
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OVA1 + Klinik
Am J Obstet Gynecol 2014;210:78.e1-9.
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OVA1 + Klinik - premenapoz
Am J Obstet Gynecol 2014;210:78.e1-9.
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OVA1 + Klinik - postmenapoz
Am J Obstet Gynecol 2014;210:78.e1-9.
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Copenhagen Index
• CPH‐I = −14.0647 + 1.0649 x log2 (HE4) + 0.6050 log2(CA125) + 0.2672 x yaş/10
• Tahmin edilen olasılık (PP) :
PP = e(CPH‐I) / ( 1 + e (CPH‐I ) )
Gynecologic Oncology 138 (2015) 640–646
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CPH-I v ROMA v RMI
Gynecologic Oncology 138 (2015) 640–646
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Duyarlılık (SP) / Özgüllük (SN)
Gynecologic Oncology 138 (2015) 640–646
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Değerlendirme v RMI v ROMA
European Journal of Cancer (2012) 48, 1649– 1656
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Model development and internal validation (n = 1066)Role of CA 125 in diagnosing ovarian cancer
Long-term behavior of ovarian masses managed expectantlyPropose an evidence-based clinical management protocol for all adnexal masses
Performance of main IOTA approaches in the hands ofexaminers with different levels of ultrasound experienceEvaluation of impact on referral patterns using LR2 instead of RMI
Assessment of second-stage tests (3D power Doppler,intravenous contrast, proteomics, new tumor markers)
External validation of main IOTA models and direct comparison with RMI and established non-IOTA models (n = 997) Role of CA 125 in diagnosing ovarian cancer
Temporal validation (n = 507) of main IOTA approaches(LR1, LR2, simple rules)
IOTA 11999–2002
IOTA 1b2002–2005
IOTA 22005–2007
IOTA 32009–2012
IOTA 42012–2013
IOTA 52012–2017
Ultrasound Obstet Gynecol 2013; 41: 9–20
International Ovarian Tumor Analysis
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Selim v Malign / LR modeli
J Clin Oncol 2005;23:8794-8801
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Selim v Malign / LR modeli
J Clin Oncol 2005;23:8794-8801
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Selim v Malign / LR modeli
J Clin Oncol 2005;23:8794-8801
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IOTA bölüm 1 deki 11 model
Clin Cancer Res 2009;15(2) January 15, 2009
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IOTA bölüm 1 deki 11 model
Clin Cancer Res 2009;15(2) January 15, 2009
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Non-IOTA v IOTA modelleri
Clin Cancer Res 2011; 18(3); 815–25
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Non-IOTA v IOTA modelleri
Clin Cancer Res 2011; 18(3); 815–25
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Non-IOTA v IOTA modelleri
Clin Cancer Res 2011; 18(3); 815–25
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Non-IOTA v IOTA modelleri
Clin Cancer Res 2011; 18(3); 815–25
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Non-IOTA v IOTA modelleri
Clin Cancer Res 2011; 18(3); 815–25
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Non-IOTA v IOTA modelleri
Clin Cancer Res 2011; 18(3); 815–25
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International Ovarian Tumor Analysis (IOTA) logistic regression model LR1(a) Over kanseri öyküsü (evet=1, hayır=0);
(b) Halen hormon tedavisi alma (evet=1, hayır=0);
(c) Yaş (yıl);
(d) Lezyonun max çapı (mm);
(e) Ultrason muayenesinde ağrı (evet=1, hayır=0);
(f) Asit (evet=1, hayır=0);
(g) Solid papiller çıkıntıda kan akımı varlığı (evet=1, hayır=0);
(h) Tümüyle solid tümör varlığı (evet=1, hayır=0);
(i) Solid kısmın max çapı (mm, >50 mmden fazla değil);
(j) Kist duvarlarının içlerinde düzensizlik (evet=1, hayır=0);
(k) Akustik gölgelerin olması (evet=1, hayır=0);
(l) Renk skoru (1, 2, 3, 4).
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LR1 Habis olma riski
= 1/(1 + e−z)
z = −6.7468 + 1.5985(a) − 0.9983(b) + 0.0326(c) + 0.00841(d) − 0.8577(e) + 1.5513(f) + 1.1737(g) + 0.9281(h) + 0.0496(i) + 1.1421(j) − 2.3550(k) +0.4916(l)
http://www.iotagroup.org/index.php/software
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LB2 Habis olma riski
= 1/(1 + e−z)
z= −5.3718 + 0.0354(c) + 1.6159(f) + 1.1768(g) +0.0697(i) + 0.9586(j) − 2.9486(k).
http://www.iotagroup.org/index.php/software
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Ultrason özellikleri
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Basit kurallar
Ultrasound Obstet Gynecol 2013; 41: 9–20
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Basit kurallar
BMJ 2010;341:c6839
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SR v SA v LR1 v LR2
BMJ 2010;341:c6839
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SR v SA v LR1 v LR2
BMJ 2010;341:c6839
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SR v SA v LR1 v LR2
BMJ 2010;341:c6839
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Tm çapına göre Duyarlılık (SP) / Özgüllük (SN)
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AUC
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6 tanımlayıcı
Ultrasound Obstet Gynecol 2012; 40: 582–591
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Basit kurallar -SR
Ultrasound Obstet Gynecol 2012; 40: 582–591
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Kombinasyonlar
Ultrasound Obstet Gynecol 2012; 40: 582–591
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Ultrasound Obstet Gynecol 2012; 40: 582–591
![Page 53: Adneksial kitlelerde malignite araştırması · Ultrasound Obstet Gynecol 2013; 41: 9–20 International Ovarian Tumor Analysis . Selim v Malign / LR modeli ... Tm çapına göre](https://reader033.vdocuments.net/reader033/viewer/2022060918/60aaa6c27178df7b551a325e/html5/thumbnails/53.jpg)
IOTA çalışması - bölüm 3
British Journal of Cancer (2014) 111, 680–688
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Basit kurallar
Ultrasound Obstet Gynecol 2013; 41: 9–20
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Test performansı
British Journal of Cancer (2014) 111, 680–688
![Page 56: Adneksial kitlelerde malignite araştırması · Ultrasound Obstet Gynecol 2013; 41: 9–20 International Ovarian Tumor Analysis . Selim v Malign / LR modeli ... Tm çapına göre](https://reader033.vdocuments.net/reader033/viewer/2022060918/60aaa6c27178df7b551a325e/html5/thumbnails/56.jpg)
Test performansı pre/postmenapoz
British Journal of Cancer (2014) 111, 680–688
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LR1 ve LR2 Değişkenleri
British Journal of Cancer (2014) 111, 680–688
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Basit kurallar değişkenleri
British Journal of Cancer (2014) 111, 680–688
![Page 59: Adneksial kitlelerde malignite araştırması · Ultrasound Obstet Gynecol 2013; 41: 9–20 International Ovarian Tumor Analysis . Selim v Malign / LR modeli ... Tm çapına göre](https://reader033.vdocuments.net/reader033/viewer/2022060918/60aaa6c27178df7b551a325e/html5/thumbnails/59.jpg)
Assessment of Different NEoplasias in the adneXa (ADNEX) model
– yaş,
– serum CA-125 seviyesi (log transformed),
– Merkez tipi,
– Lezyonun maksimum çapı (log transformed),
– Solid dokunun oranı (with quadratic term),
– Papiller uzantıların sayısı,
– 10dan fazla kistik lokül,
– Akustik gölgelenme,
– asit.
http://www.iotagroup.org/adnexmodel/site%20iota.htmlBMJ 2014;349:g5920
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ADNEX için seçilen US belirteçleri
Facts Views Vis Obgyn, 2015, 7 (1): 32-41
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ADNEX model
BMJ 2014;349:g5920
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ADNEX model
BMJ 2014;349:g5920
![Page 63: Adneksial kitlelerde malignite araştırması · Ultrasound Obstet Gynecol 2013; 41: 9–20 International Ovarian Tumor Analysis . Selim v Malign / LR modeli ... Tm çapına göre](https://reader033.vdocuments.net/reader033/viewer/2022060918/60aaa6c27178df7b551a325e/html5/thumbnails/63.jpg)
ADNEX model
BMJ 2014;349:g5920
![Page 64: Adneksial kitlelerde malignite araştırması · Ultrasound Obstet Gynecol 2013; 41: 9–20 International Ovarian Tumor Analysis . Selim v Malign / LR modeli ... Tm çapına göre](https://reader033.vdocuments.net/reader033/viewer/2022060918/60aaa6c27178df7b551a325e/html5/thumbnails/64.jpg)
Basit kurallar – Test performansı
Facts Views Vis Obgyn, 2015, 7 (1): 42-59
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LR2 ve RMI tanısal performansı
Facts Views Vis Obgyn, 2015, 7 (1): 42-59
![Page 66: Adneksial kitlelerde malignite araştırması · Ultrasound Obstet Gynecol 2013; 41: 9–20 International Ovarian Tumor Analysis . Selim v Malign / LR modeli ... Tm çapına göre](https://reader033.vdocuments.net/reader033/viewer/2022060918/60aaa6c27178df7b551a325e/html5/thumbnails/66.jpg)
Ultrasound Obstet Gynecol 2011; 38: 456–465
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Ultrasound Obstet Gynecol 2011; 38: 456–465
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Sonuç
Human Reproduction Update, Vol.20, No.3 pp. 449–462, 2014
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Ultrasound Obstet Gynecol 2013; 41: 9–20
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Dikkatiniz için teşekkür ederim.
Dr. Tevfik Yoldemir
http://www.slideshare.net/dryoldemir