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Prospective Evaluation of Logistic Regression Models for the Diagnosis of Ovarian Cancer

From the Early Pregnancy and Gynaecology Ultrasound Unit, Department of Obstetrics and Gynaecology, King’s College Hospital; the Department of Obstetrics and Gynaecology, Greenwich District Hospital; the Department of Obstetrics and Gynaecology, University Hospital Lewisham; and the Department of Public Health Sciences, Guy’s, King’s, and St. Thomas’ School of Medicine, King’s College Hospital, London, United Kingdom.

Address reprint requests to: Davor Jurkovic, MD, PhD, Early Pregnancy and Gynaecology Ultrasound Unit, Department of Obstetrics and Gynaecology, King’s College Hospital, Denmark Hill, London SE5 8RX, United Kingdom, E-mail: davor.jurkovic{at}kcl.ac.uk

Objective: To test the accuracy of three logistic regression models in diagnosing malignancy in women with adnexal masses.

Methods: This was a prospective collaborative study. Women were recruited from three hospitals and all assessments were performed at the Gynaecology Ultrasound Unit, King’s College Hospital. One hundred women with known adnexal masses were examined preoperatively. The demographic, biochemical, and sonographic data recorded for each patient included age, menopausal status, CA 125 levels, ultrasound morphology, and Doppler blood flow analysis. The diagnosis of malignancy was made for each woman using three logistic regression models previously described by Alcazar et al, Tailor et al, and Timmerman et al. Variables used in these models were then combined to form a new model. The results were compared with the final histopathologic diagnosis.

Results: Sixty-seven women had benign tumors and 33 had ovarian cancer. Women with malignant tumors were older than those with benign masses. There were significant differences in CA 125 levels, presence of papillary proliferations, and ascites between the two groups. The sensitivities and specificities achieved respectively by the models were as follows: 45% and 93% with Tailor et al’s model, 9% and 99% with Alcazar et al’s model, and 73% and 91% with Timmer-man et al’s model. There was no significant improvement over the performance of Timmerman et al’s model and the new combined model.

Conclusion: All models performed less well than originally reported. Combining the models did not lead to a significant improvement in performance. Larger sample sizes that incorporate all types of ovarian tumors are necessary to design more accurate diagnostic models.

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