Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass

Robert E. Bristow, Melissa Hodeib, Alan Smith, Daniel W. Chan, Zhen Zhang, Eric T. Fung, Krishnansu S. Tewari, Donald G. Munroe, Frederick R. Ueland

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To determine the impact on referral patterns of using a Multivariate Index Assay, CA125, modified-American College of Obstetricians and Gynecologists referral guidelines, and clinical assessment among patients undergoing surgery for an adnexal mass after initial evaluation by nongynecologic oncologists. Study Design Overall, 770 patients were enrolled by nongynecologic oncologists from 2 related, multiinstitutional, prospective trials and analyzed retrospectively. All patients had preoperative imaging and biomarker analysis. The subset of patients enrolled by nongynecologic oncologists was analyzed to determine the projected referral patterns and sensitivity for malignancy based on multivariate index assay (MIA), CA125, modified-American College of Obstetricians and Gynecologists (ACOG) guidelines, and clinical assessment compared with actual practice. Results The prevalence of malignancy was 21.3% (n = 164). In clinical practice, 462/770 patients (60.0%) were referred to a gynecologic oncologist for surgery. Triage based on CA125 predicted referral of 157/770 patients (20.4%) with sensitivity of 68.3% (95% confidence interval [CI], 60.8-74.9). Triage based on modified-ACOG guidelines would have resulted in referral of 256/770 patients (33.2%) with a sensitivity of 79.3% (95% CI, 72.4-84.8). Clinical assessment predicted referral of 184/763 patients (24.1%) with a sensitivity of 73.2% (95% CI, 65.9-79.4). Risk stratification using multivariate index assay would have resulted in referral of 429/770 (55.7%) patients, with sensitivity of 90.2% (95% CI, 84.7-93.9). MIA demonstrated statistically significant higher sensitivity (P <.0001) and lower specificity (P <.0001) for detecting malignancy compared with clinical assessment, CA125, and modified-ACOG guidelines. Conclusion In this study population, use of MIA as a risk stratification test was associated with referral patterns by nongynecologic oncologists comparable to actual clinical practice and higher sensitivity for malignancy than other adnexal mass triage algorithms.

Original languageEnglish (US)
Pages (from-to)581.e1-581.e8
JournalAmerican journal of obstetrics and gynecology
Volume209
Issue number6
DOIs
StatePublished - Dec 2013

Keywords

  • adnexal mass
  • referral patterns

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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