Accuracy of Magnetic Resonance Imaging for Identifying Ovarian Cancer in a Community-Based Setting

Area of Science:

• Radiology
• Gynecologic Oncology
• Medical Imaging

Background:

• Ultrasound often reveals ovarian and adnexal masses with indeterminate appearances, raising cancer concerns.
• Magnetic resonance imaging (MRI) is typically considered reliable for distinguishing benign from malignant masses.
• Limited data exists on MRI's accuracy in real-world, community-based practice settings.

Purpose of the Study:

• To evaluate the accuracy of MRI in differentiating benign from malignant adnexal masses in a community-based health system.
• To assess the sensitivity, specificity, and predictive values of MRI interpretations in this setting.

Main Methods:

• Retrospective review of women undergoing MRI for adnexal masses (2016-2017).
• MRI reports were classified as favoring malignancy, benign, or indeterminate, blinded to pathology.
• Minimum 2-year follow-up to identify ovarian cancers and borderline tumors.

Main Results:

• Of 338 women, 144 had surgery. MRI favored malignancy in 4.9%, benign in 62.2%, and was indeterminate in 33.6%.
• MRI favoring malignancy had low sensitivity (16.7%) and positive predictive value (28.5%), identifying only 2 of 7 malignant cases.
• 10 additional cancers/borderline tumors were found in women with indeterminate (6) or benign-appearing (4) MRI reports.

Conclusions:

• In community practice, MRI favoring malignancy is frequently associated with benign disease.
• The current ability of MRI to accurately differentiate benign from malignant adnexal masses in community settings is limited.
• Findings suggest a need for improved MRI interpretation or complementary diagnostic strategies for adnexal masses.