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@article{Van:2020:10.1136/bmj.m2614,
author = {Van, Calster B and Valentin, L and Froyman, W and Landolfo, C and Ceusters, J and Testa, AC and Wynants, L and Sladkevicius, P and Van, Holsbeke C and Domali, E and Fruscio, R and Epstein, E and Franchi, D and Kudla, MJ and Chiappa, V and Alcazar, JL and Leone, FPG and Buonomo, F and Coccia, ME and Guerriero, S and Deo, N and Jokubkiene, L and Savelli, L and Fischerova, D and Czekierdowski, A and Kaijser, J and Coosemans, A and Scambia, G and Vergote, I and Bourne, T and Timmerman, D},
doi = {10.1136/bmj.m2614},
journal = {BMJ: British Medical Journal},
pages = {1--12},
title = {Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study},
url = {http://dx.doi.org/10.1136/bmj.m2614},
volume = {370},
year = {2020}
}

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TY  - JOUR
AB  - Objective To evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively.Design Multicentre cohort study.Setting 36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre.Participants Consecutive adult patients presenting with an adnexal mass between January 2012 and March 2015 and managed by surgery or follow-up.Main outcome measures Overall and centre specific discrimination, calibration, and clinical utility of six prediction models for ovarian malignancy (risk of malignancy index (RMI), logistic regression model 2 (LR2), simple rules, simple rules risk model (SRRisk), assessment of different neoplasias in the adnexa (ADNEX) with or without CA125). ADNEX allows the risk of malignancy to be subdivided into risks of a borderline, stage I primary, stage II-IV primary, or secondary metastatic malignancy. The outcome was based on histology if patients underwent surgery, or on results of clinical and ultrasound follow-up at 12 (±2) months. Multiple imputation was used when outcome based on follow-up was uncertain.Results The primary analysis included 17 centres that met strict quality criteria for surgical and follow-up data (5717 of all 8519 patients). 812 patients (14%) had a mass that was already in follow-up at study recruitment, therefore 4905 patients were included in the statistical analysis. The outcome was benign in 3441 (70%) patients and malignant in 978 (20%). Uncertain outcomes (486, 10%) were most often explained by limited follow-up information. The overall area under the receiver operating characteristic curve was highest for ADNEX with CA125 (0.94, 95% confidence interval 0.92 to 0.96), ADNEX without CA125 (0.94, 0.91 to 0.95) and SRRisk (0.94, 0.91 to 0.95), and lowest for RMI (0.89, 0.85 to 0.92). Calibration varied among centres for all models, however the ADNEX models and SRRisk were the be
AU  - Van,Calster B
AU  - Valentin,L
AU  - Froyman,W
AU  - Landolfo,C
AU  - Ceusters,J
AU  - Testa,AC
AU  - Wynants,L
AU  - Sladkevicius,P
AU  - Van,Holsbeke C
AU  - Domali,E
AU  - Fruscio,R
AU  - Epstein,E
AU  - Franchi,D
AU  - Kudla,MJ
AU  - Chiappa,V
AU  - Alcazar,JL
AU  - Leone,FPG
AU  - Buonomo,F
AU  - Coccia,ME
AU  - Guerriero,S
AU  - Deo,N
AU  - Jokubkiene,L
AU  - Savelli,L
AU  - Fischerova,D
AU  - Czekierdowski,A
AU  - Kaijser,J
AU  - Coosemans,A
AU  - Scambia,G
AU  - Vergote,I
AU  - Bourne,T
AU  - Timmerman,D
DO  - 10.1136/bmj.m2614
EP  - 12
PY  - 2020///
SN  - 0959-535X
SP  - 1
TI  - Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study
T2  - BMJ: British Medical Journal
UR  - http://dx.doi.org/10.1136/bmj.m2614
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000556139900004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.bmj.com/content/370/bmj.m2614
UR  - http://hdl.handle.net/10044/1/82924
VL  - 370
ER  -

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