Advanced statistical techniques: how to use your data more effectively?

OBJECTIVE: Because external validation of the present models has not been reported, the purpose of the present study was to assess existing diagnostic models that are used to distinguish malignant from benign masses. METHODS: We tested the performance of existing models in a prospectively assembled data set of 170 patients with an adnexal mass. Twenty-one models that have been reported previously were assessed. The models were based on combinations of ultrasound findings, color Doppler tests, CA-125 measurement, age, and/or menopausal status. For each model, we constructed ROC curves and calculated an area under the ROC curve. RESULTS: Of the 170 adnexal masses that were operated on, 30 (18%) were malignant. The area under the ROC curve of 21 models that were externally validated varied between 0.69 and 0.90. We found the performance of the existing models to be inferior to the performance reported in the initial studies. Even models that incorporated multiple diagnostic tools and that were developed using logistic regression models or neural networks had an area under the ROC curve of 0.86 at maximum. In the case where we focused on almost perfect sensitivity, the highest specificities varied between 0.45 and 0.60. CONCLUSION: Although diagnostic models might be of value in the preoperative assessment of the adnexal mass, their diagnostic performance is not as good as that reported in the original publications.

Adnexal Diseases↗

PubMed2001

Randomized double-masked comparison of radially expanding access device and conventional cutting tip trocar in laparoscopy.

OBJECTIVE: To compare postoperative wound pain associated with the radially expanding access device and the conventional disposable cutting-tip trocar. METHODS: Our randomized, double-masked, self-controlled study involved 34 women scheduled for laparoscopic adnexal surgery. In each, a 10-mm radially expanding access device was inserted laterally on one side of the lower abdomen and a size-matched disposable cutting-tip trocar was placed on the other side, using random assignment. Postoperative pain for each studied wound and patient satisfaction toward the wounds were assessed using a visual analog scale. Any bleeding complication associated with insertion of the trocar was also recorded. RESULTS: The radially expanding access device was associated with significant reduction in severity (median 1.4 versus 5.0, P <.001) and duration (median 11 versus 21 days, P <.001) of postoperative wound pain, shorter wound scars (14 versus 17 mm, P <.001), a lower incidence of wound induration (0 versus 9, P <.01), and a higher patient satisfaction (median 9.7 versus 6.2, P <.001). There were four inferior epigastric artery injuries, all at the conventional trocar wound. CONCLUSION: The radially expanding access device was associated with less postoperative wound pain and more patient satisfaction than the conventional cutting-tip trocar.

Adnexal Diseases↗

PubMed2001

[Management of adnexal tumors: role and risks of laparoscopy].

The laparoscopic management of adnexal tumeurs remains controversial because of the potentials risks of cancer dissemination suggested by many case reports and national surveys. From experimental data, the laparoscopic treatment of gynecologic cancer has potential advantages and disadvantages. The risk of dissemination appears high when a large number of malignant cells are present so that adnexal tumors with external vegetations, and bulky lymph nodes may be considered as contra-indications to CO2 laparoscopy. Laparoscopic surgery has become the gold standard in the treatment of benign adnexal tumeurs, whereas laparotomy remains the standard for the treatment of malignant tumors. The surgical diagnosis is the key to adequate management of adnexal tumeurs. In our experience, after a careful preoperative evaluation, the laparoscopic diagnosis of malignancy is reliable. Moreover in national surveys, many malignant tumeurs were considered as benign despite suspicious laparoscopic findings. Using strict guidelines, laparoscopic diagnosis can be proposed for both non suspicious and complex tumeurs, thus avoiding many unnecessary laparotomies for benign tumeurs suspicious at ultrasound. The more controversial limits of laparoscopic treatment are discussed. If a laparotomy was performed for all tumeurs suspicious at surgery, 80% of the cases would be treated by laparoscopy. The role of laparoscopy for restaging and second look operations for ovarian cancer requires further evaluation.

Adnexal Diseases↗