Alan Smith,Donald G. Munroe,Frederick R. Ueland,Rowan G. Bullock,Scott T. Goodrich,Todd C. Pappas,Tricia I.  Fredericks,Vinicius Bonato,
Combining A Second-Generation Multivariate Index Assay with Ovarian Imaging Improves the Preoperative Assessment of An Adnexal Mass
Journal of Surgical Oncology
2019
2674-3000
http://dx.doi.org/10.31487/j.JSO.2019.03.04
https://www.sciencerepository.org/combining-a-second-generation-multivariate-index-assay-with-ovarian-imaging-improves-the-preoperative-assessment-of-an-adnexal-mass_JSO-2019-3-104 
Abstract: Background: To understand the relationship between imaging and the next generation multivariate index
assay (MIA2G) in the preoperative assessment of an adnexal mass. Methods: Serum samples and imaging
data from two previously published studies are reanalyzed using the MIA2G test. We calculated the clinical
performance of MIA2G and discrete imaging features associated with malignant risk. Results: 878 women
were eligible for this analysis, 48.3% post-menopausal and 51.7% pre-menopausal. The prevalence of
having a malignant pathology was 18%. Ultrasound was the most frequently used imaging modality. The
combination of MIA2G “or” ultrasound resulted in higher sensitivity than either test alone, 93.5% compared
to 87.6% for MIA2G and 74.2% for ultrasound. The negative predictive value was high: 94.6% for
ultrasound, 98.1% for MIA2G “or” ultrasound. MIA2G “and” ultrasound had higher specificity but lower
sensitivity than MIA2G or ultrasound alone. Similar results were seen for CT scan when evaluated with
MIA2G. Conclusion: MIA2G and pelvic imaging are complementary tests and interpreting them together
can provide important information about the malignant risk of an ovarian tumor. For physicians making
decisions about a referral to a specialist, the combination of MIA2G “or” ultrasound has the highest
sensitivity in predicting ovarian malignancy.Keywords: MIA2G, multivariate index assay, ovarian cancer, adnexal mass, pelvic imaging, ovarian malignancy, transvaginal ultrasound, serum biomarker test