Clinical Performance of a Multivariate Index Assay in Detecting Early-Stage Ovarian Cancer in Filipino Women

Clarissa L. Velayo (), Kareen N. Reforma, Renee Vina G. Sicam, Michele H. Diwa, Alvin Duke R. Sy and Ourlad Alzeus G. Tantengco
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Clarissa L. Velayo: Department of Physiology, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
Kareen N. Reforma: Department of Obstetrics and Gynecology, University of the Philippines—Philippine General Hospital, Taft Avenue, Manila 1000, Philippines
Renee Vina G. Sicam: Department of Obstetrics and Gynecology, University of the Philippines—Philippine General Hospital, Taft Avenue, Manila 1000, Philippines
Michele H. Diwa: Department of Pathology, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
Alvin Duke R. Sy: Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines, Manila 1000, Philippines
Ourlad Alzeus G. Tantengco: College of Medicine, University of the Philippines Manila, Manila 1000, Philippines

IJERPH, 2022, vol. 19, issue 16, 1-10

Abstract: This study evaluated the clinical performance and overall utility of a multivariate index assay in detecting early-stage ovarian cancer in a Filipino population. This is a prospective cohort study among Filipino women undergoing assessment for an ovarian mass in a tertiary center. Patients diagnosed with early-stage ovarian cancer and who underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation, multivariate index assay (MIA2G), and surgery for an adnexal mass were included in this study. Ovarian tumors were classified as high-risk for malignancy based on the IOTA-LR2 score. The ovarian imaging and biomarker results were correlated with the reference standard: surgico-pathologic findings. The MIA2G exhibited the best overall performance among individual classifiers with a sensitivity of 91.7% and NPV of 84.7%, with a concomitant higher sensitivity in early-stage disease, whether as an individual classifier (93.5%) or in serial combination with ultrasound (85.5%). The performance of biomarkers (specificity, positive predictive values, and AUROC) such as MIA2G and CA-125 significantly improved when combined with an ultrasound risk scoring approach ( p < 0.01). MIA2G showed a higher sensitivity for detecting lesions among EOC and late-stage ovarian cancers than otherwise. The application of biomarkers for evaluating ovarian masses in our local setting is secondary to ultrasound but adopting multivariate index assays rather than CA-125 would increase the detection of early-stage ovarian cancers regardless of menopausal status. This is most relevant in areas where level III sonographers or gynecologic oncologists are limited and preoperative referrals to these specialists can improve the survival of our patients.

Keywords: CA-125; IOTA-LR2; multivariate index assays; ovarian mass; Philippines; ultrasound (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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