7 The logical extension of this work was to use logistic regression models 8, 9 or neural networks 10, 11 to establish the most important variables and improve test performance. 6 Other workers used menopausal status and the serum CA-125 level to produce a risk-of-malignancy index. 3- 5 In 1989, it was also shown that an ultrasound-derived index of tumoral blood flow might be an important risk factor. This approach was later incorporated into scoring systems to improve test performance. In 1989, Granberg et al 2 reported that transvaginal sonographic images of an ovarian mass could be used to predict the likelihood of malignancy. Appropriate surgical treatment is essential because the rupture of a stage 1 ovarian cancer during the operation may worsen the prognosis. Advances in surgery have provided more treatment options, but their potential usefulness depends on a prior assessment of the mass using noninvasive procedures. The preoperative assessment of adnexal tumors remains a major challenge for the gynecologist.
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