This study determined the utility of ovarian imaging and a second-generation multivariate index assay in predicting  the risk of ovarian malignancy. Among the 379 women with adnexal masses enrolled in this study, 291 were evaluable with ultrasound imaging, biomarker assays, and histopathological results. Our research showed that serial
testing with IOTA-LR2 (International Ovarian Tumour Analysis – Logistic Regression 2) and MIA2G (second-generation multivariate index assay) were useful in classifying patients with a high risk for ovarian malignancy. Using this particular evaluation strategy would benefit primary centers where most first-line evaluations of ovarian tumors occur. This will help clinicians and general obstetrician-gynecologists in maximizing gynecologic-oncology subspecialist referrals. Since there is no internationally accepted system, and national guidelines need continual revision according to updated techniques, this study highlights that ease and familiarity with the different elements of scoring, user experience, and the number of cases seen are factors affecting their measurements of accuracy. Thus, imaging scoring methods adopted for use in institutions need to be locally validated. Future studies are needed to establish population-based cut-offs for multivariate index assays and to incorporate other factors aside from menopausal status, such as ethnicity and family history of ovarian cancer, in risk prediction algorithms.

The strengths of this research include the prospective data collection for ovarian imaging and independent multivariate index assay tests, the large sample size in a Filipino population, and the inclusion of all types of ovarian cancer. This was also the first and the most extensive study in the Philippines that showed the diagnostic accuracy of a multivariate index assay alone and in combination with ovarian imaging for ovarian cancer prediction. This study emphasized the importance of validating imaging scoring methods adopted for use in institutions.

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