DIAGNOSTIC ACCURACY OF MRI IN DIAGNOSING MALIGNANT ADNEXAL MASSES, TAKING HISTOPATHOLOGY AS GOLD STANDARD

Abstract

Objective: To determine the diagnostic accuracy of magnetic resonance imaging in identifying malignant adnexal masses using histopathology as the gold standard.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Radiology, CMH, Rawalpindi from 28^th  May 2024 to 28^th November 2024.

Methodology: A total of 80 female patients with adnexal masses detected on ultrasound or clinical examination were included using non-probability consecutive sampling. Patients aged 18–65 years planned for surgical intervention were included. Patients with contraindications to MRI, pregnancy, or previous pelvic malignancy were excluded. MRI scans were performed using a 1.5 Tesla scanner with T1, T2, diffusion-weighted, and contrast-enhanced sequences. Lesions were classified as benign, borderline, or malignant by two radiologists. Surgical excision and histopathology were considered the gold standard. Sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated using SPSS version 26. Agreement between MRI and histopathology was assessed with Cohen’s kappa coefficient.

Results: Mean age of participants was 42.5 ± 11.3 years. Histopathology showed 35 malignant, 10 borderline, and 35 benign masses. MRI correctly identified 32 malignant and 33 benign lesions. Sensitivity was 91.4%, specificity 94.3%, positive predictive value 91.4%, negative predictive value 94.3%, and overall diagnostic accuracy 93.8%. Cohen’s kappa showed strong agreement (κ = 0.86, p < 0.001).

Conclusion: MRI demonstrates high diagnostic accuracy in differentiating malignant from benign adnexal masses. It is especially useful in evaluating indeterminate or complex lesions detected on ultrasound, aiding surgical planning. MRI should be considered in selected patients where ultrasound is inconclusive