Diagnostic accuracy of magnetic resonance imaging in the preoperative characterization of ovarian neoplasms: a retrospective study with histopathological correlation

Abstract

Background: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative characterization of ovarian neoplasms using histopathological examination (HPE) as the reference standard. Methods: This retrospective observational study included 105 women with indeterminate or suspicious adnexal masses who underwent preoperative MRI followed by surgical management and histopathological examination at a tertiary care centre. MRI findings were categorized as benign or borderline/malignant based on morphological and tissue-specific imaging characteristics. Histopathological examination served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall diagnostic accuracy, and Cohen's kappa coefficient were calculated. Results: Histopathological examination identified 73 (69.5%) benign and 32 (30.5%) borderline/malignant ovarian neoplasms. MRI correctly classified all 73 benign lesions and 27 of the 32 borderline/malignant lesions, while five borderline/malignant lesions were incorrectly classified as benign. MRI demonstrated a sensitivity of 84.4%, specificity of 100%, PPV of 100%, NPV of 93.6%, and overall diagnostic accuracy of 95.2%. Agreement between MRI and histopathological classification was excellent (κ=0.88). Conclusion: MRI demonstrated high diagnostic accuracy and excellent agreement with histopathological examination in differentiating benign from borderline/malignant ovarian neoplasms. Its high specificity supports its role as a valuable problem-solving modality in the preoperative characterization of ovarian masses. However, histopathological examination remains essential for definitive diagnosis.