The Adoption of Radiomics and machine learning improves the diagnostic processes of women with Ovarian MAsses (the AROMA pilot study).

Purpose: To develop and evaluate the performance of a radiomic and machine learning model applied to ultrasound images in predicting the risk of malignancy of ovarian masses (OMs).

Methods: Single-center retrospective evaluation of consecutive patients who underwent transvaginal ultrasound (US) with images storage and surgery for ovarian masses. Radiomics methodology was applied to US images according to the International Biomarker Standardization Initiative guidelines. OMs were divided into three homogeneous groups: solid, cystic and motley. TRACE4 radiomic platform was used thus obtaining a full-automatic radiomic workflow. Three different classification systems were created and accuracy, sensitivity, specificity, AUC and standard deviation were defined for each group.

Results: A total of 241 women were recruited. OMs were divided in the three groups: 95 (39.5%) solid, 66 (27.5%) cystic, 80 (33%) motley. For solid OMs, 269 radiomic features were used for the training-validation-testing of the model with accuracy 80%, sensitivity 78%, specificity 83%, AUC 87%. For cystic OMs, 278 radiomic features were used for the training-validation-testing of the model with accuracy 87%, sensitivity 75%, specificity 90%, AUC 88%. For mixed OMs, 306 radiomic features were used for the training-validation-testing of the model with accuracy 81%, sensitivity 81%, specificity 81%, AUC 89%.

Conclusion: Radiomics is a promising tool in improving preoeprative work-up of women diagnosed with OMs. Even in the absence of the subjective impression of expert ultrasound examiner, radiomics allows to easily identify patients with ovarian cancer. Future validation studies on larger series are needed.