LR2 risk model to diagnose ovarian cancer
The LR2 risk model can be used by medical doctors to preoperatively diagnose ovarian cancer in women who have at least one persistent adnexal (ovarian, para-ovarian, and tubal) tumor and are considered to require surgery.1 LR2 estimates the probability that an adnexal tumor is malignant. LR2 was developed by clinicians and statisticians from the International Ovarian Tumor Analysis (IOTA) group, based on clinical and ultrasound data from 754 women recruited at 9 centers in 5 countries (Italy, Belgium, Sweden, France, and UK). All patients included required surgery as judged by a local clinician. All current diagnostic models for adnexal tumors (e.g. IOTA models, RMI, ROMA) have been created for patients undergoing surgery, i.e. patients selected for expectant management were excluded when creating the model.
LR2 uses six predictors. There is one clinical variable, age, and five ultrasound variables, maximal diameter of the largest solid component, irregular internal cyst walls, presence of papillary projections with detectable flow, acoustic shadows, and ascites. All patients included required surgery as judged by a local clinician. As with all current diagnostic models for adnexal tumours (e.g. IOTA models, RMI, ROMA) it implies that patients selected for expectant management were excluded when creating the model. As a consequence LR2 cannot be applied to conservatively treated adnexal tumors.
The manuscript describing the model is published in the Journal of Clinical Oncology.1 The model has been externally validated in several subsequent studies.2-10 These studies confirm the discrimination between benign and malignant masses. However, calibration results suggest that LR2 underestimates the risk of malignancy. The discrimination performance of LR2 has been included in two systematic reviews on the subject.11-12
LR2 cannot replace training and experience in ultrasonography and cannot compensate for poor quality ultrasound equipment. The parameters used in LR2 are based on the terms and definitions as published by the IOTA group.13
LR2 is implemented electronically in various formats:
- App for Android
- App for iPhone (updated for the most recent Apple version)
By installing this software you agree to the terms of the License Agreement.
- Timmerman D, et al. J Clin Oncol 2005;23:8794-801.
- Van Holsbeke C, et al. Clin Cancer Res 2009;15:684-91.
- Timmerman D, et al. Ultrasound Obstet Gynecol 2010;36:226-34.
- Van Holsbeke C, Van Calster B, et al. Clin Cancer Res 2012;18:815-25. [same data as ref 3]
- Nunes N, et al. Ultrasound Obstet Gynecol 2012;40:355-9.
- Sayasneh A, et al. Br J Cancer 2013;108:2448-54.
- Kaijser J, et al. Gynecol Oncol 2013;129:377-83.
- Nunes N, et al. Int J Gynecol Cancer 2013;23:1583-9.
- Testa A, Kaijser J, et al. Br J Cancer 2014;111:680-8.
- Meys EM, et al. Ultrasound Obstet Gynecol 2016 [Epub ahead of print].
- Kaijser J, et al. Hum Reprod Update 2014;20:449-62.
- Meys EM, et al. Eur J Cancer 2016;58:17-29.
- Timmerman D, et al. Ultrasound Obstet Gynecol 2000;16:500-505