Validation Of the Modified Goff Symptom Index for Early Detection of Ovarian Cancer in Pakistani Women

Abstract

Background: Ovarian cancer is one of those cancers that display general symptoms that do not inform health care professionals that the individual may be facing a medical complication, resulting in late-stage diagnosis and reduced lethality of the disease.

Objectives: to determine the Modified Goff Symptom Index's effectiveness in early detection of ovarian cancer in Pakistani women, assess its validity, and evaluate its diagnostic performance in terms of sensitivity, specificity, and risk stratification based on the presence of particular symptoms.

Methodology:  This cross-sectional study evaluated 150 women aged 20 years and older, who, over the previous 6 months, had presented with chronic abdominal, gastrointestinal and or pelvic symptoms to tertiary clinics. Participants completed the MGSI and were then scheduled for pelvic ultrasounds and/or indicated histopathology. Calculations of sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic curve analyses were performed using SPSS version 24.0, with p values set at 0.05 for statistical significance.

Results: A total of 150 symptomatic women enrolled in the study, with a mean age of 48.6 ± 11.4 years. Ovarian cancer was confirmed by histology in 22 women (22%), and 78 (78%) had benign adnexal pathology. Common symptoms of malignancy were abdominal bloating (81.8%), early satiety (77.2%), pelvic pain (72.7%), and urinary urgency (59.1%). MGSI was significantly higher in malignancy cases compared with benign cases (p < 0.001). Postmenopausal status and the frequency of symptoms of 12 or more continued per month were also significantly associated with malignancy (p = 0.01 and p = 0.002, respectively). The Modified Goff Symptom Index (MGSI) had a sensitivity of 86.3%, specificity of 80.7%, PPV of 61.9%, and NPV of 93.4% for ovarian malignancy. The ROC curve AUC was 0.88, indicating strong differentiation. Symptoms of malignancy were of early satiety (p < 0.001), progressive abdominal distension (p < 0.001), and pelvic pain (p = 0.004). The MGSI identified women with malignancy significantly better, with a higher negative predictive value; it also identified malignancy more effectively than the original Goff Index (p < 0.02). This is developing MGSI to identify women with malignancy and determine whether reserve imaging or biopsy is needed, and its application in the clinically resource-deficient Pakistan is valuable.

Conclusion: Early detection of ovarian cancer is feasible by utilizing the Modified Goff Symptom Index. The tool has high diagnostic accuracy and negative predictive value, making it appropriate for targeting high-risk patients even in rudimentary diagnostic imaging environments. Including the MGSI in standard gynaecological assessments has the potential to improve detection rates significantly, timely referrals, and patient prognosis for the general population..