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Research and Professional Guidelines

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Research and Professional Guidelines

A Protein Biomarker Test and Artificial Intelligence-Based Algorithm for Ovarian Endometriosis

Dive into our latest findings on AI-enhanced biomarker analysis presented at the Society for Reproductive Investigation as we discover a path forward to non-invasive endometriosis diagnostics.

Download the poster presented by Aspira’s collaboration partners Dana Farber Cancer Institute and Brigham and Women’s Hospital showing miRNA’s potential to improve the diagnostic accuracy of non-invasive diagnostic tests.

“Improving the diagnostic accuracy of an ovarian cancer triage test using a joint miRNA-protein model”

Download our clinical study describing real-world evidence supporting the use of OvaWatchSM for the clinical management of adnexal masses, entitled:

“Validation of a Deep Neural Network-Based Algorithm Supporting Clinical Management of Adnexal Masses”

Ova1 Clinical Validation Data 5,8

In the pivotal study by Bristow, et al., Ova1(MIA) with clinical assessment:

Graphic showing that 83% of cancers missed by clinical assessment were identified by OVA1
Graphic showing that 71% of cancers missed by CA-125 were identified by OVA1
Graphic showing that OVA1 demonstrated negative predictive value of up to 98%

Ova1 Performance and Ethnicity

Superior detection of ovarian malignancy risk in African American women is shown in data from our clinical studies. Ova1 has a 46% higher rate of detection (sensitivity) for ovarian malignancy vs. CA-125 in African American women.14

Graph showing test results of OVA1 vs CA125 in African American Women and Caucasian Women.

Detecting Early Stage Cancer5,9

Bristow, et al.’s (5) clinical study was the second pivotal trial of Ova1 (MIA) with 494 surgeries and 92 cancers. The results of this study validated Ova1’s standalone sensitivity of 92% and Ova1 (MIA) with Clinical Impression of 96%. The data showed a significant difference in the sensitivity between CA-125II standalone vs. Ova1 (MIA) standalone to capture early-stage cancers (stage I and II):

Sensitivity By Stage

Assay AloneStage 1Stage 2Early StagePre-menopausal Early StagePost-menopausal Early Stage
CA-125II64%71%66%46%75%
Ova1*89%100%91%91%92%

*Intended use is with clinical assessment

Longoria, et al. further studied risk assessment of early stage cancers by comparing CA-125II, Clinical Impression, and the modified ACOG guidelines to Ova1 (MIA) across the two Ova1 pivotal trials (N=1,016 surgeries with 86 early-stage cases; 62 stage I, 24 stage II). Ova1 (MIA) showed statistically superior sensitivity for risk stratification. Adding Ova1 (MIA) to Clinical Impression reduced early-stage cancers missed from 31% to just 5% (85% reduction). Early-stage detection enables appropriate referral and surgery to avoid potential for upstaging.

Rate of Cancer Detection by Types of Risk Assessment

Graph showing an 85% reduction in rate of cancer missed by OVA1

This large, prospectively enrolled, multi-institutional study demonstrated that use of Ova1 detected more early-stage malignancy than the current standard of care.

– Longoria, et al.

Detecting Cancer Across Menopausal Status5,8

The patient cohorts of the two pivotal trials (Bristow et al. and Ueland et al.) can be evaluated based on menopausal status. The data showed that 91% (69/76) of cancers in pre-menopausal and 98% (173/177) of cancer in post-menopausal were detectable with Ova1 (MIA) with Clinical Impression. See chart for the break down.

The multivariate index assay demonstrated higher sensitivity and lower specificity compared with physician assessment and CA-125 in detecting ovarian malignancies.

– Ueland et al.
Sensitivity across Menopausal Status

Detecting Cancer Subtypes**

Different types of ovarian cancer are diagnosed depending on where they start in a given cell. In the pivotal 2013 Bristow, et al. study also included the effectiveness of using Ova1 (MIA) to detect ovarian cancer subtypes. Ova1 (MIA) detected epithelial ovarian cancer (EOC) at a 99% rate compared to CA-125 at 89%. Ova1 (MIA) also had a higher detection rate among non-epithelial cancer (Non-EOC) at a 92% compared to 76 percent for CA-125. The study reemphasizes Ova1’s sensitivity to menopausal status, ovarian cancer stage, and ovarian cancer subtypes including:

  • Serous
  • Transitional
  • Mucinous
  • Carcinosarcoma
  • Endometrioid
  • Mixed and undifferentiated
  • Clear cell
  • Sarcoma

Non-EOC Subtypes:

  • Sex cord-stromal
  • Germ cell
  • Other

**Data on file based on cohort from Bristow. et al., Obstet Gynecol 2013;128:252-259

OVA1 Sensitivity Across Subtypes

Considering the high sensitivity and negative predictive value, utilization of Ova1 as a risk stratification instrument would be associated with retention of over 50% of patients with benign adnexal masses, ensure that more than 96% of retained surgical patients would not have ovarian cancer, and provide appropriate referral to a gynecologic oncologist for over 95% of patients with ovarian cancer.

– Bristow et al.12

Predicted Impact on Referral Rates

Bristow, et al. also evaluated the referral rate of using different modalities of pre-surgical pelvic mass risk assessment. The study demonstrated that use of Ova1 (MIA) was associated with referral patterns comparable to actual clinical practice and with higher sensitivity for malignancy than any individual option12. Ova1 (MIA) has a 56% referral rate while other options have a 60% referral rate.

Ova1 was associated with a gynecologic oncologist referral rate (56%) comparable to actual clinical practice (60%) and had higher sensitivity for malignancy than clinical assessment, CA125, and modified ACOG guidelines.

– Bristow et al.
OVA1 Sensitivity vs Individual Options

Ova1 is supported by professional guidelines.

ACOG: LEVEL B – Practice Bulletin 17415

Consultation with or referral to a gynecologic oncologist is recommended for women with an adnexal mass who meet one or more of the following criteria:

Premenopausal or postmenopausal women with an elevated score on a formal risk assessment test such as the multivariate index assay (MIA = OVA 1)

SGO Position Statement16

Tests monitoring blood levels of five proteins may be useful in identifying women with an ovarian mass who should be referred to a gynecologic oncologist.

Download Clinical Summaries

  • Webber et al. 2023 Improving the diagnostic accuracy of an ovarian cancer triage test using a joint miRNA-proteinmodel
  • Reilly et al. 2023 Analytical Validation of a Deep Neural Network Algorithm for the Detection of Ovarian Cancer
  • Dunton et al. 2019 Multivariate Index Assay Is Superior to CA125 andHE4 Testing in Detection of Ovarian Malignancy inAfrican-American Women
  • Forde et al.
  • Longoria et al.
  • Eskander et al.
  • Goodrich et al.
  • Velayo et al.
  • Dunton et al. 2021
  • Coleman et al.
  • Ueland FR, et al.
  • Bristow RE, et al.
  • Bristow et al.
  • Reilly et al.
  • Dunton et al. 2019