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Pre-Operative Evaluation of Ovarian Tumors by Risk of Malignancy Index, CA125 and Ultrasound

  • Arun-Muthuvel, Veluswamy ;
  • Jaya, Vijayaraghavan
  • Published : 2014.03.30

Abstract

Purpose: To evaluate the diagnostic performances of risk of malignancy index (RMI), CA-125 and ultrasound score in differentiating between benign and borderline or malignant ovarian tumors and find the best diagnostic test for referral of suspected malignant ovarian cases to gynaecologic oncologists. Materials and Methods: This prospective study covered 467 women with pelvic tumors scheduled for surgery at our hospital between July 2011 and July 2013. The RMI was obtained from ultrasound score, CA125 and menopausal status. The diagnostic values of each parameter and the RMI were determined and compared using Statistical Packages for Social Sciences Version 14.0.1. Results: In our study, 61% of ovarian tumors were malignant in the post-menopausal age group. RMI with a cut-off 150 had sensitivity of 84% and specificity of 97% in detecting ovarian cancer. CA-125>30 had a sensitivity of 84% and a specificity of 83%. An ultrasound score more than 2 had a sensitivity of 96% and specificity of 81%. RMI had the least false malignant cases thus avoiding unnecessary laparotomies. Ultrasound when used individually had the best sensitivity but poor specificity. Conclusions: Our study has demonstrated the RMI to be an easy, simple and applicable method in the primary evaluation of patients with pelvic masses. It can be used to refer suspected malignant patients to be operated by a gynaecologic oncologist. Other models of preoperative evaluation should be developed to improve the detection of early stage invasive, borderline and non-epithelial ovarian cancers.

Keywords

Ovarian tumours;RMI;CA125;ultrasound;malignancy;staging

References

  1. Stashwick C, Post MD, Arruda JS, et al (2011). Surgical risk score predicts suboptimal debulking or a major perioperative complication in patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer. Int J Gynecol Cancer, 21, 1422-7. https://doi.org/10.1097/IGC.0b013e31822c7704
  2. Webb PM, Purdie DM, Grover S, et al (2004). Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer. Gynecol Oncol, 92, 232-9. https://doi.org/10.1016/j.ygyno.2003.09.005
  3. Yurkovetsky Z, Skates S, Lomakin A, et al (2010). Development of a multimarker assay for early detection of ovarian cancer. J Clin Oncol, 28, 2159-66. https://doi.org/10.1200/JCO.2008.19.2484
  4. Li L, Xu Y, Yu C-X (2013). Proteomic analysis of serum of women with elevated ca-125 to differentiate malignant from benign ovarian tumors. Asian Pac J Cancer Prev, 13, 3265-70 https://doi.org/10.7314/APJCP.2012.13.7.3265
  5. Menon U, Gentry-Maharaj A, Hallett R, et al (2009). Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK collaborative Trial of ovarian cancer screening (UKCTOCS). The Lancet Oncology, 10, 327-40. https://doi.org/10.1016/S1470-2045(09)70026-9
  6. Rafii A, Halabi NM, Malek JA (2012). High-prevalence and broad spectrum of cell adhesion and extracellular matrix gene pathway mutations in epithelial ovarian cancer. J Clin Bioinforma, 2, 15. https://doi.org/10.1186/2043-9113-2-15
  7. Tingulstad S, Hagen B, Skjeldestad FE, et al (1996). Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the preoperative diagnosis of pelvic masses. Br J Obstet Gynaecol, 103, 826-31. https://doi.org/10.1111/j.1471-0528.1996.tb09882.x
  8. Tingulstad S, Hagen B, Skjeldestad FE, et al (1999). The riskof- malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol, 93, 448-52. https://doi.org/10.1016/S0029-7844(98)00433-5
  9. Van trappen PO, Rufford BD, Mills TD, et al (2007). Differential diagnosis of adnexal masses: risk of malignancy index, ultrasonography, magnetic resonance imaging, and radioimmunoscintigraphy. Int J Gynecol Cancer, 17, 61-7. https://doi.org/10.1111/j.1525-1438.2006.00753.x
  10. Vergote I, Trope CG, Amant F, et al (2010). Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med, 363, 943-53. https://doi.org/10.1056/NEJMoa0908806
  11. Bast RC, Badgwell D, Lu Z, et al (2005). New tumor markers: CA125 and beyond. Int J Gynecol Cancer, 3 274-81.
  12. Bruchim I, Ben-harim Z, Piura E, Tepper R, Fishman A (2013). Preoperative clinical and radiological features of metastatic ovarian tumors. Arch Gynecol Obstet, 288, 615-9. https://doi.org/10.1007/s00404-013-2776-1
  13. Dodge JE, Covens AL, Lacchetti C, et al (2012). Preoperative identification of a suspicious adnexal mass: a systematic review and meta-analysis. Gynecol Oncol, 126, 157-66. https://doi.org/10.1016/j.ygyno.2012.03.048
  14. Geomini P, Kruitwagen R, Bremer GL, Cnossen J, Mol BW (2009). The accuracy of risk scores in predicting ovarian malignancy: a systematic review. Obstet Gynecol, 113, 384-94. https://doi.org/10.1097/AOG.0b013e318195ad17
  15. Jacob F, Meier M, Caduff R, et al (2011). No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting. Gynecol Oncol, 121, 487-91. https://doi.org/10.1016/j.ygyno.2011.02.022
  16. Jacobs I, Oram D, Fairbanks J, et al (1990). A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol, 97, 922-9. https://doi.org/10.1111/j.1471-0528.1990.tb02448.x
  17. Jelovac D, Armstrong DK(2011). Recent progress in the diagnosis and treatment of ovarian cancer. CA Cancer J Clin, 61, 183-203. https://doi.org/10.3322/caac.20113
  18. Bian J, Li B, Kou XJ, Liu T-Z, Ming L (2013). Clinical Significance of combined detection of serum tumor markers in diagnosis of patients with ovarian cancer. Asian Pac J Cancer Prev, 14, 6241-3 https://doi.org/10.7314/APJCP.2013.14.11.6241
  19. Kawai M, Kano T, Kikkawa F, et al (1992). Transvaginal doppler ultrasound with color flow imaging in the diagnosis of ovarian cancer. Obstet Gynecol, 79, 163-7.

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