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Risk for Malignant and Borderline Ovarian Neoplasms Following Basic Preoperative Evaluation by Ultrasonography, Ca125 Level and Age

  • Karadag, Burak (Department of Obstetrics and Gynecology, Ankara Teaching and Research Hospital) ;
  • Kocak, M. (Private Edremit Gulf Hospital) ;
  • Kayikcioglu, F. (Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital) ;
  • Ercan, F. (Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University) ;
  • Dilbaz, B. (Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital) ;
  • Kose, M.F. (Department of Obstetrics and Gynecology, Faculty of Medicine, Bahcesehir University) ;
  • Haberal, A. (Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University Ankara)
  • Published : 2014.10.23

Abstract

Objective: To verify the basic preoperative evaluation in the discrimination between benign and malignant adnexal masses in our clinical practice. Materials and Methods: Data were collected on the records of 636 women with adnexal masses who had undergone surgery either by open or endoscopic approaches. Those with obvious signs of malignancy, any history of cancer, emergency surgeries without basic evaluation were excluded. The preoperative features by age, ultrasound and serum Ca125 level were compared with final histopathological diagnosis at the four departments of the institution. These are the general gynecology (Group 1: exploratory laparotomy), the gynecologic endoscopy (Group 2: laparoscopy and adnexectomy), the gynecological oncology (Group 3: staging laparotomy) and the gynecologic endocrinology and infertility (Group 4: laparoscopy and cystectomy). Results: There were simple and complex cyst rates of 22.3% and 77.2%, respectively. There were 86.3% benign, 4.1% (n:20) borderline ovarian tumor (BOT) and 6.4% (n:48) malignant lesions. There were 3 BOT and 9 ovarian cancers in Group 1 and one BOT and two ovarian cancer in the Group 2. During the surgery, 15 BOT (75%) and 37 ovarian cancer (77%) were detected in the Group 3, only one BOT was encountered in the Group 4. The risk of rate of unsuspected borderline or focally invasive ovarian cancer significantly increased by age, size, complex morphology and Ca125 (95% CI, OR=2.72, OR=6.60, OR=6.66 and OR=4.69, respectively). Conclusions: Basic preoperative evaluation by comprehensive ultrasound imaging combined with age and Ca125 level has proved highly accurate for prediction of unexpected malignancies. Neither novel markers nor new imaging techniques provide better information that allow clinicians to assess the feasibility of the planned surgery; consequently, the risk of inadvertent cyst rupture during laparoscopy may be significantly decreased in selected cases.

Keywords

Adnexal masses;ultrasonography;risk of ovarian cancer;laparoscopic surgery

References

  1. Exacustos C, Romanini ME, Rinaldo D, et al (2005). Preoperative sonographic features of borderline ovarian tumors. Ultrasound Obstet Gynecol, 25, 50-9. https://doi.org/10.1002/uog.1823
  2. Arab M, Yaseri M, Ashrafganjoi T, et al (2012). Comparison of two ovarian malignancy prediction models based on age sonographic findings and serum Ca125 measurement. Asian Pacific J Cancer Prev, 13, 4199-202. https://doi.org/10.7314/APJCP.2012.13.8.4199
  3. Bristow R, Nugent A, Zahurak M, Khouzhami V, Fox H (2009). Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass. J Adolesc Health, 39, 411-6.
  4. Brown DL, Douglas L (2007). A practical approach to the ultrasound characterization of adnexal masses. Ultrasound Quarterly, 23, 87-105. https://doi.org/10.1097/01.ruq.0000263849.45926.cb
  5. Fenchei S, Grab D, Nuessie K, et al (2002). Asymptomatic adnexal masses:correlation of FDG PET and histopathologic findings. Radiology, 223, 780-9. https://doi.org/10.1148/radiol.2233001850
  6. Ghezzi F, Cromi A, Bewrgamini V, et al (2008). Should adnexal mass size influence surgical approach? a series of 186 laparoscopically managed large adnexal masses. Intl J Obstet Gynecol, 115, 1020-7.
  7. Gocmen A, Atak T, Ucar M, Sanlikal F (2009). Laparoscopyassisted cystectomy for large adnexal cysts. Arch Gynecol Obstet, 279, 17-22. https://doi.org/10.1007/s00404-008-0651-2
  8. Gostout BS, Brewer Molly AD (2006). Guidelines for referral of the patient with an adnexal mass. Clin Obstet Gynecol, 49, 448-58. https://doi.org/10.1097/00003081-200609000-00005
  9. Heilbrun ME, Olpin J, Shaaban A (2009). Imaging of benign adnexal masses: characteristic presentations on ultrasound, computed tomography, and magnetic resonance imaging. Clin Obstet Gynecol, 52, 21-39. https://doi.org/10.1097/GRF.0b013e318195834b
  10. Mancuso A, De Vivo A, Triolo O, Irato S (2004). The role of transvaginal ultrasonography and serum Ca125 assay combined with age and hormonal state in the differential diagnosis of pelvic masses. Eur J Gynaecol Oncol, 25, 207-10.
  11. Hillaby K, Alsam N, Salim R, et al (2004). The value of detection of normal ovarian tissue (the 'ovarian crescent sign') in the differential diagnosis of adnexal masses. Ultrasound Obstet Gynecol, 23, 63-7. https://doi.org/10.1002/uog.946
  12. Jemal A, Siegel R, Ward E (2007). Cancer Statistics. Cancer J Clin, 57, 43-66. https://doi.org/10.3322/canjclin.57.1.43
  13. Jokubkiene L, Sladkevicius P, Valentin L (2007). Does threedimensional power doppler ultrasound help in discrimination between benign and malignant ovarian masses? Obster Gyenol Survey, 62, 308-9. https://doi.org/10.1097/01.ogx.0000261651.84161.92
  14. Marana R, Muzii L, Ferrari S, et al (2009). Management of adnexal cystic masses with unexpected intracystic vegetations detected during laparoscopy. J Minim Invasive Gynecol, 12, 502-8.
  15. Moore RG, Brown AK, Miller C, et al (2008). The use of multiple novel tumor biomarkers fort he detection of ovarian carcinoma in patients with pelvic mass. Gynecol Oncol, 108, 402-8. https://doi.org/10.1016/j.ygyno.2007.10.017
  16. Murta EFC, Nomelini RS (2006). Early diagnosis and predictors of malignancy of adnexal masses. Curr Opin Obstet Gynecol, 18, 14-9. https://doi.org/10.1097/01.gco.0000192967.67567.e9
  17. Nezhat FR, Ezzati M, Chuang L, et al (2009). Laparoscopic management of early ovarian and fallopian tube cancers:surgical and survival outcome. Am J Obstet Gynecol, 200, 1-6. https://doi.org/10.1016/j.ajog.2008.09.007
  18. Panici PB, Palaia I, Bellati F, et al (2007). Laparoscopy compared with laparoscopically guided minilaparotomy for large adnexal masses: a randomized controlled trial. Obstet Gynecol, 110, 241-8. https://doi.org/10.1097/01.AOG.0000275265.99653.64
  19. Riccardo M, Ludovico M, Giovan FC, et al (2004). Laparoscopic excision of adnexal masses. J Am Assoc Gynecol Laparosc, 11, 162-6. https://doi.org/10.1016/S1074-3804(05)60191-0
  20. Vladimir N, Malaika A, Feng S et al (2008). The early detection of ovarian cancer:from traditional methods to proteomics. Can we really do beter than serum Ca125? Am J Obstet Gynecol, 199, 215-23 https://doi.org/10.1016/j.ajog.2008.04.009
  21. Robin AF, Martin EG, John HS (2005). Ovarian cancers related to minimal access surgery. Int J Obstet Gynaecol, 102, 726-30.
  22. Royal College of Obstetricians and Gynaecologists. Ovarian cysts in postmenopausal women.Guideline No.34. Oct and urokinase plasminogen activator receptor in the sera of lung cancer patients. Oncol Lett, 2, 693-9.
  23. Sagiv R, Golan A, Glezerman M (2005). Laparoscopic management of extremely large ovarian cysts. Obstet Gynecol, 105, 1319-122. https://doi.org/10.1097/01.AOG.0000159690.18634.f0
  24. Shaaban A and Maryam R (2009). Ovarian cancer: detection and radiologic staging. Clin Obstets Gynecol, 52, 73-93 https://doi.org/10.1097/GRF.0b013e3181961625
  25. Tantipalakorn C, Wanapirak C, Khunamornpong S, et al (2014). IOTA simple rules in differentiating between benign and malignant ovarian tumors. Asian Pac J Cancer Prev, 15, 5123- 6. https://doi.org/10.7314/APJCP.2014.15.13.5123
  26. Yavuzcan A, Caglar M, Ozgu E, et al (2013). Should cutoff values of the risk of malignancy index be changed for evaluation of adnexal masses in Asian and Pacific populations? Asian Pac J Cancer Prev, 14, 5455-9. https://doi.org/10.7314/APJCP.2013.14.9.5455

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