Comparación del rendimiento diagnóstico de cuatro índices de riesgo de malignidad para cáncer de ovario / Comparison of the diagnostic performance of four malignancy risk indices for ovarian cancer

Resumen OBJETIVO: Evaluar el rendimiento diagnóstico de cuatro índices de riesgo de malignidad (IRM) en la predicción de riesgo de cáncer de ovario. MATERIALES Y MÉTODOS: Estudio comparativo y retrospectivo efectuado en pacientes mayores de 18 años con tumor anexial atendidas en el Hospital Christus Muguerza Conchita y Alta Especialidad del 2016 al 2021. Para evaluar el rendimiento diagnóstico de cada índice se utilizó la curva ROC y el índice de Youden para la obtención de sensibilidad y especificidad. RESULTADOS: Se incluyeron 330 pacientes con media de edad de 38 años. Para el IRM1 una S 73.9% y E de 85.3% con punto de corte en 126; IRM2 el mejor punto de corte se estableció en 210, con una S 72.5% y E de 89.3%; IRM3 el mejor punto de corte se estableció en 125, con una S 73.9% y E 85.8%; y para el IRM4 el punto de corte fue 436, con una S 68.1% y E 89.7%. CONCLUSIONES: El IRM es un método fácil, de bajo costo y accesible para la discriminación de pacientes con probable masa anexial maligna. En la población mexicana del noreste de México puede recomendarse la aplicación de cualquiera de los índices.

Abstract OBJECTIVE: Compare the diagnostic performance of four malignancy risk indices in predicting ovarian risk at Hospital Christus Muguerza Conchita and Alta Especialidad. MATERIALS AND METHODS: Retrospective study including clinical records of patients older than 18 years with adnexal tumor treated at the Christus Muguerza Conchita and Alta Especialidad Hospital from 2016 to 2021. The ROC curve was used to evaluate the diagnostic performance of each index, through the obtaining the best cut-off point with the highest sensitivity and specificity from the Youden index. RESULTS: A total of 330 patients were included for the adnexal tumor assessment approach. The mean age of the patients was 38.8 years. For IRM1 an S 81.2% and E of 69.3% with a cut-off point at 126; IRM2 the best cut-off point was established at 210, with an S 72.5% and E of 89.3%; IRM3 the best cut-off point was established at 125, with an S 73.9% and E 85.8%; and for IRM4 the cut-off point was 436, with an S 68.1% and E 89.7%. CONCLUSIONS: MRI is an easy, low-cost and accessible method for the discrimination of patients with probable malignant adnexal mass. The use of any of the indices can be recommended in the Mexican population of northeastern Mexico.

Delivering a female with missing cervix: a case report

Authors received a case in our casualty, 26 years old, G2P1L1, with full term pregnancy, spontaneous conception, previous normal vaginal delivery, with labour pain. On evaluation, she was having uterine contraction, fetal heart rate normal, vitally stable, with no cervix on per speculum and per vaginal examination, with solid globular mass per rectum. She was shifted to emergency operation theatre with provisional diagnosis of uterine rupture or rectal perforation or pelvic mass. After delivering a live baby, uterus was intact, but there was an impacted mass in pouch of Douglas, it was a twisted ovarian mass, sent for histopathology examination. Post-operative period was uneventful, and patient was discharged with healthy baby with corrected pelvic anatomy.

Endosalpingiosis with concurrent endometriosis of ovary masquerading as ovarian malignancy

Endosalpingiosis is a rare gynecological disorder of müllerian origin, characterized by the presence of tubal epithelium outside the fallopian tube, which involves structures of the female genital tract, peritoneum, and sub-peritoneal tissues. Endosalpingiosis can be associated with endometriosis or endocervicosis, although it often appears alone. Authors report a case of endosalpingiosis with concurrent endometriosis in a 42-year-old P2L1 patient. The patient presented to us with complaints of heaviness in lower abdomen, a feeling a lump in the lower abdomen and low-grade fever for 15 days. On per abdominal examination, a large solid cystic mass up to 20 weeks size was felt, which was more on the left side. Cervix was normal on speculum examination, the same mass was felt on per vaginal examination, separate from the uterus, the right fornix appeared free. Patient was asked to get a set of investigations done and to review as early as possible. An exploratory laparotomy with peritoneal wash cytology, total abdominal hysterectomy, bilateral salpingo-ophorectomy with supracolic and infracolic omentectomy and bilateral pelvic lymph nodes dissection was done on 18/07/18. Per operatively, there was a large cystic mass occupying the abdominal cavity adhered to the bowel and to posterior wall of the uterus, adhesiolysis followed by staging laparotomy was done.Patient’s postoperative course was uneventful and she was discharged on the 5th day of surgery in stable condition. The final histopathology report was suggestive of endosalpingiosis with concurrent endometriosis.

Degenerated fibroid: a diagnostic dilemma

Leiomyoma is one of the most commonly encountered benign gynaecological neoplasms. With a wide range of symptoms, sometimes even asymptomatic, these tumors are easy to diagnose and treat, unless there are degenerative changes, which makes them difficult to diagnose and differentiating them from other serious conditions including malignancy, thereby, complicating their management also. Here, the case present to you a case of 48-year-old women with symptoms and clinical examination suggesting fibroid uterus but imaging studies inconclusive to differentiate fibroid uterus with ovarian malignancy, thus, creating a diagnostic dilemma. Ultimately, patient underwent exploratory laparotomy, keeping possibility of ovarian malignancy. Histopathological examination of the specimen of total abdominal hysterectomy with bilateral salpingo-oopherectomy concluded extensive cystic degeneration of leiomyoma and no evidence of malignancy.

Impact of perioperative period on disease-free survival among carcinoma ovary patients treated with the interval cyto-reductive surgery at a tertiary cancer centre in Kerala, India: a retrospective study

Background: Global incidence of ovarian malignancies is 300,000 as per GLOBOCAN 2018. The treatment protocol for advanced ovarian malignancies (stage IIIc and stage IV) includes neo-adjuvant chemotherapy and surgery followed by adjuvant chemotherapy. Aims of the study was to determine the effect of duration of chemo interruption on disease free survival of ovarian malignancies treated by interval cytoreduction followed by surgery.Methods: A total 48 patients were studied for events such as recurrence, death, patient’s status on last follow up, peri-operative period between 3rd cycle of chemo therapy and 4th cycle of chemo therapy. Based on the median duration of peri operative period patients was classified as early or delayed receivers of adjuvant chemo therapy. Difference in duration of over-all survival and disease-free survival was analysed through Kaplan Meier survival analysis using log-rank test. Hazard ratio adjusted for background characteristics such as staging, performance status, grade of tumour were analysed using cox proportional hazard model.Results: The two peri operative period categories based on mean value (85 days) didn’t show any significant association to disease free interval (minimum-21days, maximum-146 days, Hr = 1.3, p-value = 0.52). Other established factors like stage, extent of resection, response to chemotherapy, also didn’t show any significant association. Serum marker level showed a significant negative correlation with disease free survival (minimum-9 days, maximum-30659, p-value =.04, Hr = 3.19).Conclusions: The study could not establish any correlation between peri operative period and median disease-free survival. The small sample size is a limiting factor, well controlled randomized trials may needed for further clarification.

Clinical Usefulness of Cancer Antigen (CA) 125, Human Epididymis 4, and CA72-4 Levels and Risk of Ovarian Malignancy Algorithm Values for Diagnosing Ovarian Tumors in Korean Patients With and Without Endometriosis

BACKGROUND: Tumor markers are useful for detection and preoperative evaluation of ovarian tumors. We evaluated the clinical usefulness of cancer antigen (CA) 125, human epididymis 4 (HE4), and CA72-4 levels and Risk of Ovarian Malignancy Algorithm (ROMA) values for differential diagnosis of malignant and borderline tumors among suspected ovarian tumors, and the effects of endometriosis on these tumor markers. METHODS: In a total of 266 patients (213, 14, and 39 with benign, borderline and malignant tumors, respectively), CA125, HE4, and CA72-4 levels were measured, and ROMA values were calculated. Medians of each marker were compared among the three groups. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to analyze the diagnostic performance of each marker. RESULTS: All markers were significantly higher in the malignant group than in the benign group. HE4 levels and ROMA values were significantly higher in the malignant group than in the borderline group. ROMA value had the highest AUC for distinguishing the malignant and borderline groups from the benign group in premenopausal (0.773) and postmenopausal (0.927) patients. CA125 level was significantly higher in patients with endometriosis than in those without (P<0.001), whereas HE4 and CA72-4 levels were not affected by endometriosis (P=0.128 and 0.271, respectively). CONCLUSIONS: ROMA value is the best marker to distinguish malignant and borderline tumors from benign tumors in pre- and postmenopausal patients. HE4 and CA72-4 levels provide information on possible CA125 elevation due to endometriosis.

Immunohistochemical expression of human epididymis 4 in ovarian malignancy

Background: Ovarian malignancies has the highest mortality rate among all gynaecological malignancies. Surface epithelial tumors form two thirds of all ovarian neoplasm and 90% of all ovarian cancers are surface epithelial carcinomas. Mortality in case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve the case specific management. HE4 (Human Epididymis Protein 4) which is proved to be overexpressed in the ovarian cancer cells, is considered a new biomarker for ovarian cancer diagnosis which helps in early diagnosis and patient management. Aims and objectives of the study was to evaluate the immunohistochemical expression of HE4 in various ovarian malignancies.Methods: It was a cross sectional, prospective, single institution-based study, conducted in the department of Pathology in collaboration with the Department of Gynaecology and Obstetrics, from December 2016 to January 2019 in institution. A total 74 ovarian malignancies were selected for this study.Results: Serous carcinoma was the most common ovarian malignancy followed by endometrioid carcinoma. Highest percentage of expression of HE4 was seen in high grade serous cancer and malignant endometrioid tumor.Conclusions: HE4 was highly expressed in malignant ovarian tumour especially serous and endometrioid carcinoma and can be used as an important biomarker for malignant ovarian neoplasm. Expression in high grade ovarian serous cancer support its prognostic value also.

Genital Tract Tuberculosis in a 42-year Female Masquerading as Ovarian Malignancy

Female genital tuberculosis is one the known causes of infertility in the tropics. The symptom complex arediverse and it is one of the known causes of pyrexia of unknown origin. Instances of mimicry of ovarian cancer with raised CA125, have been reported. We present a case report in a 42-year-old woman with abdominal pain and progressive abdominal pain of 3 weeks durations, who had confounding symptom of raised CA125, forcing a presumptive diagnosis of ovarian cancer.She had exploratory total abdominal hysterectomy (TAH). The surgical findings and histopathological diagnosis were suggestive of tuberculosis, for which she is undergoing treatment and showing remarkable improvement

Comparison of efficiency between RMI1 and RMI2 in diagnosing ovarian malignancy

Background: This study was conducted in department of obstetrics and gynaecology, to know the efficiency of risk of malignancy index (RMI) to differentiate a malignant from a benign tumor and to compare the efficiency of risk of malignancy index 1 and 2 (RMI1 and RMI2). The study was conducted from June 2012 to August 2013 in women who got admitted with adnexal tumor.Methods: It was a prospective study. A proforma was designed for each patient which included, name, age, complaints, menopausal status, parity, past and family history and associated medical condition were asked. Indivisual parameters namely ultrasound score, CA125 and menopausal status and risk of malignancy index was calculated and compared with final histopathological diagnosis and sensitivity specificity and positive predictive value was calculated for each.Results: : The sensitivity of RMI1 is 87.95%, specificity is 75%, positive predictive value is 94.8%, negative predictive value is 54.54%, percentage of false negative is 12.04% and percentage of false positive is 25%. The sensitivity of RMI2 is 86.74%, specificity is 81.25%, positive predictive value is 96%, negative predictive value is 54.16%, percentage of false negative is 13.25% and percentage of false positive is 18.75%.Conclusions: The efficiency of RMI was definitely better than indivisual parameters and efficiency of RMI 1 and RMI2 are similar.

​Pre-operative Evaluation of Ovarian Masses with Color Doppler and its Correlation with Pathological Finding

Introduction: The management of ovarian tumors remains a common clinical gynecologic problem. The early and definitediagnosis of ovarian malignancy is of grave clinical importance. Recently, the role of color and spectral Doppler in the diagnosisof ovarian malignancy has been a subject of enormous debate.Aim: The purpose of the study was to evaluate the efficiency of color flow Doppler and its parameters with pulsatility index (PI)and resistive index (RI), to discriminate the benign and malignant ovarian masses.Methods: In 24 months period selected 100 patients, in whom adnexal mass was detected by ultrasound and had further evaluatedby Color flow Doppler at the radiology department. PI was calculated from the reproducible spectral waveforms generated fromflow central to peripheral within the mass or adjacent to the mass. The resistive index was calculated as the mean of threeconsecutive waveforms with the lowest RI. Each lesion was categorized on the basis of gray scale morphology as benign,borderline, and malignant. Other parameters such as a wall and septal thickness and echogenicity also were recorded. Theseimage-guided indices were further confirmed with histopathological findings to differentiate benign and malignant ovarian tumors.Results: Of the 100 patients 85 were benign, two were borderline, and 13 were a malignant ovarian mass with mean age 35.2,45.0, and 48.3, respectively. The threshold of PI >1 and RI >0.4 was diagnosed as benign. PI <0.8 and RI <0.4 were low andused as predictors of ovarian malignancy. Similarly, other parameters were calculated to discriminate the lesion.Conclusion: The study showed a high positive predictive value of high impedance flow in benign and predominant low impedanceflow in the malignant lesion. In the present study, fairly good specificity and sensitivity with PI <1 and the resistive index <0.4were achieved in ovarian malignancy. Color Doppler study was the diagnostic modality of choice for the patients with adnexalmass to establish the diagnosis of malignant ovarian tumors.

Application value of risk ovarian malignancy algorithm in early diagnosis of epithelial ovarian cancer / 吉林大学学报(医学版)

Objective: To investigate the value of risk ovarian malignancy algorithm (ROMA) in evaluation of the risk of epithelial ovarian cancer and its association with the clinical pathological stages, and to provide a basis for the clinical diagnosis and treatment and prognosis analysis of epithelial ovarian cancer.Methods: The clinical materials of 135 patients with ovarian tumor confirmed by paraffin section pathology after operation were retrospectively analyzed. The patients were divided into benign ovarian tumor group(n=66), epithelial ovarian cancer group(n=58) and non-epithelial ovarian cancer group(n=11).According to the cutoff values of HE4,CA125,and ROMA of the patients in various groups,the positive rates of HE4,CA125,and ROMA of the patients in various groups were calculated.Based on the serum levels of human epididymis protein 4(HE4) and carbohydrate antigen 125(CA125) detected before operation of the patients in various groups, the relationships between the positive rates of serum HE4, CA125 and ROMA and the clinical stages of the patients with ovarian cancer;their diagnosis efficacies in the patients with ovarian cancer were evaluated. Results: The serum CA125, HE4 levels and ROMA value of the patients in epithelial ovarian cancer group were significantly higher than those in benign ovarian tumor group and non-epithelial ovarian cancer group (P0.05). Among the three indexes, ROMA had the highest diagnostic efficacy index and CA125 had the lowest.Conclusion: The diagnostic value of ROMA for evaluating the risk of epithelial ovarian cancer was higher than those of CA125 and HE4, which has a better diagnostic value for the postmenopausal patients and can improve the early diagnosis efficiency of ovarian cancer.

Comparison of serum cancer antigen 125, human epididymis protein 4, ROMA, and CPH-I for diagnosis of ovarian cancer in Chinese patients with ovarian mass / 南方医科大学学报

OBJECTIVE@#To compare the performance of serum cancer antigen 125 (CA125), human epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA) and Copenhagen index (CPH-I) for differential diagnosis of benign and malignant diseases in patients with ovarian mass.@*METHODS@#We retrospectively analyzed the data of 719 women with pelvic mass, and the performance of preoperative serum levels of CA125 and HE4, ROMA and CPH-I for differential diagnosis of the masses was compared.@*RESULTS@#Of the 710 women analyzed, 531 were diagnosed with benign ovarian lesions, 44 with borderline ovarian tumors (BOTs), 119 with epithelial ovarian cancers (EOCs), and 25 with non-EOCs. In differentiating ovarian cancer (OC) and BOT from benign lesions, the area under the receiver-operator characteristic (ROC) curve (AUC) was 0.854 for HE4, 0.856 for ROMA, 0.854 for CPH-I, and 0.792 for CA125, demonstrating better diagnostic performance of HE4, ROMA, and CPH-I than CA125 alone; the diagnostic sensitivity was 56.9% for HE4, 70.2% for CA125, 69.1% for ROMA, and 63.8% for CPH-I; the specificity was the best with HE4 (94.4%) and CPH-I (94.7%). In sub-analysis of EOC benign lesions, the AUCs of HE4, ROMA, and CPH-I increased to 0.946, 0.947, and 0.943, respectively, all greater than that of CA125 (0.888). In other sub-analyses, HE4, ROMA, and CPH-I all showed greater AUCs than CA125 alone.@*CONCLUSIONS@#This study confirms the accuracy of HE4, ROMA, and CPH-I for differentiating malignant from benign ovarian mass, and all these 3 tests show better performance than CA125. Furthermore, HE4 and CPH-I is superior to ROMA and CA125 in terms of specificity, while CA125 and ROMA have better diagnostic sensitivities.

Diagnostic value of serum human epididymis protein 4 and carbohydrate antigen 125 combined with risk of ovarian malignancy algorithm index for ovarian cancer / 肿瘤研究与临床

Objective To investigate the clinical value of serum human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125) combined with risk of ovarian malignancy algorithm (ROMA) index in the diagnosis of ovarian cancer. Methods A total of 541 patients in the Department of Gynaecology in Baoji Central Hospital from August 2016 to February 2018 were collected. The serum HE4 and CA125 levels were measured by using electrochemiluminescence immunoassay in 226 cases of ovarian cancer (ovarian cancer group), 315 cases of ovarian benign disease (ovarian benign disease group) and 100 female healthy people (the control group). ROMA index was calculated according to ROMA model and the results were analyzed statistically. Results The levels of serum HE4, CA125 and ROMA index were significantly different in premenopausal and postmenopausal ovarian cancer group, ovarian benign disease group and the control group (all P<0.05). The sensitivity and Yonden's index of the three combined diagnosis of serum HE4, CA125 and ROMA for premenopausal ovarian cancer were 97.01 ％ and 77.01 ％ respectively, which were higher than those of a single detection (HE4:79.37％, 69.11％;CA125:76.06％, 66.38％;ROMA index:89.55％, 72.41％;χ2sensitivity=12.35, P=0.000;χ2Yonden's index=6.460, P=0.013. The sensitivity and Yonden's index ofthe three combined diagnosis of serum HE4, CA125 and ROMA for postmenopausal ovarian cancer were 98.99 ％ and 82.99 ％ respectively, which were higher than those of a single detection (HE4: 86.90 ％, 79.40 ％; CA125: 82.98 ％, 76.31 ％; ROMA index: 93.54 ％, 80.64 ％; χ2sensitivity = 14.25, P = 0.000;χ2Yonden's index= 4.822, P= 0.031). The area under the curve of the combined detection of three indicators was higher than that of a single detection (premenopausal group: 0.871 vs. 0.682, 0.626, 0.708; postmenopausal group: 0.981 vs. 0.724, 0.705, 0.833), and there were significant differences (premenopausal group: χ2 =11.24, P= 0.000; postmenopausal group: χ2= 16.38, P= 0.000). Conclusion The combined detection of serum HE4, CA125 and ROMA index can increase the sensitivity and accuracy for diagnosing ovarian cancer, which can provide a more reliable basis for diagnosis and screening of ovarian cancer.

Tuberculosis peritoneal simulando carcinoma de ovario / Peritoneal tuberculosis mimicking ovarian carcinoma

La tuberculosis peritoneal es una ubicación extrapulmonar común en mujeres, con características similares a neoplasias malignas ováricas avanzadas. Es difícil de diagnosticar debido a que produce ascitis masiva y crecimiento peritoneal marcado, similar a la carcinomatosis. Se necesitan estudios patológicos y cultivos bacterianos para confirmarlo, ya que no existen hallazgos clínicos, de laboratorio o radiológicos patognomónicos para la patología. El tratamiento temprano generalmente tiene un buen pronóstico. Se presenta un caso de tuberculosis peritoneal con la triada clásica (ascitis similar a carcinoma ovárico en etapas avanzadas, tumores abdominopélvicos y aumento de las concentraciones séricas de CA-125). La laparotomía mostró nódulos abdominales-peritoneales con inflamación granulomatosa. La paciente inició tratamiento y, durante el seguimiento, los síntomas al igual que las concentraciones de CA-125 normalizaron.

Peritoneal tuberculosis is a common extrapulmonary site in females, mimicking an advanced ovarian malignancy. It is difficult to diagnose because it may produce massive ascites, and a gross peritoneal appearance similar to carcinomatosis. It requires confirmation by pathological studies and bacterial cultures, as there are not pathognomonic clinical, laboratory or radiologic findings. Early treatment usually is associated to good prognosis. A case of peritoneal tuberculosis with the classic triad (advanced-stage ovarian carcinoma-like ascites, abdominopelvic tumors and elevated serum CA-125 levels) is presented. Laparotomy showed abdominal and peritoneal nodules reported as granulomatous inflammation on biopsy. Patient started treatment and, on follow-up, symptoms and CA-125 levels normalized.

The value of HE4, CA125, and ROMA model in diagnosis of the ovarian carcinoma / 重庆医学

Objective To explore the value of human epididymis protein 4(HE4),cancer antigen 125(CA125) and the risk of ovarian malignancy algorithm(ROMA) in the diagnosis of ovarian cancer.Methods Electrochemical luminescence and Enzymelinked immunosorbent assay (ELISA) were used to determine the levels of serum HE4,CA125 in 56 patients with ovarian carcinoma,73 cases of ovarian benign tumor and 50 health women,and the ROMA was calculated by HE4 and CA125 levels depending on the menopause state,drawing the receiver operating characteristics(ROC) curve and calculating the area under the curve(AUC).Results The average levels of the HE4,CA125 and the value of the ROMA were (345.33±605.03)pmol/L,(701.46±1 500.30) U/mL,(58.72±31.00) ％ in the ovarian carcinoma group,(53.84± 14.68)pmol/L,(44.25±45.81)U/mL,(10.80± 6.75) ％ in the ovarian benign tumor group,and (46.03±10.26)pmol/L,(17.39±10.64)U/mL,(6.92±3.85)％ in the health control group respectively,compared with the benign tumor group and the health control group,the ovarian carcinoma group were higher in HE4,CA125 and the ROMA value,and the difference were significantly (P＜0.05),whereas compared in the ovarian benign group and the health group,except the CA125 was higher in the benign group and the difference had statistical significance(P＜0.05),the HE4 level and the value of the ROMA had no statistical significance(P＞0.05).The sensitivities of the HE4,CA125 and ROMA were 71.43％,76.79 ％,89.28％,the specificities were 93.15 ％,53.42％,94.52 ％ and the ROC-AUCs were 0.930,0.809,0.937 respectively.When the specificity for the diagnosis of the ovarian carcinoma was 95.00％,the sensitivities of the HE4,CA125 and ROMA were 80.40％,53.60％,83.90％ respectively.Conclusion HE4 and CA125 combined detection to calculate the ROMA can elevate the sensitivity and specificity for the ovarian carcinoma diagnosis.

Analysis of falsely elevated risk of ovarian malignancy algorithm in women with ovarian endometrioma

OBJECTIVE: To estimate the incidence of falsely elevated risk of ovarian malignancy algorithm (ROMA) in a group of women with pathologically confirmed endometrioma and to investigate the associated factors. METHODS: One hundred premenopausal women surgically diagnosed with ovarian endometrioma were selected. Preoperative clinical, laboratory, and surgical characteristics were compared between the elevated-risk group (ROMA-premenopausal value, ≥7.4%) and normal-risk group (ROMA-premenopausal value, 82.3 U/mL and serum level of human epididymis protein 4 (HE4) >46 pmol/L could predict an elevated ROMA test with a statistical significance. When serum level of HE4 ≤46 pmol/L, none of the women showed an elevated ROMA test, regardless of serum level of CA 125; however, 55.6% of the women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 ≤82.3 U/mL and all women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL. CONCLUSION: The incidence of falsely elevated ROMA was 15% in the group of women with pathologically confirmed endometrioma. Interpretation of the ROMA results should be cautious when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL in women with suspicious ovarian endometrioma.

Human Epididymis Protein 4 as a Diagnostic Marker of Ovarian Cancer and Its Reference Interval in Korean Population

Human epididymis protein 4 (HE4), which complements cancer antigen 125 (CA125), has emerged as a new diagnostic biomarker that can discriminate between benign and malignant ovarian tumors. The risk of ovarian malignancy algorithm (ROMA) incorporates CA125, HE4, and menopausal status to classify patients with pelvic masses into those at high or low risk of developing ovarian cancer. The reference interval of HE4 among Korean population was different from those recommended by the manufacturer or evaluated in the Chinese.

Abdominopelvic tuberculosis masquerading ovarian malignancy - Histopathology key to management.

Abdominopelvic tuberculosis (genital tuberculosis) may mimic ovarian malignancy in clinical presentation, ultrasound findings and laboratory tests. We present two cases of genital tuberculosis where a provisional diagnosis of ovarian carcinoma was made. One patient underwent surgery and the other was treated conservatively. These cases underline the mandatory need of a high index of suspicion in our country, towards pelvic tuberculosis preoperatively in a patient with adnexal mass.

Evaluation of ovarian cancer biomarkers HE4 and CA-125 in women presenting with a suspicious cystic ovarian mass / 부인종양

OBJECTIVE: Women presenting with a large or complex ovarian cyst are referred to extensive surgical staging to ensure the correct diagnosis and treatment of a possible epithelial ovarian cancer. We hypothesized that measurement of the biomarkers HE4 and CA-125 preoperatively would improve the assignment of these patients to the correct level of care. METHODS: Patients diagnosed with a cystic ovarian mass and scheduled for an operation at our center of excellence for ovarian cancer surgery from 2001 to 2010 were prospectively included (n=394) and plasma was collected consecutively. Cut-off for HE4 was calculated at 75% specificity (85 pM and 71.8 pM for post and premenopausal women). For CA-125, 35 U/mL cut-off was used. The study population included women with malignant (n=114), borderline (n=45), and benign (n=215) ovarian tumors. RESULTS: Receiver operator characteristic (ROC) area under the curve (AUC) in the benign versus malignant cohorts was 86.8% for CA-125 and 84.4% for HE4. Negative predictive value was 91.7% when at least one of the biomarkers was positive, with only early stage epithelial ovarian cancer showing false negative results. Sensitivity at set specificity (75%) was 87% for risk of ovarian malignancy algorithm (ROMA) in the postmenopausal cohort (cut-off point, 26.0%) and 81% in the premenopausal cohort (cut-off point, 17.3%). ROC AUC in the benign versus stage I epithelial ovarian cancer was only 72% for HE4 and 76% for CA-125. CONCLUSION: In our study, population HE4 did not outperform CA-125. Based on our data a prospective trial with patients already diagnosed with an ovarian cyst may be conducted.

1 case of Meigs' syndrome with markedly elevated serum CA 125 level / 대한산부인과학회지

Meigs' syndrome is named when benign and solid ovarian tumors with the gross appearance of a fibroma is accompanied by ascites and pleural effusion, which disappear after removal of the ovarian tumors. Ovarian tumors with markedly elevated CA 125 level are highly suggestive of ovarian malignancy but, patients with Meigs' syndrome can have elevated serum CA 125 levels as well. We present a 75-year-old woman's case of Meigs' syndrome with markedly elevated serum CA 125 level (1,068 IU/mL).