Comparison of ultrasound and computed tomography in the diagnosis of malignant ovarian tumours at tertiary care center

Background: Accurate diagnosis of ovarian tumours is a diagnostic challenge. Multiple modes are used for the early detection of ovarian tumours. Early detection provides a survival advantage. Ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) are important imaging modalities in this regard. This study aims to compare the diagnostic accuracy of USG and CT imaging in the detection of malignant ovarian tumours.Materials: An observational cross-sectional study is conducted in the department of radiodiagnosis of Narayan medical college and hospital, Bihar over a period of 18 months from August 2021 to March 2024. Fifty-three patients with suspected ovarian malignancy who were not pregnant or had contraindications for administration of contrast media were included in the study. USG, CT and histopathology reports were compared for diagnostic accuracy with respect to different components.Results: Mean age of the patients was seen to be 49.6�.8 years. Abdominal pain was the most common presentation Majority of the patients had vascular lesions with a well-differentiated margin, heterogenous enhancement and septations. USG and CT agree almost perfectly in, identifying septations, calcification, and in differentiating margin of the tumours and very poorly for the identification of lymphadenopathy. CT had better sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) when compared to USG for diagnosis of ovarian malignanciesConclusions: CT has superior diagnostic accuracy compared to USG for diagnosis of ovarian tumours. However, USG provides similar diagnostic accuracy for identifying septations, calcification, and in differentiating margins of tumours.

Role of pre-operative serum IL-6 and CA-125 in the prediction of malignant ovarian tumor

Background: Ovarian cancer is the most lethal gynecological malignancy. The present study was therefore designed to determine the accuracy of IL-6 and CA-125 in the early diagnosis of malignant ovarian tumors. The aim of the study was to evaluate the predictive value of pre-operative serum IL-6 and CA-125 levels in identifying malignant ovarian tumors.Methods: This cross-sectional study took place at BSMMU and NICRH in Dhaka, Bangladesh, from February 2022 to January 2023. It involved 94 women undergoing surgery for suspected ovarian tumors. The Mann-Whitney test was used to compare IL-6 and CA-125 levels between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to correlate serum markers with histopathological diagnoses. Statistical analysis used SPSS version 23.0 with significance set at p<0.05.Results: The study involved 94 patients with ovarian tumors, where the mean age was higher in those with malignant tumors. The most common malignant histopathological finding was serous carcinoma (34%), while benign tumors often included endometriotic cysts (12.8%) and mucinous cystadenomas (10.6%). Elevated levels of IL-6 and CA-125 were significantly associated with malignant tumors (p<0.05). Both IL-6 and CA-125 showed high diagnostic accuracy in identifying malignant ovarian tumors when used alone or in combination, as indicated by receiver-operator characteristic curves.Conclusions: Serum IL-6 shows higher sensitivity and specificity for detecting malignant ovarian tumors, both epithelial and non-epithelial, making it a valuable diagnostic tool alongside CA-125 in assessing suspicious ovarian masses.

Características clínicas del cáncer de ovario epitelial en el Instituto Oncológico Nacional de Panamá

Objetivo: Describir las características clínicas de las pacientes con cáncer de ovario epitelial en el Instituto Oncológico Nacional de Panamá́. Métodos: Se realizó un estudio descriptivo en el Instituto Oncológico Nacional. Se revisaron todos los expedientes de las pacientes con cáncer de ovario epitelial desde enero 2012 a diciembre 2021. Aquellas con diagnóstico histopatológico confirmado de cáncer de ovario epitelial primario fueron incluidas en el estudio. Entre las variables evaluadas, se encontraban edad, lugar de procedencia, grupo histológico, etapa al diagnóstico, tratamiento y recidivas. Resultados: Se incluyeron 547 pacientes. El 49% (266) de las pacientes residían en la provincia de Panamá. La edad media fue de 56 años (DE:13.2). El 71% (386) estaban aseguradas. El 80% (439) presentaron síntomas relacionados al cáncer. El 80% (442) presentaron valores de CA-125 elevados. El 59% (321) eran de tipo seroso. El 62% (338) fueron tratadas con una combinación de cirugía y quimioterapia. En etapa I, el 19% (27) recayeron mientras que en etapa III, el 39% (103). El 80% (138) de las recidivas recibieron sólo quimioterapia. Conclusiones: En general, el cáncer epitelial se presentó en etapas avanzadas en mujeres mayores de 40 años asociado a sintomatología y valores de CA-125 elevados. El tipo histológico más frecuente fue el seroso y el tratamiento habitual fue una combinación de cirugía y quimioterapia. El porcentaje de muerte fue directamente proporcional con la etapa al diagnóstico. (provisto por Infomedic International)

Objetivo: Describir las características clínicas de las pacientes con cáncer de ovario epitelial en el Instituto Oncológico Nacional de Panamá́. Métodos: Se realizó un estudio descriptivo en el Instituto Oncológico Nacional. Se revisaron todos los expedientes de las pacientes con cáncer de ovario epitelial desde enero 2012 a diciembre 2021. Aquellas con diagnóstico histopatológico confirmado de cáncer de ovario epitelial primario fueron incluidas en el estudio. Entre las variables evaluadas, se encontraban edad, lugar de procedencia, grupo histológico, etapa al diagnóstico, tratamiento y recidivas. Resultados: Se incluyeron 547 pacientes. El 49% (266) de las pacientes residían en la provincia de Panamá. La edad media fue de 56 años (DE:13.2). El 71% (386) estaban aseguradas. El 80% (439) presentaron síntomas relacionados al cáncer. El 80% (442) presentaron valores de CA-125 elevados. El 59% (321) eran de tipo seroso. El 62% (338) fueron tratadas con una combinación de cirugía y quimioterapia. En etapa I, el 19% (27) recayeron mientras que en etapa III, el 39% (103). El 80% (138) de las recidivas recibieron sólo quimioterapia. Conclusiones: En general, el cáncer epitelial se presentó en etapas avanzadas en mujeres mayores de 40 años asociado a sintomatología y valores de CA-125 elevados. El tipo histológico más frecuente fue el seroso y el tratamiento habitual fue una combinación de cirugía y quimioterapia. El porcentaje de muerte fue directamente proporcional con la etapa al diagnóstico. (provided by Infomedic International)

A rare case on ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy

Spontaneous form of ovarian hyperstimulation syndrome in pregnancy (OHSS) is extremely rare and characterized by gastro-intestinal symptoms and complication of shift of fluid in the third space. It is often associated with multiple gestations, hypothyroidism, polycystic ovarian syndrome and molar pregnancy. Treatment depends on the patient抯 clinical condition. The aim of this case report is to bring into light a case of spontaneous OHSS in a healthy Indian pregnant woman that presented with pain abdomen, abdominal distension and vomiting at 14 weeks of gestation without any of the above-mentioned risk factors. Ultrasonography showed a single viable intrauterine pregnancy along with bilateral enlarged cystic ovaries, ascites and raised CA-125 levels. There was no history of ovulation induction in present and previous pregnancy. We successfully managed the patient conservatively with Dopamine agonist Cabergoline and she delivered a healthy baby at 33 weeks. Although spontaneous OHSS is a rare entity, it should be included in differential diagnosis of acute abdomen in pregnant women. OHSS can lead to life threatening complications, early diagnosis is required for proper management.

Inflammatory myofibroblastic tumour

Inflammatory myofibroblastic tumor (IMT) is a rarely described tumor of unknown etiology and pathogenesis. An IMT may occur in almost any part of the body, from the central nervous system to the limbs, and has nonspecific clinical manifestations. Histologically these lesions appear as an inflammatory infiltrate within a variable myofibrotic background. We here present a case of 67-year-old woman who presented with vague abdominal mass and her TAH with BSO was done in view of preoperative diagnosis of ovarian malignancy, which after histopathology came out to be IMT of pelvis.

Risk of malignancy index 4 for differentiating benign from malignant ovarian tumor

Background: Approximately 22% of gynaecologic cancers are of ovarian origin, but 47% of all gynaecologic cancer deaths occur in women who have ovarian cancer. Ovarian cancer is usually diagnosed at an advanced stage because most of the symptoms are nonspecific, hence, the difficulty in diagnosis at early stages. In general, there is no effective screening test for ovarian cancer. Aim was to evaluate the ability of risk of malignancy index 4 (ROMI 4) to differentiate benign from malignant ovarian tumors.Methods: A prospective observational study was conducted in April 2019 to march 2020.Results: In the present study the ROMI 4 score at cut-off ? 450 had sensitivity, specificity, PPV and NPV of 74.3%, 65.3%, 42.6% and 88% respectively for malignant ovarian tumor.Conclusions: Preoperative ROMI 4 score ?450 will lead to rational basis for further referral to higher centre or gynaecology oncologist timely for appropriate surgical intervention/ management.

Research on the ability of high diffusion sensitivity coefficient DWI and DCE-MRI combined with tumor CA 125 in judging the nature of early ovarian lesions / 中国医学装备

Objective:To investigate the clinical effect of high diffusion sensitivity coefficient(high b value)diffusion-weighted imaging(DWI),dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with tumor carbohydrate antigen 125(CA125)in judging the nature of ovarian lesions.Methods:A total of 100 patients with ovarian lesions who were treated in Nantong Haimen People's Hospital from April 2020 to April 2022 were selected for retrospective study.All of them underwent CA125,DWI,DCE-MRI and pathologically qualitative examination.According to the pathological results,58 patients with malignant lesions of ovarian were divided into malignant group and patients with benign lesions of ovarian were divided into benign group.The CA125 levels of the two groups were analyzed and compared,and the results of the receiver operating characteristics(ROC)of different detection methods(DWI with high b value+CA125,DCE-MRI+CA125,DWI with high b value+DCE-MRI+CA125)also were analyzed and compared.Results:The CA125 index of the malignant group was significantly higher than that of the benign group,with a statistically significant difference(t=29.357,P＜0.05),and the CA125 positive rate of the malignant group was significantly better than that of the benign group,with a statistically significant difference(x2=34.456,P＜0.05).The apparent diffusion coefficient(ADC)value[(0.91±0.18)×103mm2/s]of the malignant group was significantly less than that[(33±0.21)×103mm2/s]of the benign group,while the contrast agent volume conversion constant(Ktrans),rate constant(Kep)and the extracellular space volume ratio outside of blood vessels(Ve)of the malignant group were significantly higher than those of the benign group,with significant differences(t=16.863,9.686,10.205,P＜0.05),respectively.The diagnostic accuracy,sensitivity,negative predictive value and positive predictive value of DWI with high b-value+DCE-MRI+CA125 examination method were higher than those of DWI with high b-value + CA125 or DCE-MRI+CA125 examination method in diagnosing malignant ovarian tumors.There were not significant differences in various indicators between DCE-MRI+CA125 examination method and DWI with high b-value +CA125 examination method(P＞0.05).ROC curve analysis showed that the area under curve(AUC)of the DWI with high b-value +DCE-MRI+CA125 examination method was the best(AUC=0.920).Conclusion:The combined examination method of DWI with high b-value + DCE-MRI + CA125 has better overall diagnostic efficiency,which can improve the screening ability of clinical diagnosis for malignant ovarian tumors.It has a certain clinical application value.

Preoperative cancer antigen-125 levels as a predictor of recurrence in early-stage endometrial cancer

SUMMARY OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries, with a majority of cases being low-grade endometrioid endometrial cancer. Identifying risk factors for disease recurrence and poor prognosis is critical. This study aimed to assess the correlation between preoperative cancer antigen-125 levels and disease recurrence in early-stage endometrioid endometrial cancer patients. METHODS: The study was a retrospective analysis of 217 patients diagnosed with endometrioid endometrial cancer who underwent surgical treatment at a university-affiliated tertiary hospital between 2016 and 2022. Patients were divided into two groups based on their preoperative cancer antigen-125 levels and compared with clinicopathological findings and disease recurrence. Disease-free survival rates were calculated, and logistic regression analysis was performed to determine independent factors affecting disease-free survival. RESULTS: The mean age of patients was 61.59±0.75 years, and the mean follow-up time was 36.95±1.18 months. The mean cancer antigen-125 level was 27.80±37.81 IU/mL. The recurrence rate was significantly higher in the group with elevated cancer antigen-125 levels (p=0.025). Disease-free survival was lower in patients with elevated cancer antigen-125 compared with those with normal levels (p=0.005). Logistic regression analysis revealed that elevated cancer antigen-125 levels were associated with disease recurrence (OR: 3.43, 95%CI 1.13-10.37, p=0.029). CONCLUSION: The findings of this study suggest that preoperative cancer antigen-125 levels can be used as a predictor of disease recurrence in early-stage endometrioid endometrial cancer patients. cancer antigen-125 levels may be a useful tool for risk stratification and patient management in endometrial cancer.

The value of CEA, CYFRA21-1 and CA125 tests in opportunistic screening for non-small cell lung cancer: a meta-analysis / 中华健康管理学杂志

Objective:To evaluate the value of CEA, CYFRA21-1 and CA125 tests in opportunistic screening of non-small cell lung cancer (NSCLC) based on meta-analysis.Methods:The original research literatures on the diagnostic value of CEA, CYFRA21-1 and CA125 in Chinese NSCLC patients were searched from databases of PubMed, Embase, The Cochrane Library, CNKI, VIP, Database and Wanfang database from establishment to June 2023. The literature screening, data extraction and quality evaluation were carried out independently by two researchers. The quality evaluation tool of diagnostic accuracy studies was used to evaluate the quality of the literature. A summary receiver operating characteristic (SROC) curve was used to assess the overall effectiveness of the tests. The outcome stability and publication bias were detected by using sensitivity analysis and Deeks′ test.Results:A total of 23 studies met the inclusion and exclusion criteria were included. The results of meta-analysis showed that the overall sensitivity of CEA, CYFRA21-1 and CA125 alone in the diagnosis of NSCLC was relatively low, it was 0.49(95% CI: 0.43-0.55), 0.56(95% CI: 0.49-0.63) and 0.41(95% CI: 0.33-0.49), respectively. The overall sensitivity of the combined detection of the three markers for the diagnosis of NSCLC increased to 0.83(95% CI: 0.69-0.91), but the overall specificity decreased to 0.76(95% CI: 0.69-0.83). Conclusions:The single detection of CEA, CYFRA21-1 and CA125 is not recommended for screening NSCLC in population receiving physical examination. Although the sensitivity of the combined detection of CEA, CYFRA21-1 and CA125 for screening NSCLC is improved, but the specificity is decreased, the misdiagnosis rate is increased, so the screening effect is limited.

Clinical Study on Yangxue Sanhan Tongmai Prescription for the Treatment of Endometriosis of Blood Deficiency and Cold Coagulation Type / 广州中医药大学学报

Objective To observe the clinical efficacy of Yangxue Sanhan Tongmai Prescription(derived from the modification of Danggui Sini plus Wuzhuyu Shengjiang Decoction,i.e.,Danggui Sini Decoction with Euodiae Fructus and Zingiberis Rhizoma Recens added)for the treatment of endometriosis(EMS)of blood deficiency and cold coagulation type.Methods A total of 120 cases of EMS with blood deficiency and cold coagulation syndrome were randomly divided into the study group and the control group,with 60 cases in each group.The study group was treated with Yangxue Sanhan Tongmai Prescription,and the control group was treated with Shaofu Zhuyu Granules.Both groups were treated for a period of 3 months,and were followed up for one year after the completion of the treatment.The two groups were observed in the changes of the visual analogue scale(VAS)scores of menstrual abdominal pain,the grading scores of dysmenorrhea,non-menstrual pelvic pain,pain during sexual intercourse,pelvic pressure pain and sacral ligament tenderness,the size of ovarian endometriosis cysts,and the serum levels of carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF),soluble intercellular adhesion molecule 1(SICAM-1),matrix metalloproteinase 9(MMP-9)and tissue inhibitor of metalloproteinase 2(TIMP-2).After treatment,the clinical efficacy and safety,recurrence and pregnancy in the two groups were evaluated.Results(1)In the course of the trial,3 cases fell off in the study group and 5 cases fell off in the control group,and a total of 112 patients were eventually included in the statistical analysis,including 57 cases in the study group and 55 cases in the control group.(2)After 3 months of treatment,the total effective rate in the study group was 92.98%(53/57)and that in the control group was 85.45%(47/55),and the intergroup comparison showed that the efficacy of the study group was significantly superior to that of the control group(P＜0.05).(3)After treatment,VAS scores of menstrual abdominal pain and the grading scores of dysmenorrhea,non-menstrual pelvic pain,pain during sexual intercourse,pelvic pressure pain and sacral ligament tenderness in the two groups were significantly reduced compared with those before treatment(P＜0.05),and the reduction in the study group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the ovarian endometriosis cysts of the two groups were slightly reduced,but the intragroup pre-and post-treatment differences and the intergroup post-treatment differences were not statistically significant(P＞0.05).(5)After treatment,the levels of serum CA125,VEGF,SICAM-1 and MMP-9 were decreased and the serum TIMP-2 level was increased in both groups compared with those before treatment(P＜0.05).And the decrease of serum CA125,VEGF,SICAM-1 and MMP-9 as well as the increase of serum TIMP-2 in the study group were significantly superior to those in the control group(P＜0.05).(6)The results of one-year follow-up showed that the recurrence rate of the study group was 30.19%(16/53),which was significantly lower than that of the control group(68.09%,32/47),and the difference was statistically significant between the two groups(P＜0.05).In the study group,there were 21 patients having the fertility desire,and then 14 cases of them were pregnant after treatment,with a pregnancy rate of 66.67%(14/21);in the control group,there were 20 cases having fertility desire,and then 4 cases of them were pregnant after treatment,with a pregnancy rate of 20.00%(4/20).The intergroup comparison showed that the pregnancy rate of the study group was significantly higher than that of the control group,and the difference was statistically significant(P＜0.05).(7)During the treatment period,there were no obvious adverse reactions in the two groups,and there were no abnormal changes in the safety indexes of blood,urine,and stool routine test,electrocardiogram,and liver and kidney function.Conclusion Yangxue Sanhan Tongmai Prescription exerts certain effect in treating patients with endometriosis of blood deficiency and cold coagulation type,which can significantly alleviate various pain symptoms,improve pregnancy outcomes,and effectively regulate the levels of serum CA125,VEGF,SICAM-1,MMP-9 and TIMP-2 of the patients.

Sarcoidosis presenting as ovarian mass with omental and peritoneal nodules with elevated CA 125 level; mimicking malignancy

Sarcoidosis is a systemic inflammatory disease of unknown aetiology with a variety of nonspecific clinicoradiological features making diagnosis challenging. Sarcoidosis commonly involves pulmonary and lymphoreticular systems; ovarian involvement being extremely rare. We present a case of a 50-year Indian postmenopausal female, with a history of abdominal pain and distension, referred from the peripheral hospital for management of a solid complex left adnexal mass and elevated CA 125 levels. Based on ultrasonography and contrast-enhanced computed tomography, ovarian carcinoma was a differential diagnosis. Ascitic and pleural fluid cytology and ovarian fine needle aspiration cytology (FNAC) didn抰 give any conclusive diagnosis. Hence surgical intervention was carried out. Histopathology revealed noncaseating granulomas in ovaries, peritoneum, and omentum. Tissue polymerase chain reaction (PCR) for tuberculous and nontuberculous mycobacteria was negative. Post-operatively serum angiotensin-converting enzyme (ACE) and calcium levels were elevated. These findings supported the diagnosis of sarcoidosis and the patient responded well to systemic steroids.

Comprehensive review of adnexal masses in a tertiary care hospital

Background: Adnexal masses can be either be a physiological luteal cyst, a benign tubo-ovarian mass or a malignancy. The signs and symptoms along with tumour markers and imaging modalities are considered to differentiate between a benign and a malignant adnexal mass. Adnexal masses in pregnancy can be asymptomatic or can present with acute abdomen in cases of ectopic pregnancy and torsion. The aim was to study the prevalence of various histopathologic types of adnexal masses in different age groups.Methods: This was a retrospective study carried out in the department of obstetrics and gynecology in a tertiary care hospital from May-2019 to April-2022. Women with sonographically diagnosed adnexal mass were evaluated. Data regarding ultrasound findings, tumour markers, RMI score and the management done were recorded from medical record charts. Descriptive statistics was applied and results shown in the form of frequencies and percentages.Results: Among 31 study participants, the most common presentation was pain abdomen. Majority (93.5%) patients had benign adnexal pathology and 6.45% had malignant pathology. The most common ovarian pathology encountered was Benign surface epithelial tumours (48.4%). Early diagnosis of 2 tubal ectopic and 1 ovarian ectopic pregnancy was made and managed conservatively.Conclusions: Early diagnosis and intervention is helpful in adolescent girls to conserve their ovarian function. Early diagnosis of ectopic pregnancy in stable patients can be managed conservatively. A high RMI should raise a suspicion of malignancy.

Comprehensive review of adnexal masses in a tertiary care hospital

Background: Adnexal masses can be either be a physiological luteal cyst, a benign tubo-ovarian mass or a malignancy. The signs and symptoms along with tumour markers and imaging modalities are considered to differentiate between a benign and a malignant adnexal mass. Adnexal masses in pregnancy can be asymptomatic or can present with acute abdomen in cases of ectopic pregnancy and torsion. The aim was to study the prevalence of various histopathologic types of adnexal masses in different age groups.Methods: This was a retrospective study carried out in the department of obstetrics and gynecology in a tertiary care hospital from May-2019 to April-2022. Women with sonographically diagnosed adnexal mass were evaluated. Data regarding ultrasound findings, tumour markers, RMI score and the management done were recorded from medical record charts. Descriptive statistics was applied and results shown in the form of frequencies and percentages.Results: Among 31 study participants, the most common presentation was pain abdomen. Majority (93.5%) patients had benign adnexal pathology and 6.45% had malignant pathology. The most common ovarian pathology encountered was Benign surface epithelial tumours (48.4%). Early diagnosis of 2 tubal ectopic and 1 ovarian ectopic pregnancy was made and managed conservatively.Conclusions: Early diagnosis and intervention is helpful in adolescent girls to conserve their ovarian function. Early diagnosis of ectopic pregnancy in stable patients can be managed conservatively. A high RMI should raise a suspicion of malignancy.

Serum CA 125 level in normotensive and pre-eclamptic pregnancies in a tertiary care hospital

Background: Preeclampsia is one main reason for high-risk pregnancy. Among the disorders in hypertension, preeclampsia develops in antenatal period and it is defined by high blood pressure of more than 140/90 mmHg and arteriolar vasoconstriction, both of which lower uteroplacental perfusion and ultimately lead to placental hypoxia. The objectives of this study was (a) to estimate CA125 level in normotensive and pre eclamptic pregnancies; and (b) to predict severity of pre-eclampsia with CA125 levels with cut off value of CA125 level as 23.7 IU/ml.Methods: This two year cross sectional study was conducted on all antenatal mothers bestween 20 -40 weeks gestational age getting admitted RLJH and research centre Tamaka (January 2021-December 2022), for the period of 2 years who fulfilled inclusion and exclusion criteria. Detailed clinical history along with antenatal examination was done. For each study subject the blood pressure was recorded. Complete blood picture was done and CA125 levels were done of the study subjects.Results: Mean CA125 among normal subjects was 24.24±13.71 IU/ml and Mean CA125 among pre-eclampsia subjects was 30.61±15.69 IU/ml. There was a statistical significance found between two groups with respect to CA125.Conclusions: In pre-eclampsia, CA125 was increased more compared to normotensive group. This indicates the importance in estimation of CA125 level in preeclampsia. The same has been determined with significant p value.

Clinico-radiological and histopathological study of ovarian masses at a tertiary care centre

Background: Counselling and rapid referral to a specialised facility might be improved with the use of a scoring system that could diagnose ovarian cancer. The relative simplicity of the Risk of Malignancy Index (RMI) scoring technique and the ease with which it may be applied make it a strong candidate to use as a primary diagnostic tool for individuals with pelvic masses.Methods: Prospective observations study conducted on women diagnosed with ovarian mass by clinical examination and confirmed by ultrasonography, undergoing surgery at RL Jalappa Hospital, Kolar from January 2021 to December 2022. Histopathological report was considered as Primary outcome parameter. Age group, Parity, Menstrual history, Risk Malignancy Index, etc., were considered as explanatory parameters.Results: A total of 40 subjects are included among which 22.50% are aged ?40 years and 77.50% are aged >40 years. Using a cut off of 25, majority (88.2%) of those with malignancy had RMI?25 and in benign histopathology report 56.5% had ?25 RMI. Histopathology report, there was a statistically significant (p<0.05) difference in RMI values. The RMI had a sensitivity of 88.24% in predicting malignancy with specificity 43.48%, positive predictive value 53.57%, negative predictive value 83.33% with a total diagnostic accuracy of 62.50%.Conclusions: Results from RMI and histopathology correlate positively. The results of this research show that RMI is a reliable and practicable method for assessing patients with pelvic masses at the commencement of therapy and identifying those who are good candidates for centralised surgical treatment.

Ca-125: A Useful Marker to Distinguish Pulmonary Tuberculosis from Bacterial Pneumonia

Background: Ca-125 is a large molecular-weight glycoprotein synthesized by different cells originating from the coelomic epithelium. Although classically it has been used to monitor the course of ovarian epithelial cancer, there are other established circumstances associated with high serum Ca -125 levels and pulmonary tuberculosis is one of them. Diagnosing pulmonary tuberculosis, which is not bacteriologically positive often very challenging. Because many procedures are available for such cases but they are of limited use because some of them are lengthy or expensive or need sophisticated equipment, highly skilled personnel, etc. Serum CA-125 is a rapid, relatively inexpensive investigation. Objective: The present study aimed to assess the role of CA-125 in distinguishing pulmonary TB from bacterial pneumonia. Methods: This analytical cross-sectional study was conducted in the Department of Medicine, Dhaka Medical College Hospital for the period of March 2018 to September 2020.100 pulmonary tuberculosis patients were taken in group I, and 100 bacterial pneumonia patients were taken in group II according to selection criteria. Informed written consent was taken from each of the participants. All were subjected to detail clinical and demographic history along with thorough physical examination. Relevant investigations were done including serum CA-125. All final data were collected in the semi-structured and pretested case record form. After data collection, data were checked for errors, and analysis was done. Results: In this study, the mean CA-125 value was 62.29 (SD±31.51) IU/mL in group I(pulmonary tuberculosis). In group II (bacterial pneumonia) mean value was 22.95(±8.25) IU/mL. The mean value of CA-125 was significantly higher (p-value <0.001) in group I patients compared to group II. About 59.0% of patients in group I had a high level of serum CA-125 which had a significant difference from group II (p<0.001). ROC analysis of CA-125 in the diagnosis of patients with active pulmonary tuberculosis showed a cut-off value of ?31.7 IU/mL had sensitivity, specificity, PPV, NPV, PLR, NLR, and accuracy of 72%, 87%, 84.7%, 75.7%, 5.54%, 0.321%, and 79.5% respectively. Conclusion: This study’s findings stated that serum CA-125 may be a useful marker in distinguishing PTB from bacterial pneumonia. Therefore, further study with a more generalized study population is recommended.

Clinicopathological significance of preoperative thrombocytosis in patients with epithelial ovarian cancer

Background: Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer.Methods: This was a cross-sectional study conducted in the Department of Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during January to December 2019. A total of 94 patients with epithelial ovarian cancer between 18-70 years of age who underwent primary surgical treatment were included in this study. Chi-square tests were done to see the significance of differences between the two groups where p<0.05 considered as the level of significance with 95% CI.Results: The mean age was 45.39±13.23 years in the thrombocytosis and 48.98±15.46 years in without thrombocytosis group with a range of 18 to 70 years (p=0.231). The difference in education and occupation were statistically significant (p<0.05) between the two groups. The mean Hb% was 10.02±1.47 (gm/dl) in thrombocytosis and 11.15±1.52 (gm/dl) without thrombocytosis group. The difference was statistically significant (p<0.001) between two groups. The study showed that 30 (75.0%) patient’s serum CA-125 was >500 in the thrombocytosis group and 9 (16.7%) in the without thrombocytosis group (p=0,001), OR=15.0, 95.0% CI=4.92 to 47.72, p=0.001. Optimal cytoreduction between two groups were observed statistically significant (p=0.004), OR=3.49, 95.0% CI=1.33 to 9.28. The difference of grade of tumor observed statistically significant between the groups (p=0.022). The 11 (27.5%) patients had lymph node metastasis in thrombocytosis group and 6 (11.1%) in without thrombocytosis, OR=3.03, 95.0% CI=0.91 to 10.48, p=0.022. The OR of developing lymph node metastasis was 3.03 times higher in the thrombocytosis group.Conclusions: Thrombocytosis was commonly detected in preoperative evaluation of women diagnosed with epithelial ovarian cancer. Anemia, higher serum CA-125 level >500, sub-optimal cytoreduction, advanced stage disease, higher grade tumor, and lymphnode metastasis were significantly more frequent in patients with thrombocytosis.

Analysis of serum CA125 and related influencing factors in silicosis patients with pulmonary heart disease / 中华劳动卫生职业病杂志

Objective: To analyze the serum carbohydrate antigen 125 (CA125) level and its influencing factors in male silicosis patients with pulmonary heart disease. Methods: In October 2021, data of 38 male patients with simple silicosis (silicosis group), 28 cases of silicosis with pulmonary heart disease (pulmonary heart disease group), and 27 healthy controls (control group) in the same age group were collected in inpatient and outpatient of Nanjing Occupational Disease Prevention and Control Hospital from January 2017 to December 2020. The serum CA125 levels of the three groups were compared, and the correlation between disease-related indexes and serum CA125 in silicosis patients with pulmonary heart disease was analyzed, as well as the influencing factors of pulmonary heart disease and serum CA125 levels in silicosis patients. Results: The serum CA125 level[ (19.95±7.52) IU/ml] in pulmonary heart disease group was higher than that in silicosis group[ (12.98±6.35) IU/ml] and control group[ (9.17±5.32) IU/ml] (P<0.05). There was no significant difference in serum CA125 level between the silicosis group and the control group (P>0.05). Serum CA125 levels were positively correlated with blood uric acid and fasting blood glucose in silicosis patients with pulmonary heart disease (r=0.39, 0.46, P<0.05). Serum CA125 level was a risk factor for silicosis patients with pulmonary heart disease (OR=1.13, 95%CI: 1.02-1.24, P<0.05). Dust exposure time, lactate dehydrogenase and smoking history were positively correlated with serum CA125 level in silicosis patients (P<0.05) . Conclusion: The serum CA125 level of male silicosis patients with pulmonary heart disease is significantly increased, and the level of CA125 is correlated with the level of fasting blood glucose and blood uric acid.

Characteristics of endometriosis in 18F-FDG PET/CT imaging / 中华核医学与分子影像杂志

Objective:To explore the 18F-FDG PET/CT imaging features in endometriosis (EMS), in order to provide valuable information for accurate clinical diagnosis. Methods:The clinical and imaging data of 21 patients (age range 23-72 (44.0±11.4) years) who underwent 18F-FDG PET/CT imaging in Fudan University Shanghai Cancer Center between December 2016 and May 2021, and were pathologically confirmed to be EMS, were retrospectively collected. The symptoms and signs, carbohydrate antigen (CA)125 levels, and the characteristics of the lesions on PET/CT images were analyzed. According to the intraoperative lesion invasion score, patients were divided into group A with lesion confined to the adnexal region (the score ≤4), and group B with multiple sites invaded (the score >4). The differences in age, CA125, SUV max, SUV mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were analyzed by independent-sample t test or Mann-Whitney U test. Results:About 42.9%(9/21) had a history of dysmenorrhea. CA125 was elevated in 95.2%(20/21) of the patients. CA125 levels of the group A and group B were 88.4(42.0, 351.5) and 619.8(72.3, 1 420.0) kU/L, respectively, which meant the higher the CA125 and the wider the lesion involvement ( z=-2.32, P=0.041). The older the patients, the more likely the lesions were confined to the adnexal region ( t=-2.10, P=0.049). The SUV max of the two groups were 3.67±1.78 and 3.93±1.88, respectively ( t=0.33, P=0.746). The other metabolic parameters (SUV mean, MTV and TLG) of the 2 groups were not significantly different either ( t=0.79, both z=-1.16, P values: 0.446, 0.245, 0.245). About 23.8%(5/21) of patients were with SUV max greater than 5, and 4 of them had inflammation. Conclusions:EMS patients are often accompanied by abdominal pain and increased CA125. The older the age, the more prone to focal involvement of appendages. The higher the CA125 level, the wider the lesion involvement. The 18F-FDG metabolism level has nothing to do with the scope of the lesion, but when the SUV max of the lesion >5, it is often accompanied by acute inflammation, which is easy to be misdiagnosed.

Marcadores tumorales CA125, He4 e índice ROMA en cáncer de ovario / Tumor markers CA125, He4, ROME index in ovarian cancer / Marcadores tumorais CA125, He4 e índice ROMA no câncer de ovário

El cáncer de ovario es un problema de salud pública para el cual no se cuenta con métodos de tamizaje estandarizados, no obstante, los marcadores Ca125, He4 y el índice de Roma tiene un gran valor en el diagnóstico y pronóstico de esta patología. Objetivo. Analizar el comportamiento de los marcadores tumorales Ca125 y He4 e índice de Roma en la predicción de malignidad en pacientes con masas ováricas. Materiales y Métodos. Se tomaron los resultados de laboratorio de 112 mujeres atendidas en el Hospital General Ambato de los valores séricos de Ca125, He4 y su correspondiente cálculo del índice de Roma. Se los dividió en el grupo pre y postmenopáusico, maligno y benigno. Resultados. El análisis de los resultados definió la relación de Ca 125 y He4 con el diagnóstico de cáncer de ovario con un nivel de confianza del 95% y valor de p<0,05. La probabilidad de diferenciar cáncer de ovario de procesos benigno para Ca125, He4 e índice de Roma fue del 93,33%, 84,4 y 99,7, respectivamente. Conclusiones. El mejor predictor de malignidad es el índice de Roma. Se encontraron valores séricos elevados de He4 mayores para pacientes postmenopáusicas. Se requieren más estudios que avalen un método de tamizaje estandarizado para el cáncer de ovario.

Ovarian cancer is a public health problem for which there are no standardized screening methods; however, Ca125, He4 and Rome index markers are of great value in the diagnosis and prognosis of this pathology. Objective. To analyze the behavior of tumor markers Ca125 and He4 and Rome index in the prediction of malignancy in patients with ovarian masses. Materials and Methods. The laboratory results of 112 women attended at Hospital General Ambato were taken for serum Ca125, He4 and their corresponding calculation of the Rome index. They were divided into premenopausal and postmenopausal, malignant and benign groups. Results. Analysis of the results defined the relationship of Ca 125 and He4 with the diagnosis of ovarian cancer with a confidence level of 95% and value of p<0.05. The probability of differentiating ovarian cancer from benign processes for Ca125, He4 and Rome index was 93.33%, 84.4 and 99.7, respectively. Conclusions. The best predictor of malignancy is the Rome index. Elevated serum He4 values were found to be higher for postmenopausal patients. Further studies are needed to support a standardized screening method for ovarian cancer.

O câncer do ovário é um problema de saúde pública para o qual não existem métodos de triagem padronizados. No entanto, os marcadores índice Ca125, He4 e Roma são de grande valor no diagnóstico e prognóstico desta patologia. Objetivo. Analisar o comportamento dos marcadores tumorais Ca125 e He4 e o índice de Roma na previsão de malignidade em pacientes com massas ovarianas. Materiais e métodos. Os resultados laboratoriais de 112 mulheres tratadas no Hospital Geral Ambato foram tomados para o soro Ca125, He4 e seu correspondente cálculo do índice de Roma. Eles foram divididos em grupos pré e pós-menopausa, malignos e benignos. Resultados. A análise dos resultados definiu a associação de Ca125 e He4 com o diagnóstico de câncer de ovário a um nível de confiança de 95% e valor de p<0,05. A probabilidade de diferenciar o câncer de ovário dos processos benignos para Ca125, He4 e índice de Roma foi de 93,33%, 84,4 e 99,7, respectivamente. Conclusões. O melhor preditor de malignidade é o índice de Roma. Os valores elevados de soro He4 foram considerados mais altos para pacientes na pós-menopausa. São necessários mais estudos para apoiar um método padronizado de triagem para o câncer de ovário.