Development of a multimarker assay for differential diagnosis of benign and malignant pelvic masses.

BACKGROUND: HE4, a novel tumor marker for detecting ovarian cancer, has been recently applied to clinical practice. However, the comprehensive evaluation of HE4 combined with other markers is still missing. We evaluated an optimal mode of HE4 employment for differential diagnosis of benign and malignant pelvic masses. METHODS: Serum HE4, CA125, CA153, CA199, CA211 and CA724 were measured from 232 patients with pelvic messes (100 malignant masses, 132 benign diseases), and the risk of ovarian malignancy algorithm (ROMA) was also calculated. Receiver operating characteristic curves (ROC), the area under the curve (AUC), sensitivity and specificity were estimated. RESULTS: The combination of HE4 and CA125 (AUC of 0.963, sensitivity of 96.6%, specificity of 65.7%) provided the best differential power in diagnosing ovarian cancer. ROMA performed better in the diagnosis of pelvic masses (AUC of 0.917, sensitivity of 82.0%, specificity of 78.8%) and uterine cancer (AUC of 0.838, sensitivity of 82.0%, specificity of 60.0%) compared with applying HE4 and CA125 individually. CONCLUSION: The optimal cut-off values (CA125: 93.2U/ml, HE4: 87.6 pmol/l, ROMA: 18.1% for pre- and 31.5% for postmenopausal women), simultaneous use of CA125 and HE4 complemented by ROMA showed better performance than the traditional detection modes for differential diagnosis of ovarian cancer. We also observed that ROMA added more accuracy for differentiating the benign and malignant pelvic masses and auxiliary diagnosis of uterine cancer.

Thrombophilia Markers in Patients with Recurrent Early Miscarriage.

BACKGROUND: This study was to investigate the association between thrombophilia and REM by the change of thrombophilia markers and to evaluate their contribution in diagnosis and treatment of REM. METHODS: 199 women with REM history were divided into two groups within the study group: 151 pregnant (REM-P) and 48 nonpregnant (REM-NP). In addition, 121 healthy age-matched women without REM history were divided into two groups of the control group: 75 pregnant (Control-P) and 46 nonpregnant (Control-NP). Lupus anticoagulant (LA), anticardiolipin antibodies (ACA), and anti-ß2-glycoprotein-I antibodies (anti-ß2GPI-ab) and coagulation-related factors such as protein S (PS), protein C (PC), anti-thrombin III (AT-III), and D-dimer were analysed. The prevalence of antiphospholipid antibodies (aPL) and the coagulation-related factors between groups were compared. RESULTS: The overall prevalence of aPL positivity in REM-P (14.57%) showed a difference compared with REM-NP (2.66%) but not for aCL, anti-ß2GPI-ab or LA alone. There were significant differences in the mean levels of protein S, protein C, and AT-III in REM-P. The mean values of protein C (90.3 ± 28.42%) and protein S (71.80 ± 24.68%) in the aPL positive study group were similar with that of the aPL negative study group (p = 0.406, p = 0.880). Comparing with the aPL negative study group, the mean value of AT-III (87.71 ± 21.84%) was significantly lower (p = 0.018), while the mean value of D-dimer (0.98 ± 1.1 mg/L FEU) was significantly higher (p = 0.013). CONCLUSIONS: We briefly address the role of the prevalence of aPL and the related coagulation factors for predicting a prethrombotic state in patients with REM. The results of the use of anticoagulants for treating REM are encouraging.