scholarly journals Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses

2017 ◽  
Vol 6 (2) ◽  
pp. 626
Author(s):  
Shyamala Jothy M. ◽  
Anju Padmasekar
Keyword(s):  
Ovarian Cancer ◽  
Scoring System ◽  
Early Stage ◽  
Menopausal Status ◽  
Ca 125 ◽  
Screening Methods ◽  
Surgical Removal ◽  
Color Flow ◽  
Early Stage Disease ◽  
Ovarian Masses

Background: Ovarian cancer is the most frequent cause of death from Gynaecological malignancies in the world. Most patients with epithelial ovarian cancer are asymptomatic in early stage disease and usually present with stage III or IV disease. There are various screening methods for detection of ovarian cancer like bimanual pelvic examination, ultrasound examination (TVS and TAS) with or without color Doppler flow imaging and measurement of various circulating proteins like CA 125. The Purpose of a study is to determine optimal cut off point for a morphological scoring system and color flow directed Doppler values to differentiate benign and malignant ovarian masses.Methods: This study was done at Department of obstetrics and Gynaecology, Government Rajah Mirasudhar Teaching Hospital attached to Government Thanjavur Medical College, Thanjavur, Tamilnadu, India during the period of June – 2011 to October – 2012. This study consisted of 73 patients, 3 patients were not operated as they were not fit for surgery for medical reasons. Hence 70 patients were included in the study. A note was made of their main symptoms at admission, Parity, menopausal status, family history of carcinoma. Patients admitted with diagnosis of ovarian masses and clearly ovarian by sonomorphology and surgery were only included in this study. Morphological Score, RI and PI were calculated. All patients underwent exploratory laparotomy with surgical removal of the tumor. The final diagnosis obtained based on HPE were classified as either benign or malignant. The score of each mass and the Doppler values were assessed individually and in combination with regard to its relationship to final diagnosis.Results: In summary the resistance to flow measurement obtained by Doppler had a higher sensitivity and specificity compared to the morphological scoring system in differentiating benign and malignant ovarian masses. The combination of morphological score and Doppler Measurements improved the specificity positive predictive value for differentiating benign and malignant ovarian masses. Conclusions: The combination of ultrasound and Doppler values is better in differentiating benign from malignant ovarian masses. The cut off point for ultrasound guided morphological scoring system was 4 and Doppler velocimetry for differentiating benign and malignant ovarian masses was a RI of 0.55 and PI of 0.8.

Final results of 4-monthly screening in the UK Familial Ovarian Cancer Screening Study (UKFOCSS Phase 2).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5507-5507 ◽  
Author(s):  
Adam N Rosenthal ◽  
Lindsay Fraser ◽  
Susan Philpott ◽  
Ranjit Manchanda ◽  
Philip Badman ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Transvaginal Ultrasound ◽  
Phase 1 ◽  
Menopausal Status ◽  
Cancer Registries ◽  
Ovarian Cancer Screening ◽  
Fallopian Tube Cancer ◽  
Early Stage Disease ◽  
Optimal Debulking

5507^ Background: Annual transvaginal ultrasound (TVS) and serum CA125 screening for women at high-risk of Ovarian/Fallopian tube cancer (OC/FTC) in Phase 1 of UKFOCSS lacked sensitivity for early stage disease but downstaged disease volume and may have improved optimal debulking rates. More frequent screening might provide greater benefits. Here we report the final results of 4-monthly screening in one of the largest such trials worldwide. Methods: Between 14/06/2007 and 29/03/2012, 4,531 women at an estimated ≥10% lifetime risk of OC/FTC were recruited and screened by 42 UK centres for 14,263 women screen years. Screening comprised 4-monthly CA125 tests analysed by a risk of ovarian cancer algorithm, adjusted for menopausal status. TVS was annual in those with normal algorithm results, but was triggered sooner if results were non-normal. Women with suspicious scan and/or algorithm results were referred for consideration of surgical intervention. Participants were followed prospectively by centres, questionnaire and national cancer registries. Data was censored 365 days after final screen, withdrawal or death. Clinical trial information: 32794457.

scholarly journals Role of PET/CT in Assessment of Recurrent Ovarian Tumors

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S Kadry ◽  
A Haggag ◽  
A Ekbal
Keyword(s):  
Ovarian Cancer ◽  
Tumor Marker ◽  
Early Stage ◽  
Ovarian Tumors ◽  
University Hospital ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Major Health Problem ◽  
Pet Ct ◽  
Suspected Recurrence

Abstract Background Ovarian cancer remains a major health problem worldwide, with over 225,000 new cases and 140,000 deaths reported annually. Despite high response after initial treatment, 20-30% of patients with early-stage disease and up to 75% of patients with advanced disease present with recurrence within two years. Early diagnosis of recurrence is crucial for determination of the best treatment. Aim of the Work is to detect the significance of PET/CT in the early detection of recurrent ovarian tumors. Patients and Method The study included 25 patients who have been diagnosed with ovarian cancer, received treatment and achieved complete response. All of the 25 patients had suspected recurrence either due to elevated tumor markers or suspicious clinical findings. The 25 patients have been referred for PET/CT scan at ElDemerdash university hospital from July 2017 to August 2018. Results Total of 25 patients were included in the study. 18 of 25 patients had high tumor marker (CA 125) level. The remaining 7 patients had suspected recurrence with normal tumor marker levels. Recurrence was confirmed by histopathology or clinical and imaging follow up in 19 patients of the 25 patients. Recurrent disease was not shown in 5 of 19 patients on CECT imaging and 1 of 19 patients on PET/CT imaging. PET/CT had a sensitivity of (94.74%), specificity of (100%) and accuracy of (96%). CECT has been reported with sensitivity of (73.68), specificity of (83.33%) and accuracy of (76%). Conclusion PET/CT is a useful tool and has a higher sensitivity, specificity and accuracy than CECT in detection of recurrent ovarian cancer.

scholarly journals Risk of Malignancy Index is not accurate as a Triage Tool for Ovarian Cancer

2014 ◽  
pp. 50-54
Author(s):  
Gregorius Tanamas ◽  
Jasmine Iskandar ◽  
Tofan W Utami ◽  
Tricia D Anggraeni ◽  
Kartiwa H Nuryanto
Keyword(s):  
Ovarian Cancer ◽  
Menopausal Status ◽  
Ca 125 ◽  
Normal Body Mass Index ◽  
Ovarian Cancer Risk ◽  
Malignant Case ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Pathological Report ◽  
Ovarian Masses

Objective: To evaluate Risk of Malignancy Index (RMI) as a triage tool for ovarian cancer in Dr. Cipto Mangunkusumo Hospital. Method: This is a retrospective study conducted from January 2008-December 2012 in patients diagnosed with ovarian mass. Patients admitted for surgery due to ovarian masses were included to this study. RMI 3 score was calculated based on ultrasonography examination in Dr. Cipto Mangunkusumo Hospital, CA-125 test and menopausal status. Patients without final pathological report and incomplete data were excluded from study. Data were analysed using SPSS 20 to evaluate RMI result and final pathlogical report in benign and malignant case. Result: From 882 patients identified with ovarian masses from cancer registry, only 99 patients aged 17-70 y.o were included in this study. Most of the patients were nully-parity (28.3%), non-menopausal women (60.6%), normal body mass index (40.4%), and with stage IIIC ovarian cancer (33.3%). Ultrasonography examination showed that most of patients had solid mass and ascites (19.2%). Meanwhile, CA-125 showed that patients with <35 U/ml were 10.1% and ≥ 35 U/ml were 89.9%. Patients with RMI scores <200 (benign cases) were 19 cases (19.2%) and ≥ 200 (malignant cases) were 80 cases (80.8%). Meanwhile, patients with benign final pathological report were 23 cases (23.2%) and malignant cases were 76 cases (76.8%). There was no statistical difference in RMI between benign and malignant cases based on final pathological report. Conclusion: Our study showed that RMI was not accurate as triage tool for ovarian cancer in our hospital. Further investigation and more patients are needed to confirm this study. Keywords: CA-125, menopausal status, ovarian cancer, risk of malignancy index (RMI), ultrasonography.

Preoperative Sensitivity and Specificity for Early-Stage Ovarian Cancer When Combining Cancer Antigen CA-125II, CA 15-3, CA 72-4, and Macrophage Colony-Stimulating Factor Using Mixtures of Multivariate Normal Distributions

2004 ◽  
Vol 22 (20) ◽  
pp. 4059-4066 ◽  
Author(s):  
Steven J. Skates ◽  
Nora Horick ◽  
Yinhua Yu ◽  
Feng-Ji Xu ◽  
Andrew Berchuck ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Screening Sensitivity ◽  
Stimulating Factor ◽  
Combining Information

Purpose In CA-125–based ovarian cancer screening trials, overall specificity and screening sensitivity of ultrasound after an elevated CA-125 exceeded 99.6% and 70%, respectively, thereby yielding a positive predictive value (PPV) exceeding 10%. However, sensitivity for early-stage disease was only 40%. This study aims to increase preoperative sensitivity for early-stage ovarian cancer while maintaining the annual referral rate to ultrasound at 2% by combining information across CA-125II, CA 15-3, CA 72-4, and macrophage colony-stimulating factor (M-CSF). For direct comparisons between marker panels, all sensitivity results correspond to a 98% fixed first-line specificity (referral rate 2%). Patients and Methods Logistic regression, classification tree, and mixture discriminant analysis (MDA) models were fit to a training data set of preoperative serum measurements (63 patients, 126 healthy controls) from one center. Estimates from the training set applied to an independent validation set (60 stage I to II patients, 98 healthy controls) from two other centers provided unbiased estimates of sensitivity. Results Preoperative sensitivities for early-stage disease of the optimal panels were 45% for CA-125II; 67% for CA-125II and CA 72-4; 70% for CA-125II, CA 72-4, and M-CSF; and 68% for all four markers (latter two results using MDA). Conclusion Efficiently combining information on CA-125II, CA 72-4, and M-CSF significantly increased preoperative early-stage sensitivity from 45% with CA-125II alone to 70%, while maintaining 98% first-line specificity. Screening trials with these markers using MDA followed by referral to ultrasound may maintain previously high levels of specificity and PPV, while significantly increasing early-stage screening sensitivity. MDA is a useful, biologically justified method for combining biomarkers.

scholarly journals Nadir CA-125 has prognostic value for recurrence, but not for survival in patients with ovarian cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Szymon Piatek ◽  
Grzegorz Panek ◽  
Zbigniew Lewandowski ◽  
Dominika Piatek ◽  
Przemyslaw Kosinski ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Additive Models ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Risk Of Recurrence ◽  
Increased Risk

AbstractThe objective of this study was to evaluate the nadir CA-125 in patients with epithelial ovarian cancer. A total of 168 patients who achieved complete remission (no clinical and radiological signs, CA-125 ≤ 35 U/ml) after first-line treatment were enrolled in the study. The relationship between CA-125 and survival was examined by applying generalized additive models to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7–35 U/ml). The nadir CA-125 was related to progression-free survival but not to overall survival. The risk of recurrence in patients with 11–25 U/ml and 26–35 U/ml compared to patients with ≤ 10 U/ml was 1.87 (p < 0.0024) and 2.17 (p < 0.018), respectively. An increased risk of recurrence according to the nadir CA-125 (≤ 10 U/ml vs. 11–25 U/ml and ≤ 10 U/ml vs. 26–35 U/ml) was found in patients with high-grade tumours (hazard ratio, HR = 2.08 and 2.59, respectively), advanced disease (HR = 2.38 and 2.03, respectively), serous histology (HR = 2.08 and 2.43, respectively) and after complete cytoreduction (HR = 2.7 and 2.72, respectively). No correlation between the CA-125 nadir and recurrence risk was found in patients with early-stage disease or those receiving neoadjuvant chemotherapy or bevacizumab.

scholarly journals Screening methods of ovarian cancer in adults

2005 ◽  
Vol 133 (1-2) ◽  
pp. 72-75 ◽  
Author(s):  
Vera Milenkovic ◽  
Radmila Sparic ◽  
Jasmina Atanackovic
Keyword(s):  
Ovarian Cancer ◽  
High Mortality ◽  
Early Stage ◽  
Uterine Cancer ◽  
Direct Result ◽  
High Risk Population ◽  
Screening Methods ◽  
Ovarian Cancer Screening ◽  
Early Stage Disease ◽  
Stage Disease

Ovarian cancer is associated with high mortality rate which has improved a little despite therapeutic advances. It causes more deaths than combined cervical and uterine cancer. High mortality is believed to be a direct result of already advanced stage at the time of diagnosis. Survival is excellent in case of early stage disease but poor in late stage disease, regardless of histology. The goal of screening for ovarian cancer is restricted to detection of asymptomatic early stage disease, as precursor lesions of ovarian cancer have not been identified. At present, there is no reliable method of ovarian cancer screening which has been shown to reduce mortality from ovarian cancer. Therefore, routine screening of women in general population can not be currently advised. Screening should be limited to high-risk population and subjects participating in research projects as long as the results of current studies are available.

scholarly journals Nadir CA-125 Is Prognostic for Recurrence, but Not for Survival in Patients With Ovarian Cancer

2021 ◽  
Author(s):  
Szymon Piatek ◽  
Grzegorz Panek ◽  
Zbigniew Lewandowski ◽  
Dominika Piatek ◽  
Przemyslaw Kosinski ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Additive Models ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Risk Of Recurrence

Abstract Objective of this study was to evaluate nadir CA-125 in patients with epithelial ovarian cancer. 168 patients, who achieved complete remission (no clinical and radiological signs, CA-125< 35 U/ml) after first line treatment were enrolled in the study. The relation between CA-125 and survival were examined using generalized additive models applied to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7-35 U/ml). No correlation between CA-125 nadir and overall survival was found (p linear = 0.13; p nonlinear = 0.52). Patients with CA-125 serum concentrations of 11 - 25 U/ml and 26 - 35 U/ml had significantly higher risk of recurrence compared to patients with CA-125 concentration ≤ 10 U/ml with HR = 1.865 (P <0.0024) and HR = 2.17 (P <0.018), respectively. Nadir CA125 was not relevant for risk of recurrence in FIGO I and II (p=0.75 and p=0.99, respectively), neoadjuvant chemotherapy (p=0.49 and p=0.26 respectively) or bevacizumab (p=0.066 and p=0.26). Nadir CA-125 is not related to overall survival. Risk of ovarian cancer relapse increase with CA-125 nadir level. However in patients with early stage disease or those receiving neoadjuvant chemotherapy or bevacizumab may not be associated with recurrence risk.

The Role of CA 125 in Screening for Ovarian Cancer

1998 ◽  
Vol 13 (4) ◽  
pp. 216-220 ◽  
Author(s):  
A.N. Rosenthal ◽  
I.J. Jacobs
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Survival Rates ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Mathematical Algorithm ◽  
Gynaecological Malignancy ◽  
Stage Disease ◽  
Screening Strategies ◽  
Randomised Controlled

Ovarian cancer has the worst prognosis of any gynaecological malignancy, primarily because it tends to present at an advanced stage. The excellent survival rates of early stage disease have provided the rationale for efforts to detect ovarian cancer early by screening, in the hope that survival rates will be improved. Available data suggests that CA 125 is elevated in the majority of epithelial ovarian malignancies prior to clinical presentation. Large trials of screening for ovarian cancer indicate that using a CA 125 cutoff value of 30 U/mL has good sensitivity, but inadequate specificity for detecting preclinical disease. Use of transvaginal ultrasonography as a second-line test in women with elevated CA 125 levels improves specificity to acceptable levels, as does use of a mathematical algorithm which analyses rates of change of CA 125. Two major randomised controlled trials, investigating the effect of screening strategies incorporating CA 125 on mortality, are currently underway.

Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature

2007 ◽  
Vol 17 (1) ◽  
pp. 21-31 ◽  
Author(s):  
A. Gadducci ◽  
S. Cosio ◽  
P. Zola ◽  
F. Landoni ◽  
T. Maggino ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Fdg Pet ◽  
Recurrent Disease ◽  
Early Stage ◽  
Gynecological Cancer ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Asymptomatic Patients

Epithelial ovarian cancer is the leading cause of death from gynecological cancer in the Western countries. Approximately 20%–30% of patients with early-stage disease and 50%–75% of those with advanced disease who obtain a complete response following first-line chemotherapy will ultimately develop recurrent disease, which more frequently involves the pelvis and abdomen. Few formal guidelines exist regarding the surveillance of these patients, and there is no agreement in the literature about the type and timing of examinations to perform. Moreover, the objective of follow-up is unclear as recurrent epithelial ovarian cancer continues to be a therapeutic dilemma and quite all the relapsed patients will eventually die of their disease. The follow-up of asymptomatic patients generally include complete clinical history, serum cancer antigen (CA)125 assay, physical examination, and often ultrasound examination, whereas additional radiologic imaging techniques are usually performed when symptoms or signs appear.18Fluoro-2-deoxy-glucose (18FDG)–positron emission tomography (PET) has a sensitivity of 90% and a specificity of 85% approximately for the detection of recurrent disease, and this examination appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Recently, technologic advances have led to novel combined18FDG-PET/computed tomography (CT) devices, which perform contemporaneous acquisition of both18FDG-PET and CT images. The role of18FDG-PET/CT for the detection of recurrent ovarian cancer is very promising, and this technique may be especially useful for the selection of patients with late recurrent disease who may benefit from secondary cytoreductive surgery.

scholarly journals Automated Assay of a Four-Protein Biomarker Panel for Improved Detection of Ovarian Cancer

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 325
Author(s):  
Christopher Walker ◽  
Tuan-Minh Nguyen ◽  
Shlomit Jessel ◽  
Ayesha B. Alvero ◽  
Dan-Arin Silasi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Detection ◽  
Predictive Value ◽  
Early Stage ◽  
Ca 125 ◽  
Healthy Controls ◽  
Classification Models ◽  
Serum Samples ◽  
Protein Biomarker ◽  
Biomarker Panel

Background: Mortality from ovarian cancer remains high due to the lack of methods for early detection. The difficulty lies in the low prevalence of the disease necessitating a significantly high specificity and positive-predictive value (PPV) to avoid unneeded and invasive intervention. Currently, cancer antigen- 125 (CA-125) is the most commonly used biomarker for the early detection of ovarian cancer. In this study we determine the value of combining macrophage migration inhibitory factor (MIF), osteopontin (OPN), and prolactin (PROL) with CA-125 in the detection of ovarian cancer serum samples from healthy controls. Materials and Methods: A total of 432 serum samples were included in this study. 153 samples were from ovarian cancer patients and 279 samples were from age-matched healthy controls. The four proteins were quantified using a fully automated, multi-analyte immunoassay. The serum samples were divided into training and testing datasets and analyzed using four classification models to calculate accuracy, sensitivity, specificity, PPV, negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). Results: The four-protein biomarker panel yielded an average accuracy of 91% compared to 85% using CA-125 alone across four classification models (p = 3.224 × 10−9). Further, in our cohort, the four-protein biomarker panel demonstrated a higher sensitivity (median of 76%), specificity (median of 98%), PPV (median of 91.5%), and NPV (median of 92%), compared to CA-125 alone. The performance of the four-protein biomarker remained better than CA-125 alone even in experiments comparing early stage (Stage I and Stage II) ovarian cancer to healthy controls. Conclusions: Combining MIF, OPN, PROL, and CA-125 can better differentiate ovarian cancer from healthy controls compared to CA-125 alone.

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