Menopausal status combined with serum CA125 level significantly predicted concurrent endometrial cancer in women diagnosed with atypical endometrial hyperplasia before surgery

Background: Pre-operative knowledge regarding the nature of ovarian mass is necessary in order to plan surgery. Risk malignancy index (RMI) is a simple scoring system based on three factors serum CA 125, USG score and menopausal status. The RMI was interpreted as 1) score >250=high risk, 2) 25-250=intermediate risk, 3) score <25=low risk. The objective of the study was to evaluate risk malignancy index (RMI) in pre-operatively clinically diagnosed ovarian mass and to compare the validity of individual parameter in RMI i.e. menopausal status, serum CA 125 and USG score to differentiate the nature of clinically diagnosed ovarian masses as benign or malignant.Methods: This was an observational study conducted in the Department of obstetrics and gynaecology, Trichy SRM Medical College and Research Centre, Trichy from January 2017 to January 2018 with a sample size of 77 cases with clinical diagnosis of ovarian mass admitted for surgery. The validity of RMI and validity of individual parameters were calculated and compared.Results: A total of 77 patients with ovarian tumors were enrolled in this study. According to the histological examination of the surgical specimens of the 77 women, 27.3% (n=21) had malignant tumors and 67.7% (n=56) had benign disease. Most common benign tumour was serous cystadenoma and the most common malignant tumour was mucinous cystadenocarcinoma. Among 77 patients, 42.85% (n=33) were postmenopausal, 44.15% (n=34) had USG score of 4, 27.27% (n=21) had serum CA125 level >cut-off values and 27.27% (n=21) had RMI >250. In cases where RMI>250, 18 out of 21 were malignant. In cases where USG score was 4, 19 out of 34 were malignant. Of the cases where serum CA125 level was > cut-off values 16 out of 21 were found to be malignant. RMI showed better sensitivity of 85.71%, specificity of 94.64%, PPV of 85.71%, NPV of 94.64% and diagnostic accuracy of 92.20%.Conclusions: RMI is highly valuable and reliable in differentiating benign and malignant ovarian lesions and facilitates selection of cases for conservative management and oncology referral.

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Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery

Diagnostics ◽

10.3390/diagnostics12010006 ◽

2021 ◽

Vol 12 (1) ◽

pp. 6

Author(s):

Yaochen Lou ◽

Jiongbo Liao ◽

Weiwei Shan ◽

Zhiying Xu ◽

Xiaojun Chen ◽

...

Keyword(s):

Endometrial Cancer ◽

High Risk ◽

Endometrial Hyperplasia ◽

Menopausal Status ◽

Tertiary Hospital ◽

Endometrial Biopsy ◽

Atypical Endometrial Hyperplasia ◽

Primary Surgery ◽

Postmenopausal Status ◽

Potential Risk Factors

About 10–66% of patients with atypical endometrial hyperplasia diagnosed before surgery (preoperative-AEH) are found to have concurrent endometrial cancer (EC) at definitive hysterectomy, leading to incomplete primary surgery and delayed adjuvant treatment. This study aims to investigate the potential risk factors of concurrent EC in preoperative-AEH patients in a clinical setting with a gynecological pathology review. All patients diagnosed with AEH by endometrial biopsy or curettage that then underwent definitive hysterectomy from January 2016 to December 2019 in a tertiary hospital were retrospectively analyzed. All diagnoses were reviewed by gynecological pathologists. A total of 624 preoperative-AEH patients were included, 30.4% of whom had concurrent EC. In multivariate analysis, postmenopausal status and CA125 ≥ 35 U/mL significantly correlated with concurrent EC (OR = 3.57; 95% CI = 1.80–7.06; OR = 2.15; 95% CI = 1.15–4.03). This risk was remarkably increased in patients with both postmenopausal status and CA125 ≥ 35 U/mL (OR = 16.20; 95% CI = 1.73–151.44). Notably, concurrent EC seemed to occur more frequently in women with postmenopausal time ≥ 5 years (OR = 4.04, 95% CI = 1.80–5.85). In addition, CA125 ≥ 35 U/mL seemed to be an independent risk factor (OR = 5.74; 95% CI = 1.80–18.27) for concurrent intermediate-high-risk EC. Intermediate-high-risk EC was also more commonly seen in preoperative-AEH women with postmenopausal time ≥ 5 years (OR = 5.52, 95% CI = 1.21–25.19, p = 0.027). In conclusion, preoperative-AEH patients with postmenopausal status or elevated level of CA125 might have a high risk of concurrent EC. Adequate pre-surgical evaluation might be suggested for such patients.

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Value of pre-operative serum CA125 level for prediction of prognosis in patients with endometrial cancer

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.2011.01325.x ◽

2011 ◽

Vol 51 (5) ◽

pp. 397-402 ◽

Cited By ~ 17

Author(s):

Yu-Li CHEN ◽

Chia-Yen HUANG ◽

Tsai-Yen CHIEN ◽

Shih-Hung HUANG ◽

Ching-Jung WU ◽

...

Keyword(s):

Endometrial Cancer ◽

Ca125 Level ◽

Serum Ca125 ◽

Serum Ca125 Level ◽

Prediction Of Prognosis

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Clinical analysis of benign pelvic tumors with ascites,hydrothorax and high serum CA125 level

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2008.00463 ◽

2008 ◽

Vol 28 (4) ◽

pp. 463-464

Author(s):

Ming-juan XU

Keyword(s):

Clinical Analysis ◽

High Serum ◽

Ca125 Level ◽

Pelvic Tumors ◽

Serum Ca125 ◽

Serum Ca125 Level

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Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽

10.3390/diagnostics11030442 ◽

2021 ◽

Vol 11 (3) ◽

pp. 442

Author(s):

Norbert Stachowicz ◽

Agata Smoleń ◽

Michał Ciebiera ◽

Tomasz Łoziński ◽

Paweł Poziemski ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Menopausal Status ◽

Power Doppler ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Scoring Systems ◽

Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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