Osobennosti diagnostiki i techeniya endometrioza s decidual'nym metamorfozom vo vremya beremennosti

V nastoyashchee vremya pri nalichii decidualizirovannyh endometrioidnyh kist yaichnikov (DEK) hirurgicheskoe lechenie dlya isklyucheniya zlokachestvennyh opuholej yaichnikov vypolnyayut prakticheski v 90% sluchaev. Neopravdannye hirurgicheskie vmeshatel'stva pri etom uvelichivayut risk dlya zdorov'ya materi i ploda. Cel'yu issledovaniya bylo provesti differencial'nuyu diagnostiku DEK u beremennyh dlya opredeleniya racional'nogo lecheniya. V issledovanie vklyucheny 82 pacientki: 63 iz nih byli s endometrioidnymi kistami (EK), 16 — s DEK, 3 — s redkimi formami endometrioza i 10 — s seroznymi papillyarnymi pogranichnymi opuholyami yaichnikov. Dlya ul'trazvukovoj (UZ) diagnostiki ispol'zovali predlozhennuyu avtorami model'. Poluchennye UZ-dannye sopostavlyali s koncentraciej belka-onkomarkera (SA-125), rasschityvali indeks RMI (risk of malignancy index), vypolnyali morfologicheskoe issledovanie obrazovanij. Osobo cennymi UZ-parametrami pri differencial'noj diagnostike EK, DEK i pogranichnyh seroznyh opuholej byli: izmenennaya tolshchina stenki obrazovaniya, nalichie i forma papillyarnyh obrazovanij, avaskulyarnye ekhogennye vklyucheniya bez chetkih konturov, krovotok i raspolozhenie sosudov, ascit. Rezul'taty chastotnogo analiza pokazali razlichiya mezhdu gruppami po dannym UZI (v 60–100% nablyudenij). Gistologicheskoe issledovanie vyyavilo razlichie mezhdu gruppami v 100% nablyudenij. Poluchennye rezul'taty ne pozvolili nam prolongirovat' beremennost' pri DEK bez vypolneniya hirurgicheskogo lecheniya. Rezul'taty lecheniya pacientok s DEK vo vremya beremennosti byli huzhe takovyh bez vyrazhennoj decidual'noj transformacii EK yaichnikov. V nastoyashchee vremya diagnostika DEK i lechenie bol'nyh vo vremya beremennosti ostayutsya nesovershennymi. Neobhodimy dal'nejshie klinicheskie nablyudeniya i poisk bolee nadezhnyh sposobov diagnostiki i racional'nogo lecheniya beremennyh s DEK.

Features of the decidualized endometriosis diagnosis and course during pregnancy

Currently, surgical treatment aimed to exclude the malignant ovarian tumors is performed in almost 90% of patients with decidualized endometrial cysts (DEC). However, unnecessary surgical interventions increase the risk to maternal and fetal health. The study was aimed to perform a differential diagnosis of DEC in pregnant women in order to define the rational treatment. A total of 82 female patients were included in the study: 63 had endometrial cysts (EC), 16 had DEC, 3 had rare forms of endometriosis, and 10 had ovarian serous papillary borderline tumors. When performing the diagnostic ultrasound, our proposed model was used. The ultrasound imaging data obtained were juxtaposed with the concentration of the protein tumor markers (СА-125), the risk of malignancy index (RMI) was calculated, and the morphological assessment of the masses was performed. The ultrasound imaging parameters, being the most valuable for differential diagnosis of EC, DEC, and serous borderline tumors, were as follows: the altered mass wall thickness, the existence and shape of papillary masses, avascular echogenic inclusions with blurry contour, blood circulation and arrangement of blood vessels, ascites. The frequency analysis revealed the differences between groups based on the ultrasound imaging data (in 60–100% of observations). Histological examination revealed the differences between groups in 100% of observations. Our findings have made it impossible to prolong pregnancy in patients with DEC without performing surgery. The results of treatment provided to patients with DEC during pregnancy were worse compared to those in patients with no prominent decidualization in ovarian EC. Today, the diagnosis of DEC and the treatment of patients during pregnancy remain unsophisticated. Further clinical observation and the search for more reliable methods of the diagnosis and rational treatment of pregnant women with DEC are required.

Biomarkers in Ovarian Pathology: From Screening to Diagnosis. Review of the Literature

Background: Ovarian cancer has a low incidence, but high mortality due to a habitual diagnosis in advanced cancer stages. Currently, used biomarkers have good sensitivity, but low specificity. Aim: To determine the usefulness of the biomarkers and algorithms used up to now in the screening, diagnosis, response to treatments and identification of recurrence in patients with ovarian masses. Methodology: Systematic search of publications in English in the Medline-PubMed database with the terms: “biomarkers”, “tumour”, “tumour biomarkers”, “marker”, “tumour marker”, “ovarian cancer”, “ovarian”, “Neoplasms”, “cancer”, CA-125 Antigen; Human Epididymis-specific Protein E4; Risk of Malignancy Index (RMI); Risk of Ovarian Malignancy Algorithm (ROMA); Ovarian Neoplasms. Original articles, clinical trials, reviews, systematic reviews and meta-analyses, published between January 2000 and November 2020, were selected to determine the usefulness (among others) of CA 125 and HE4 antigen in ovarian cancer. Results: Finally, 39 transcendental publications were selected to write this article to determine the usefulness of tumour markers and algorithms in ovarian cancer. Conclusions: The usefulness of the tumour markers antigen CA125 and antigen HE4 individually or as a basis for decision-making algorithms has low specificity; however, there is little evidence that confirms their usefulness as markers in ovarian cancer screening.

Risk Of Malignancy Index 4 Performance as a Predictor Advanced Stage Epithelial Ovarian Carcinoma Used for Neoadjuvant Chemotherapy

The relatively low survival rate in patients with advanced-stage carcinoma ovaries requires early detection to improve treatment outcomes. The method currently used to determine the administration of neoadjuvant chemotherapy is ascites cytology and laparoscopic. This study aims to find a non-invasive technique in determining preoperative Neoadjuvant Chemotherapy administration, and that method can use as a predictor of advanced epithelial ovarian carcinoma. The benefit of this study is to help clinicians consider administering neoadjuvant chemotherapy with a Risk Of Malignancy Index 4 score. An analytical observational study with a retrospective cross-sectional type study with samples of all patients from January 2016 to January 2020 diagnosed at the dr. Saiful Anwar Hospital in Malang indonesia. The number of initial samples of this study is 106 samples. Between the results of the Risk Of Malignancy Index 4 score and the histopathological results, it finds that the p-value was less than 0.05 (p<0.05) indicates that the Risk Of Malignancy Index 4 score is very good for predicting advanced epithelial ovarian carcinoma. With a sensitivity of 86,2%, specificity of 87,5%, the cut of value Risk Of Malignancy Index 4 to be a predictor of advanced ovarian carcinoma is 2982. This study indicates that the Risk Of Malignancy Index 4 score is excellent for predicting the stage of Epithelial Ovarian Carcinoma. This cut-off value can reference preoperative neoadjuvant therapy to avoid morbidity and mortality due to the high risk of surgery.

Approach to Gynecological Adnexal Masses

Gynecological pelvic masses are a common occurrence in women of all ages. The differential diagnosis is extensive and includes masses of all anatomical components of the female reproductive tract. This simple and refined approach leads the reader through the process of narrowing said differential. A thorough history and physical examination are essential steps that can hint to the appropriate investigations such as reproductive hormone levels, serum cancer biomarkers and imaging. Emphasis is put on ultrasound findings, helping differentiate not only diagnoses, but also the benign or malignant character of the mass. It also highlights the Risk of Malignancy Index I, commonly used in clinical practice to assess the risk of malignancy of a mass. Beyond the initial approach, some diagnoses and their management are discussed, from the very common functional cyst to the worrisome ovarian neoplasm, and mentioning more peculiar findings like tubo-ovarian abscess and leiomyoma.

Comparison of the Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients With Adnexal Masses

AimThis study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass.MethodsThis single-centre diagnostic accuracy study involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios.ResultsTo discriminate benign and malignant tumors, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P &lt; 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant.ConclusionADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

Perbandingan Nilai Prediktif antara Risk-of-Malignancy Index (RMI) dan Klasifikasi IOTA Simple Rules dalam Prediksi Keganasan pada Kasus Tumor Ovarium di RSUP Dr. Hasan Sadikin Bandung

Tujuan: Penelitian ini bertujuan untuk mengevaluasi dan membandingkan penerapan dua metode diagnostik yang telah digunakan di RSHS, yaitu skor RMI dan Klasifikasi IOTA Rules untuk memprediksi keganasan suatu tumor ovarium selama periode 2017−2018 Metode: Penelitian ini merupakan penelitian komparatif dengan pengambilan data secara retrospektif. Sumber data diperoleh dari rekam medis pasien yang menjalani operasi pengangkatan dan pemeriksaan histopalogis tumor ovarium. Dilakukan pengumpulan informasi mengenai data USG, kadar CA125, skor RMI, klasifikasi IOTA Simple Rules, dan membandingkannya dengan luaran histopatologis. Hasil: 190 kasus tumor ovarium diteliti. 156 kasus (82,1%) memiliki luaran histopatologis ganas dan 34 kasus lainnya (17.9%) jinak. 178 kasus (93,68%) memiliki skor RMI ≥200 dan 12 kasus (6,32%) <200. sebanyak 78 kasus diklasifikasikan sebagai Malignant, 42 kasus Benign, dan 70 kasus lainnya Inconclusive dengan kriteria IOTA Simple Rules. Distribusi CA125 dan Skor RMI pada kedua kelompok luaran histopatologis berbeda secara bermakna (P<0,05). Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules di RSHS masing-masing 94,23% dan 97,06%, dengan menggabungkan kelompok IOTA inkonklusif dengan kelompok ganas. Penghitungan sensitivitas dan spesifisitas skor RMI memberikan nilai 95,51% dan 14,71% dengan menggunakan cut-off-point skor RMI 200. Kesimpulan: Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules lebih baik dibandingkan dengan skor RMI dalam memprediksi keganasan suatu tumor ovarium.

Perbandingan Nilai Prediktif antara Risk-of-Malignancy Index (RMI) dan Klasifikasi IOTA Simple Rules dalam Prediksi Keganasan pada Kasus Tumor Ovarium di RSUP Dr. Hasan Sadikin Bandung

Tujuan: Penelitian ini bertujuan untuk mengevaluasi dan membandingkan penerapan dua metode diagnostik yang telah digunakan di RSHS, yaitu skor RMI dan Klasifikasi IOTA Rules untuk memprediksi keganasan suatu tumor ovarium selama periode 2017−2018 Metode: Penelitian ini merupakan penelitian komparatif dengan pengambilan data secara retrospektif. Sumber data diperoleh dari rekam medis pasien yang menjalani operasi pengangkatan dan pemeriksaan histopalogis tumor ovarium. Dilakukan pengumpulan informasi mengenai data USG, kadar CA125, skor RMI, klasifikasi IOTA Simple Rules, dan membandingkannya dengan luaran histopatologis. Hasil: 190 kasus tumor ovarium diteliti. 156 kasus (82,1%) memiliki luaran histopatologis ganas dan 34 kasus lainnya (17.9%) jinak. 178 kasus (93,68%) memiliki skor RMI ≥200 dan 12 kasus (6,32%) <200. sebanyak 78 kasus diklasifikasikan sebagai Malignant, 42 kasus Benign, dan 70 kasus lainnya Inconclusive dengan kriteria IOTA Simple Rules. Distribusi CA125 dan Skor RMI pada kedua kelompok luaran histopatologis berbeda secara bermakna (P<0,05). Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules di RSHS masing-masing 94,23% dan 97,06%, dengan menggabungkan kelompok IOTA inkonklusif dengan kelompok ganas. Penghitungan sensitivitas dan spesifisitas skor RMI memberikan nilai 95,51% dan 14,71% dengan menggunakan cut-off-point skor RMI 200. Kesimpulan: Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules lebih baik dibandingkan dengan skor RMI dalam memprediksi keganasan suatu tumor ovarium.

Comparison of ovarian crescent sign and risk of malignancy index for prediction of ovarian malignancy in adnexal masses

Background: Objective of the study was to evaluate ovarian crescent sign (OCS) as a sonographic parameter for prediction of ovarian cancer in adnexal masses suspicious of ovarian malignancy and to compare it with risk of malignancy index (RMI).Methods: Presence of OCS and calculation of RMI was done for 50 cases of adnexal masses scheduled to undergo surgery taking histopathology as gold standard.Results: 18% (9/50) of adnexal masses were malignant. OCS was absent in all malignant lesions, giving a sensitivity and negative predictive value of 100%. OCS was present in 33/41 of benign masses (specificity 80.4%). Relation of OCS to mass size<10 cm and menopausal status was significant (p<0.001). RMI≥200 could not diagnose malignancy in 4/9 cases (sensitivity 55.5%). RMI had specificity and negative predictive value of 95.1% and 90.7% respectively. Combining OCS and RMI had a lower specificity. Sequential application using OCS as first node and RMI as second node failed to diagnose 44.4% (4/9) cases as malignant.Conclusions: OCS is cheaper, easy to perform and appears to be a better test than RMI to differentiate between benign and early-stage malignant ovarian tumors. It can be used for triaging patient for referral.