Analysis on the Effects of CT- and Ultrasound-Guided Percutaneous Transthoracic Needle Biopsy Combined with Serum CA125 and CEA on the Diagnosis of Lung Cancer

The number of patients with lung cancer is difficultly diagnosed in the early stage. The purpose of the study was to investigate the effects of CT- and ultrasound-guided percutaneous transthoracic needle biopsy combined with serum CA125 and CEA on the diagnosis of lung cancer. 120 patients with suspected lung cancer admitted to our hospital from January 2019 to January 2020 were selected and divided into an ultrasound group (n = 60) and CT group (n = 60), according to different percutaneous transthoracic needle biopsy modalities. All patients received serum tumor markers detection, so as to compare the CT- and ultrasound-guided percutaneous transthoracic needle biopsy results and pathology results, levels of serum tumor markers among all patients and the patients with different lung cancer types, and diagnostic efficacy of tumor markers, as well as complication rate (CR) in patients. The sensitivity and specificity of ultrasound-guided percutaneous transthoracic needle biopsy were 0.880 and 0.800, respectively, while those of CT-guided percutaneous transthoracic needle biopsy were 0.909 and 0.625, respectively; the CA125 and CEA levels in the lung cancer group were higher than those in the benign group ( P < 0.001 ); the CA125 and CEA levels of the patients with adenocarcinoma were higher than those with squamous carcinoma, and the CEA levels of the patients with small-cell carcinoma were lower than those with adenocarcinoma ( P < 0.05 ); the sensitivity, specificity, and Youden indexes of CA125 were 0.638, 0.833, and 0.471, respectively, while those of CEA were 0.766, 0.778, and 0.544, respectively; there were no significant differences in CR between the two groups ( P > 0.05 ). CT- and ultrasound-guided percutaneous transthoracic needle biopsy is a safe and feasible diagnostic modality for lung cancer, and its combination with serum CA125 and CEA can significantly improve the accuracy of the detection results, which is worthy of promotion and application in clinical practice.

Maternal serum CA-125 repeated measurement during pregnancy and how to use as a prognostic factor of first trimester pregnancy outcome

Background: The aim of this study was to estimate the prognostic efficacy of repeated measurement of maternal serum CA125 in first trimester threatened miscarriage.Methods: Prospective case control study was conducted in the outpatient clinic. 100 pregnant women were divided into 50 women with normal course of pregnancy, and the other 50 were subdivided into 25 pregnant women with lower abdominal pain without vaginal bleeding and 25 presented with minimal vaginal bleeding. Repeated measuring of serum CA125 was done for each case on the 5th, 10th weeks of gestation.Results: Findings of this study suggested the possibility of using serum CA-125 for determining the prognosis of first trimester threatened miscarriage with cut-off value of CA125 38.25 U/ml on the 5th week of gestation and 53 U/ml on the 10th week of gestation in patients presented with pain only but in patients presented with minimal vaginal bleeding the cut-off value of CA125 on the 5th week of gestation become 45.6 U/ml and 68 U/ml on the 10th week of gestation.Conclusions: CA125, on its own, can discriminate between continued and non-continued pregnancy.

A Novel Clinical Nomogram for Predicting Lymph Node Metastasis in Ovarian Cancer: A SEER Analysis and External Validation in a Tertiary Center

Introduction The aim of the study is to investigate the risk factors for developing lymph node metastases (LNM) in cases diagnosed as a presumed early-stage ovarian carcinoma (OC). Methodology Information of patients who had been diagnosed as OC in 2018 was obtained from the SEER database. We enrolled 104 OC patients in General Hospital of Northern Theatre Command for external validation. A logistic regression was conducted to determine the independent predictors for LNM, which were used for establishing a nomogram. In order to evaluate the reliability of nomogram, we applied a receiver operating characteristic curve (ROC) analysis, calibration curves and plotted decision curves. Results We found that age(≥70, OR=0.544, p=0.022), histology type (Mucinous carcinoma, OR=0.390, p=0.001; Endometrioid carcinoma, OR=7.946, p=0.053; Others, OR=2.400, p=0.040), histology grade (Grade II, OR=2.423, p=0.028; Grade III, OR=1.982, p=0.152; Grade IV, OR=1.594, p=0.063) and preoperative serum CA125 level (positive, OR=2.236, p=0.001) were all significant predictors of LNM. The AUC of the model training cohort, internal validation cohort, and external validation cohort were 0.78, 0.79 and 0.76 respectively. The calibration curves showed that the predicted outcome fitted well to the observed outcome in the training cohort (p=0.825) internal validation cohort (p=0.503), and external validation cohort (p=0.108). The decision curves showed the nomogram had more benefits than the All or None scheme if the threshold probability is >50% and <100% in training cohort and internal validation cohort, >30% and <90% in the external validation cohort. Conclusion The multivariate logistic regression showed that age, histology type, histology grade and preoperative serum CA125 level were all significant predictors of LNM. The nomogram established using the above variables had great performance for clinical applying.

Predictive value of preoperative inflammatory markers and serum CA 125 level for surgical outcome in Indonesian women with epithelial ovarian cancer

BACKGROUND: It is essential in the management of ovarian cancers to identify the patients who will benefit from primary complete cytoreductive surgery and those who will rather benefit from neoadjuvant chemotherapy. OBJECTIVE: To evaluate the predictive value of preoperative inflammatory markers, i.e. platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), red cell distribution width (RDW), and serum CA125 level for surgical outcome in epithelial ovarian cancer. METHODS: A retrospective study was carried out in Sanglah Hospital, Denpasar, Bali. A total of 54 patients with epithelial ovarian cancer who underwent primary exploratory laparotomy from January 2018 to November 2019 was recruited. Data about clinical characteristics, preoperative inflammatory markers, serum CA125 level, and surgical outcome (optimal vs. suboptimal) was collected from the medical records. Predictive value of the markers were evaluated using ROC curve to determine their accuracy (area under the curve, sensitivity, specificity, positive and negative predictive value). RESULTS: Mean age, parity, and tumor size did not differ between the study groups (p> 0.05). The group with suboptimal outcome had significantly higher PLR, NLR, MLR, and RDW value (p< 0.05). Using the ROC curve, a cut off value was determined for each predictor, i.e. PLR: 196.50, NLR: 3.34, MLR: 0.24, RDW: 13.19, CA125: 300.85. AUC for each predictor were as follows: PLR 0.718 (95% CI: 0.578–0.859), NLR 0.676 (95% CI: 0.529–0.823), MLR 0.700 (95% CI: 0.560–0.839), RDW 0.712 (95% CI: 0.572–0.852), CA125 0.593 (95% CI: 0.436–0.750). Sensitivity, specificity, and accuracy for predicting suboptimal outcome were as follows: PLR (74.2%, 69.6%, 72.2%), NLR (64.5%, 60.9%, 62.9%), MLR (74.2%, 59.1%, 66.7%), RDW (74.2%, 60.9%, 68.5%), CA125 (54.8%, 60.9%, 57.4%). We have some limitations such as small numbers of sample, we generalized whole kinds of ovarian cancer, and this study does not describe follow-up features. CONCLUSION: Preoperative serum inflammatory markers (PLR, MLR, and RDW) may serve as useful markers to predict the surgical outcome with fair accuracy in patients with epithelial ovarian cancer.

Development and Validation of a Simple-to-Use Nomogram to Predict 3-Year Recurrence rate of Ovarian Cancer

Objective: To establish a reliable nomogram model to predict the recurrence rate of ovarian cancer after surgery. Methods: We retrospectively reviewed 216 patients diagnosed with ovarian cancer in our hospital, of which 164 cases were considered valid. Logistic regression model was used to analyze the possible predictors. After that, a nomogram model based on those significantly related predictors was established. We used the bootstrap to internally validate the predictive ability of the nomogram model and used the decision curve analysis (DCA) to compare the performance of the FIGO stage with this model. Results: The nomogram included seven significant recurrence predictors: age, histology type, FIGO stage, omentum involvement, lymphovascular space invasion (LVSI), liver metastasis, and serum CA125. The measurement values for accuracy were Brier score 0.131, correction slope 1.00, and c-index 0.870. which demonstrated this model had a good predictive ability. Compared with the FIGO stage, this hybrid model is more superior in predicting recurrence risk in ovarian cancer patients. Conclusions: We developed and validated a non-invasion and user-friendly nomogram model to predict the recurrence risk of patients with ovarian cancer after surgery.

Getting the MOST out of follow-up: a randomized controlled trial comparing 3 monthly nurse led follow-up via telehealth, including monitoring CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic based or telehealth follow-up, after completion of first line chemotherapy in patients with epithelial ovarian cancer

BackgroundPhysical symptoms, anxiety, depression, fear of recurrence, sexual dysfunction, and social withdrawal are common in women after treatment for ovarian cancer. Most patients would like and need help dealing with these symptoms. The traditional model of follow-up care is unstructured and largely focused on diagnosing recurrent disease, and most oncologists lack skills to identify and manage psychosocial issues. No high quality prospective clinical trials have been conducted to determine the optimal follow-up regimen or the cost effectiveness of ovarian cancer surveillance strategies.Primary Objective(s)To assess emotional wellbeing, acceptability, safety, and cost effectiveness of nurse led follow-up via telehealth for women with ovarian cancer following completion of primary treatment.Study HypothesisWe hypothesize that compared with routine clinic based follow-up, nurse led follow-up via telehealth, including serum CA125 monitoring and completion of a patient reported outcome instrument, the Measure of Ovarian Symptoms and Treatment concerns-Surveillance (MOST-S26), will improve emotional wellbeing in women with ovarian cancer; be feasible, safe, acceptable, and not delay the time to diagnosis of recurrent disease; will result in greater patient satisfaction; will identify more patients with psychological distress, lead to better care, and improved psychological outcomes; and be cost-effective.Trial DesignPhase II multicenter randomized trial comparing 3 monthly nurse led telehealth consultations that include serum CA125 monitoring and completion of the MOST-S26, with routine clinic based follow-up. The allocation ratio will be 1:1.Major Inclusion/Exclusion CriteriaEligible patients will be women with high grade epithelial ovarian cancer who have normalized serum CA125 (to <35 kU/L) at completion of first line chemotherapy.Primary Endpoint(s)Emotional wellbeing at 12 months.Sample Size150 patients.Estimated Dates for Completing Accrual and Presenting ResultsJuly 2023. Results expected in 2025, 24 months after the last participant is enrolled.Trial RegistrationACTRN12620000332921

Potential of combination of DCE-MRI and DWI with serum CA125 and CA199 in evaluating effectiveness of neoadjuvant chemotherapy in breast cancer

Background To determine the potential of the combination of DCE-MRI imaging method with DWI and serum CA125 and CA199 levels in the evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer patients. Methods Sixty-five breast cancer patients who received neoadjuvant chemotherapy in our hospital from April 2016 to April 2017 were selected as research subjects. The patients received 4 courses of neoadjuvant chemotherapy. Lesions were monitored using DCE-MRI and DWI, while ELISA was used to measure the serum expression levels of the tumour markers CA125 and CA199. The patients were divided into the remission group and ineffective group based on pathological diagnosis. Results There were significant differences in Kep, Ktrans, ADCmin, ADCmean, tumour volume, and serum levels of CA125 and CA199 in patients in the remission group, before and after neoadjuvant chemotherapy, and there were significant differences in post-chemotherapy values of these indexes between the remission group and the ineffective group (p < 0.01). Conclusion Combination of DCE-MRI diagnostic imaging with DWI can directly reflect the lesions in breast cancer patients after neoadjuvant chemotherapy. Serum levels of CA125 and CA199 levels are useful for evaluation of the impact of neoadjuvant chemotherapy on breast cancer patients, including risk of cancer cell metastasis and changes in some small lesions.

A Novel Classifier Based on Urinary Proteomics for Distinguishing Between Benign and Malignant Ovarian Tumors

BackgroundPreoperative differentiation of benign and malignant tumor types is critical for providing individualized treatment interventions to improve prognosis of patients with ovarian cancer. High-throughput proteomics analysis of urine samples was performed to identify reliable and non-invasive biomarkers that could effectively discriminate between the two ovarian tumor types.MethodsIn total, 132 urine samples from 73 malignant and 59 benign cases of ovarian carcinoma were divided into C1 (training and test datasets) and C2 (validation dataset) cohorts. Mass spectrometry (MS) data of all samples were acquired in data-independent acquisition (DIA) mode with an Orbitrap mass spectrometer and analyzed using DIA-NN software. The generated classifier was trained with Random Forest algorithm from the training dataset and validated in the test and validation datasets. Serum CA125 and HE4 levels were additionally determined in all patients. Finally, classification accuracy of the classifier, serum CA125 and serum HE4 in all samples were evaluated and plotted via receiver operating characteristic (ROC) analysis.ResultsIn total, 2,199 proteins were quantified and 69 identified with differential expression in benign and malignant groups of the C1 cohort. A classifier incorporating five proteins (WFDC2, PTMA, PVRL4, FIBA, and PVRL2) was trained and validated in this study. Evaluation of the performance of the classifier revealed AUC values of 0.970 and 0.952 in the test and validation datasets, respectively. In all 132 patients, AUCs of 0.966, 0.947, and 0.979 were achieved with the classifier, serum CA125, and serum HE4, respectively. Among eight patients with early stage malignancy, 7, 6, and 4 were accurately diagnosed based on classifier, serum CA125, and serum HE4, respectively.ConclusionThe novel classifier incorporating a urinary protein panel presents a promising non-invasive diagnostic biomarker for classifying benign and malignant ovarian tumors.

Efficacy of High-Intensity Focused Ultrasound Combined With GnRH-a for Adenomyosis: A Systematic Review and Meta-Analysis

Objective: High-intensity focused ultrasound (HIFU) is an innovative non-invasive technology used for adenomyosis. Gonadotropin-releasing hormone agonist (GnRH-a) is a hormone commonly used for adenomyosis. We investigated and assessed the efficacy of HIFU combined with GnRH-a for adenomyosis.Methods: For this systematic review and meta-analysis, we searched Pubmed, Cochrane Library, Web of Science, Embase, CNKI, WanFang, and VIP databases for relevant articles published in Chinese or English that compared HIFU combined with GnRH-a vs. HIFU alone in patients with adenomyosis. The last literature search was completed on January 31, 2021. Two reviewers independently assessed study eligibility and assessed risk of bias. Another two reviewers extracted the data. The RevMan5.3 software was used for the data analysis. Changes in volume of the uterine and adenomyotic lesion were defined as the primary outcomes. The secondary outcomes were visual analog scale (VAS) scores for dysmenorrhea, menstrual volume scores, serum CA125 levels, and recurrence rate. This study is registered with PROSPERO (CRD42021234301).Results: Three hundred and ninety potentially relevant articles were screened. Nine studies with data for 766 patients were finally included. Compared with the HIFU alone group, the HIFU combined with GnRH-a group had a higher rate of uterine volume reduction (MD 7.51, 95% CI 5.84–9.17, p &lt; 0.00001), smaller adenomyotic lesion volume (MD 4.11, 95% CI 2.93–5.30, p &lt; 0.00001), lower VAS score for dysmenorrhea (MD 1.27, 95% CI 0.54–2.01, p = 0.0007) and menstrual volume score (MD 0.88, 95% CI 0.73–1.04, p &lt; 0.00001), and lower CA125 level (SMD 0.31, 95% CI 0.05–0.56, p = 0.02) after the procedure. The recurrence rate in the HIFU combined with GnRH-a group was lower than that in the HIFU alone group (RR 0.28, 95% CI 0.10–0.82, p = 0.02).Conclusions: Compared with HIFU treatment alone, HIFU combined with GnRH-a for the treatment of adenomyosis has greater efficacy in decreasing the volumes of the uterine and adenomyotic lesions and alleviating symptoms. However, since the number of the included studies was too small and most of them were written in Chinese, this conclusion needs to be referenced with caution. And the long-term evidence of its efficacy is still insufficient.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ identifier [CRD42021234].