Abstract
Objectives: Ovarian malignancy being one of the most common among genital malignancy, ascendant importance has to be given to evaluate it pre-operatively with high degree of precision. It is of crowning importance because it helps to tailor neo-adjuvant chemotherapy, chemoradiation, radiotherapy and surgery. This study correlates between the clinical and HPE findings to prove that though USG helps in detection and characterization of adnexal lesion to some extent, its diagnostic ability is further improved by addition of a simple parameter CA-125.
Methods: This study is a prospective observational study carried out between January 1, 2016 to 30 June, 2017 in the department of Obs and Gynae, RHP, Patiala. All cases of ovarian masses who underwent USG and CA-125 & were followed with laparotomy, followed by HPE of the specimen, were included in the study.
Results: 55 patients were included in the evaluation. The specificity 86% of USG was enhanced to 88% on addition of CA-125 to the study. The specificity increased further to 94% when clinical examination, USG and CA-125 were combined. Sensitivity was 100% with all the three methods.
Conclusion: Optimal pre-operative evaluation was achieved with USG. But when combined with clinical features & CA-125, the diagnostic value is extremely high. This aids in planning the management.
Keywords: Adenexal masses, Ultrasound, CA-125.
References
- Berek JS, Natarajan S. Ovarian and fallopian tube cancer. In: Berek JS (Editor). Berek and Novak’s Gynaecology 15th Ed. Wolter Kluwer Health (India) Private Limited; 2012:1350-1427.
- Jaffer Y, Ehsan N, Ambreen. Clinical presentation of ovarian tumours. Journal of Surgery Pakistan (International). 2013;18(2): 82-6.
- Coleman MP, Estere J, Damiecki P. Trends in Incidence and Mortality, Lyon, IARC. 1993; 121:1-801.
- Akturk E, Karaka RE, Alanbay I, et al. Comparison of four malignancy risk indices in the detection of malignant ovarian masses. J GynecolOncol. 2011;22(3):177–182. doi: 10.3802/jgo.2011.22.3.177.[PMC free article] [PubMed] [CrossRef] [Google Scholar]
- Morgante G, Marca AI, Ditto A, et al. Comparison of two malignancy risk indices based on serum CA-125, ultrasound score and menopausal status in the diagnosis of ovarian masses. Br J Obstet Gynecol. 1999;1999(106):524–527. doi: 10.1111/j.1471-0528.1999.tb08318.x. [PubMed] [CrossRef] [Google Scholar]
- Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA-125, ultrasound and menopausal status for the accurate pre-operative diagnosis of ovarian cancer. Br J Obstet Gynecol. 1990;1990(97):922–927. doi: 10.1111/j.1471-0528.tb02448.x. [PubMed] [CrossRef] [Google Scholar]
- Swamy GG, Satyanarayana N. Nepal Med Coll J. 2010 Dec;12(4):221-3.
- Goldstein DP, Laufer MR. Benign and malignant ovarian masses. In: Email SJ, Laufer MR, Foldstein DP, Pediatrics and adolescent Gynecology, Philadelphia: Lippincott Raven: 1998.
- Pilli GS, Suneeta KP, Dhaded AV, Yenni VV. Ovarian tumors: a study of 282 cases. J Indian Med Assoc 2002;100:423-4.
- Gupta N, Bisht D, Agarwal AK, Sharma VK. Retrospective and prospective study of ovarian tumors and tumor like lesions. Indian J PatholMicrobiol. 2007;50:525-7.
- Ahmad Z, Kayani N, Hasan SH, Muzaffar S, Gill MS. Histological pattern of ovarian neoplasm. J Pak Med Assoc. 2000;50:416-9.
- Henessy BT, Coleman RL, Markman M. Ovarian cancer.Lancet 2009; 374: 1371–1382.
- Permuth-Wey J, Sellers TA. Epidemiology of ovarian cancer.MethodsMolBiol 2009; 472: 413–437.
- Malkasian GD Jr, Knapp RC, Lavin PT, Zurawski VR Jr, Podratz KC, Stanhope CR, Mortel R, Berek JS, Bast RC Jr, Ritts RE. Preoperative evaluation of serum
CA-125 levels in premenopausal and postmenopausal patients with pelvic masses: discrimination of benign from malignant disease. Am J Obstet Gynecol. 1988;159(2):341–6. [PubMed] [Google Scholar]
- Chen DX, Schwartz PE, Li XG, Yang Z. Evaluation of CA-125 levels in differentiating malignant from benign tumors in patients with pelvic masses. Obstet Gynecol. 1988;72(1):23–7. [PubMed] [Google Scholar]
- Nolen B. Serum biomarker panels for the discrimination of benign from malignant cases in patients with an adnexal mass. GynecolOncol.
- Liu J, Xu Y, Wang J. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol. 2007;62 (3):328–34. doi: 10.1016/j.ejrad.2007.02.040.[PubMed] [CrossRef] [Google Scholar]
- Risum S, Høgdall C, Loft A, Berthelsen AK, Høgdall E, Nedergaard L, Lundvall L, Engelholm SA. The diagnostic value of PET/CT for primary ovarian cancer--a prospective study. GynecolOncol. 2007;105(1):145–9. doi: 10.1016/j.ygyno.2006.11.022.
- A. Hartman C. R. T. Juliato L. O. Sarian M. C. Toledo R. M. Jales S. S. Morais D. D. Pitta E. F. Marussi S. Derchain https://doi.org/ 10.1002/uog.11201.
Corresponding Author
Dr Satinder Pal Kaur
Assistant Professor, Deptt. of Obs. & Gynae. GMC, Patiala, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.58
