Assessment of Diagnostic Values among CA-125, RMI, HE4, and ROMA for Cancer Prediction in Women with Nonfunctional Ovarian Cysts.

Shina Oranratanaphan,Surang Triratanachat,Sinee Wanishpongpan,Wichai Termrungruanglert

doi:10.1155/2018/7821574

Shina Oranratanaphan, Surang Triratanachat + Show 2 more

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https://doi.org/10.1155/2018/7821574

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Abstract

Objectives To evaluate the diagnostic performance among CA-125, RMI, HE4, and ROMA for cancer detection in women with nonfunctional ovarian cysts at King Chulalongkorn Memorial Hospital (KCMH). Secondary objective is to reconsider the proper cutoff value of HE4. Methods This is a prospective analytic study in women with nonfunctional ovarian cysts larger than 3 cm who scheduled for surgery at KCMH during 3rd June 2015 to 31st May 2016. Ultrasonogram and blood sample collection were completed before the operation. Patients' demographic information and pathologic results were obtained. SPSS software version 17 was used for statistical evaluation. Results A total of 281 participants were evaluated. 19.9% of them were malignant. Compared with CA-125, HE4 had lower sensitivity (53.4% vs. 87.9%) and NPV (89% vs. 93.6%) but higher specificity (97.8% vs. 46.2%) and PPV (86.1% vs. 29.8%). ROMA had slightly lower sensitivity (79.3% vs. 87.9%) and similar NPV (93.7% vs. 93.6%), but higher specificity (79.8% vs. 46.2%) and PPV (50.5% vs. 29.8%) compared with CA-125. The model that achieves the highest area under the ROC curve in differentiating benign versus malignant ovarian tumor was ROMA. Cutoff value of HE4 at 70 pMol/L (from 150 pMol/L) would give sensitivity 74.1% and specificity 86.5% that are comparable with ROMA. Conclusions HE4 and ROMA had better performance (higher specificity, PPV) compared to CA-125 and RMI. HE4 at 70 pMol/L could be the new cutoff value for Thai women with ovarian cysts, giving higher sensitivity and specificity.

Highlights

Ovarian cancer is the second most common gynecologic malignancy in ailand, while the most common cancer is cervical cancer
Complete tumor resection from primary cytoreductive surgery is one of the most important prognostic factors in ovarian malignancy. e chance of complete cytoreductive surgery depends on stage and operators [2]. ere are some research studies to confirm that ovarian cancer patients who were operated by gynecologic oncology surgeons have better survival rate than those operated by general gynecologists [2, 3]. erefore, there are benefits for the patients, if we can select the cases and send them to the proper operators
HE4, a novel biomarker that is expressed in normal glandular epithelium of the female genital tract and breast as well as in a number of glandular carcinomas, has the potential to achieve high sensitivity and specificity for epithelial ovarian cancer detection [7] and elevated more in early-stage EOC patients compared to CA-125 [8,9,10]

Summary

Research Article

Assessment of Diagnostic Values among CA-125, RMI, HE4, and ROMA for Cancer Prediction in Women with Nonfunctional Ovarian Cysts. Shina Oranratanaphan , Sinee Wanishpongpan, Wichai Termrungruanglert, and Surang Triratanachat. Received 8 June 2018; Revised 11 September 2018; Accepted 20 September 2018; Published 8 October 2018

Objectives

Introduction

Pathology Benign Malignancy

Results

Area under the curve

All case AUC