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Abstract
(1) OBJECTIVE: To assess the performance of CA125, HE4, ROMA index and CPH-I index to preoperatively identify epithelial ovarian cancer (EOC) or metastatic cancer in the ovary (MCO). (2) METHODS: single center retrospective study, including women with a diagnosis of adnexal mass. We obtained the AUC, sensitivity, specificity and predictive values were of HE4, CA125, ROMA and CPH-I for the diagnosis of EOC and MCO. Subgroup analysis for women harboring adnexal masses with inconclusive diagnosis of malignancy by ultrasound features and Stage I EOC was performed. (3) RESULTS: 1071 patients were included, 852 (79.6%) presented benign/borderline tumors and 219 (20.4%) presented EOC/MCO. AUC for HE4 was higher than for CA125 (0.91 vs. 0.87). No differences were seen between AUC of ROMA and CPH-I, but they were both higher than HE4 AUC. None of the tumor markers alone achieved a sensitivity of 90%; HE4 was highly specific (93.5%). ROMA showed a sensitivity and specificity of 91.1% and 84.6% respectively, while CPH-I showed a sensitivity of 91.1% with 79.2% specificity. For patients with inconclusive diagnosis of malignancy by ultrasound features and with Stage I EOC, ROMA showed the best diagnostic performance (4) CONCLUSIONS: ROMA and CPH-I perform better than tumor markers alone to identify patients harboring EOC or MCO. They can be helpful to assess the risk of malignancy of adnexal masses, especially in cases where ultrasonographic diagnosis is challenging (stage I EOC, inconclusive diagnosis of malignancy by ultrasound features).
Highlights
Epithelial ovarian cancer (EOC) is the leading cause of death in patients with gynecological malignancies [1]
The main objective of this study was to assess the performance of CA125, HE4, Risk of Ovarian Malignancy Algorithm (ROMA), and Copenhagen Index (CPH-I) on the specific detection of adnexal masses who will benefit from derivation to a reference center, prioritization in surgery waiting list and surgery performance by surgeons specialized in gynecologic oncology, that is EOC and metastatic cancer in the ovary (MCO)
Considering only adnexal masses with an inconclusive diagnosis using IOTA simple rules, ROMA performed significantly better than CPH-I and tumor markers alone (p < 0.05)
Summary
Epithelial ovarian cancer (EOC) is the leading cause of death in patients with gynecological malignancies [1]. Pelvic adnexal masses are common in female population, yet only a small percentage represent ovarian malignancies [2]. While benign ovarian masses can be managed in non-specialized centers, patients with EOC or metastatic cancer in the ovary (MCO) should be treated by a multidisciplinary experienced team [3]. Surgical staging for suspected early-stage EOC is a complex procedure. It has been demonstrated that, in advanced EOC, there is an increase in overall survival when cytoreductive surgery is performed by a specialized team in gynecologic oncology [3]. An accurate differential diagnosis and referral to specialized centers of women harboring suspicious adnexal masses is critical to enhancing their survival
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