Benign Ovarian Masses Research Articles

US of the Ovary and Adnexa: To Worry or Not to Worry?

Ultrasonography (US) is typically the first study to be requested in patients with clinical findings that may suggest pelvic disease. The evaluation of adnexal masses is a common component of the sonologist's workload, and US has been shown to be accurate for both detecting and characterizing these masses, most of which are either insignificant or benign and therefore require little or no follow-up. Recognition of the most common benign ovarian and extraovarian adnexal masses should help avoid additional or unnecessary imaging. US features that suggest malignancy include thick septations, vascularized solid components, or areas of focal wall thickening, and identifying these features will result in timely management. Indeterminate-appearing masses demonstrate atypical features and cannot easily be classified as definitely either benign or malignant. Proper reporting and management recommendations serve to alleviate both patient anxiety and physician misinterpretation. Knowledge of these recommendations and of the characteristic US features of benign, malignant, and indeterminate adnexal masses can serve as important guidelines for patient management.

Management of a suspicious adnexal mass: a clinical practice guideline.

What is the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer? What is the most appropriate surgical procedure for a woman who presents with an adnexal mass suspicious for malignancy? In Canada in 2010, 2600 new cases of ovarian cancer were estimated to have been diagnosed, and of those patients, 1750 were estimated to have died, making ovarian cancer the 7th most prevalent form of cancer and the 5th leading cause of cancer death in Canadian women. Women with ovarian cancer typically have subtle, nonspecific symptoms such as abdominal pain, bloating, changes in bowel frequency, and urinary or pelvic symptoms, making early detection difficult. Thus, most ovarian cancer cases are diagnosed at an advanced stage, when the cancer has spread outside the pelvis. Because of late diagnosis, the 5-year relative survival ratio for ovarian cancer in Canada is only 40%. Unfortunately, because of the low positive predictive value of potential screening tests (cancer antigen 125 and ultrasonography), there is currently no screening strategy for ovarian cancer. The purpose of this document is to identify evidence that would inform optimal recommended protocols for the identification and surgical management of adnexal masses suspicious for malignancy. Outcomes of interest for the identification question included sensitivity and specificity. Outcomes of interest for the surgical question included optimal surgery, overall survival, progression-free or disease-free survival, reduction in the number of surgeries, morbidity, adverse events, and quality of life. After a systematic review, a practice guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice guideline was reviewed and approved by the Gynecology Disease Site Group and the Report Approval Panel of the Program in Evidence-based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice guideline. These recommendations apply to adult women presenting with a suspicious adnexal mass, either symptomatic or asymptomatic. IDENTIFICATION OF AN ADNEXAL MASS SUSPICIOUS FOR OVARIAN CANCER: Sonography (particularly 3-dimensional sonography), magnetic resonance imaging (mri), and computed tomography (ct) imaging are each recommended for differentiating malignant from benign ovarian masses. However, the working group offers the following further recommendations, based on their expert consensus opinion and a consideration of availability, access, and harm: Where technically feasible, transvaginal sonography should be the modality of first choice in patients with a suspicious isolated ovarian mass.To help clarify malignant potential in patients in whom ultrasonography may be unreliable, mri is the most appropriate test.In cases in which extra-ovarian disease is suspected or needs to be ruled out, ct is the most useful technique.Evaluation of an adnexal mass by Doppler technology alone is not recommended. Doppler technology should be combined with a morphology assessment.Ultrasonography-based morphology scoring systems can be used to differentiate benign from malignant adnexal masses. These scoring systems are based on specific ultrasound parameters, each with several scores base on determined features. All evaluated scoring systems were found to have an acceptable level of sensitivity and specificity; the choice of scoring system may therefore be made based on clinician preference.As a standalone modality, serum cancer antigen 125 is not recommended for distinguishing between benign and malignant adnexal masses.Frozen sections for the intraoperative diagnosis of a suspicious adnexal mass is recommended in settings in which availability and patient preference allow. SURGICAL PROCEDURES FOR AN ADNEXAL MASS SUSPICIOUS FOR MALIGNANCY: To improve survival, comprehensive surgical staging with lymphadenectomy is recommended for the surgical management of patients with early-stage ovarian cancer. Laparoscopy is a reasonable alternative to laparotomy, provided that appropriate surgery and staging can be done. The choice between laparoscopy and laparotomy should be based on patient and clinician preference. Discussion with a gynecologic oncologist is recommended. Fertility-preserving surgery is an acceptable alternative to more extensive surgery in patients with low-malignant-potential tumours and those with well-differentiated surgical stage i ovarian cancer. Discussion with a gynecologic oncologist is recommended.

A comparison of CA125, HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification of ovarian masses

OBJECTIVE:Differentiation between benign and malignant ovarian neoplasms is essential for creating a system for patient referrals. Therefore, the contributions of the tumor markers CA125 and human epididymis protein 4 (HE4) as well as the risk ovarian malignancy algorithm (ROMA) and risk malignancy index (RMI) values were considered individually and in combination to evaluate their utility for establishing this type of patient referral system.METHODS:Patients who had been diagnosed with ovarian masses through imaging analyses (n = 128) were assessed for their expression of the tumor markers CA125 and HE4. The ROMA and RMI values were also determined. The sensitivity and specificity of each parameter were calculated using receiver operating characteristic curves according to the area under the curve (AUC) for each method.RESULTS:The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively. Among carcinomas, the sensitivities of CA125, HE4, ROMA (pre- and post-menopausal), and RMI were 93.5%, 87.1%, 80%, 95.2%, and 87.1%, respectively. The most accurate numerical values were obtained with RMI, although the four parameters were shown to be statistically equivalent.CONCLUSION:There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses. RMI had the lowest sensitivity but was the most numerically accurate method. HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis. All of the parameters demonstrated increased sensitivity when tumors with low malignancy potential were considered low-risk, which may be used as an acceptable assessment method for referring patients to reference centers.

Abstract 4150: Circulating microRNA patterns in ovarian cancer increased expression with surgical intervention and chemotherapy: Stable high presurgical “survival pattern” (SP) miRNA expression may reflect intrinsic ability for recognition and elimination of malignancy

Abstract Background: Epithelial ovarian cancer accounts for 90% of all cases of malignant tumors of the ovaries, the majority of patients are diagnosed at stage III disease with 70% of them succumbing to their disease within 5 years. Objectives: We addressed 3 questions 1) are there patterns in the pre-surgical miRNA profiles between survivors of stage III ovarian cancer and patients who do not survive the disease “surviving pattern” (SP) 2) are there changes in the miRNA profiles that occur during or after chemotherapy that convert patients into SP. 3) Do patients with benign ovarian masses have the SP? Methods: Between 2004 and 2011 we investigated in patterns of circulating miRNAs collected before, after surgery, during and after chemotherapy in patients presenting for surgery for ovarian masses. We also collected blood at ovarian cancer relapse and tumor and benign ovary (if available) for miRNA analysis. Raw Ct values obtained from Taqman and software Data Assist. Data were processed via programming language R. Raw data were normalized using the least variable miRNA from dataset. Differential expression was studied using the R/Bioconductor package “limma” using moderated t-statistic allowing both 2 sample comparison and multiple sample comparison. Only results with a p<0.05 were considered statistically significant. Characteristics: Six patients were operated for benign ovarian masses; 14 patients had carcinoma. Conclusion: Two patients were long term survivors of ovarian cancer diagnosed in 2004. Both had serum miRNA SP before surgical removal of tumor and at 2011 follow up. The SP pattern was not seen in any of the non-surviving ovarian cancer patients in the pre-surgical samples, post surgical samples, samples obtained during chemotherapy or at relapse. The SP pattern was not observed in the patients operated for benign ovarian masses. During chemotherapy circulating miRNA increased between 2 to 80 fold, none decreased. Most notable increases in miRNA levels were miR-16 (80x), miR-195 (50x), miR-25 (47x), miR-19a (40x), miR-19b (42x), miR-20a (36x), miR-29c (22x), miR-222 (23x), miR-146a (21x), miR-130a (21x) and miR-223 (21x). Discussion: Malignant cells are stressed during chemotherapy and rise in miRNA levels facilitate adaptation to novelty and the speed of evolutionary process needed for survival under stressful situations. This study suggests that abrupt rise in miRNA is the conserved mechanism of evolutionary adaptation during chemotherapy stress. It also suggests that specific miRNAs (SP) deter cancer progression in certain individuals. If SP is duplicated in larger cohorts the results will have important implications for the development of “replacement” miRNA therapies of the future. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4150. doi:1538-7445.AM2012-4150

Morphological study of the residual ovarian tissue removed by laparoscopy or laparotomy in adolescents with benign ovarian cysts

Background/PurposeThe stripping of benign ovarian cysts has been reported to be preferable to cyst wall ablation. The procedure can be performed via either an open or laparoscopic approach. The aim of our study was to evaluate the efficacy of the technique of stripping performed by laparoscopy and laparotomy in the treatment of benign ovarian masses in the pediatric age group with respect to healthy ovarian tissue. MethodsThis retrospective study evaluated all the pediatric or adolescent patients admitted during a 5-year period (2006-2010) for a suspected benign ovarian cyst treated with a laparoscopic technique or traditional open surgery to remove the cyst. The morphological characteristics of the tissue were graded on a semiquantitative scale from 0 to 4. ResultsThirty patients were treated and divided in 2 groups: group A laparoscopy (18 patients) and group B open (12 patients). The median age was 9.1 years. No ovarian tissue could be observed in 26 cases (86.7%). In the 4 remaining (2 laparoscopic and 2 open) cases (13.3%), ovarian tissue was found, but never more than 1 mm in thickness. This finding was always in endometriotic cysts. ConclusionsWe demonstrated that, in the pediatric population, no ovarian tissue is removed together with the cyst if this is nonendometriotic. The type of surgical procedure does not influence the removal of ovarian tissue. Laparoscopic stripping of ovarian cysts is the preferable surgical procedure in patients with prospective potential fertility because of their young age.

Access to Conservative Surgical Therapy for Adolescents With Benign Ovarian Masses

To perform a population-based analysis to determine possible factors associated with use of laparoscopy and ovarian-conserving cystectomy. Women and girls aged 18 years or younger with benign ovarian masses who underwent surgery from 2000 to 2010 and were recorded in a commercial database were analyzed. Patients were classified based on the surgical approach (open compared with laparoscopy) and procedure (oophorectomy compared with cystectomy). Use of laparoscopy and performance of cystectomy were characterized using multivariable logistic regression models accounting for patient, surgeon, and hospital characteristics. A total of 2,126 patients, including 1,425 (67.0%) who underwent laparotomy and 701 (33.0%) who had laparoscopy, were identified. Laparoscopy increased from 32.1% in 2000 to 57.9% by 2010. In a multivariable model, African American women and girls (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.37-0.65) and patients in the Northeast (OR 0.65, 95% CI 0.46-0.94) were less likely to undergo laparoscopy, whereas treatment at a high-volume hospital (OR 1.35, 95% CI 1.04-1.75) was associated with use of laparoscopy. Cystectomy was performed in 57.1% in 2000 and increased to 61.4% in 2010. The only significant predictors of cystectomy were age and the specialty of the treating physician; patients aged 13-16 years (OR 1.34, 95% CI 1.03-1.75) were more likely to undergo cystectomy than were younger patients, whereas patients treated by surgeons (OR 0.51, 95% CI 0.38-0.68) were less likely to undergo cystectomy than were those treated by gynecologists. The treatment of adolescents with benign ovarian masses is highly variable. In addition to patient characteristics, both physician and hospital factors strongly influenced treatment. II.

Role of diffusion MRI and proton magnetic resonance spectroscopy in characterization of ovarian neoplasms

IntroductionAdnexal masses are a common clinical problem and considered as the leading indication for gynecological surgery. The ovary and adnexal structures are relatively difficult to image with any technology. Magnetic resonance spectroscopy (MRS) can detect metabolic changes. As molecular changes often precede morphologic alterations, sensitivity is expected to improve by MRS. Diffusion weighted magnetic resonance imaging (DW-MRI) is sensitive to molecular diffusion which is due to random microscopic translational motion of molecules (known as Brownian motion). In the event of morphologic evaluation of cystic ovarian tumors, whether benign or malignant, DW-MR imaging and calculated apparent diffusion coefficient (ADC) values would be useful for evaluation. PurposeThe aim of this study is to evaluate the role of diffusion MRI & proton magnetic resonance spectroscopy (H-MRS) in diagnosis of ovarian neoplasms. Subjects and methodsThis study included 20 patients, their ages ranged from 20 to 72years. In all cases, diagnosis was proven by surgical and pathological examination. Trans-abdominal ultrasound (n=20) and trans-vaginal ultrasound (n=11) were included in our routine protocol to obtain baseline information preceding MR examination. The routine MR examination protocol included: T1WI, T2WI, and post contrast fat suppressed T1WI. Diffusion weighted imaging (DWI) was done to all patients at b0, b500, b1000 and ADC values were calculated. MRS was performed in all cases using multi-voxel point resolved surface coil spectroscopy (PRESS sequence) for volume localization. ResultsFourteen cases (70%) had benign ovarian masses while the remaining six cases (30%) had malignant masses. High lipid peak was detected in all three cases of mature cystic teratoma. All cases of simple serous cysts showed choline and creatine signals that were higher than the average noise level but lower than the two fold higher noise level. Sharp choline peak was detected in all malignant ovarian masses (except a case of metastases under chemotherapy) as well as the case of fibroma. Creatine signal was detected in all benign and malignant masses except two cases of mature cystic teratoma and cases of endometrioma. Lactate signal was detected only in cases of hemorrhagic cysts, mature cyst teratoma and one case of endometrioma and not obtained in any of malignant lesions except dysgerminoma. High NAA signal was detected in dysgerminoma and all three cases of mature cystic teratomas. The mean Cho/Cr ratio was significantly higher in malignant than benign ovarian masses (<0.05), there was no significant difference in mean and lowest ADC values between malignant and benign lesions. ConclusionProton MRS using Cho/Cr ratio added useful information for the diagnosis of different ovarian neoplasms. Direct visual assessment of DWI of ovarian lesions is not useful in differentiating benign from malignant ovarian lesions; determining the threshold of the ADC for diagnosing cystic ovarian tumors is difficult because of their large variance. Further experience with a larger and more biologically variable range of tumors is recommended.

Subjective assessment by ultrasound is superior to the risk of malignancy index (RMI) or the risk of ovarian malignancy algorithm (ROMA) in discriminating benign from malignant adnexal masses

PurposeThe combination of two tumour markers, CA125 and HE4, in the risk of ovarian malignancy assay (ROMA) has been shown to be successful in classifying patients into those who have a high or low risk of epithelial ovarian cancer. In the present study, the diagnostic accuracy of ROMA was assessed and compared to the diagnostic accuracy of the two most widely used ultrasound methods, namely the risk of malignancy index (RMI) and subjective assessment by ultrasound. MethodsFrom August, 2005 to March, 2009, 432 women with a pelvic mass who were scheduled to have surgery were enrolled in a single-centre prospective cohort study. A preoperative ultrasound was performed and preoperative CA125 and HE4 serum levels were measured. Once the final surgical pathology reports were obtained, the diagnostic accuracy and performance indices of ROMA, RMI and subjective assessment were calculated. ResultsOf the 432 eligible patients, 374 could be analysed. Subjective assessment had the highest area under the receiver operator characteristic curve (AUC) (0.968, 95%CI:0.945–0.984), followed by the RMI (0.931, 95%CI:0.901–0.955). The subjective assessment and RMI both had significantly higher AUCs than the ROMA (0.893, 95%CI:0.857–0.922; P<0.0001 and P=0.0030, respectively). The pre- and postmenopausal populations generated similar results. ConclusionAlthough new tumour markers models are promising, they do not contribute significantly to the diagnosis of ovarian cancer. Ultrasound, especially subjective assessment by ultrasound, remains superior in discriminating malignant from benign ovarian masses.

Benign and Suspicious Ovarian Masses—MR Imaging Criteria for Characterization: Pictorial Review

Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are currently used to evaluate ovarian tumors. US is the first-line imaging investigation for suspected adnexal masses. Color Doppler US helps the diagnosis identifying vascularized components within the mass. CT is commonly performed in preoperative evaluation of a suspected ovarian malignancy, but it exposes patients to radiation. When US findings are nondiagnostic or equivocal, MRI can be a valuable problem solving tool, useful to give also surgical planning information. MRI is well known to provide accurate information about hemorrhage, fat, and collagen. It is able to identify different types of tissue contained in pelvic masses, distinguishing benign from malignant ovarian tumors. The knowledge of clinical syndromes and MRI features of these conditions is crucial in establishing an accurate diagnosis and determining appropriate treatment. The purpose of this paper is to illustrate MRI findings in neoplastic and non-neoplastic ovarian masses, which were assessed into three groups: cystic, solid, and solid/cystic lesions. MRI criteria for the correct diagnosis and characteristics for differentiating benign from malignant conditions are shown in this paper.

Surgical Management of Benign Ovarian Masses in Girls and Adolescents

Ovarian masses requiring surgery are uncommon during girlhood and adolescence, and evidence-based guidelines are limited. Only about 10% of these masses are malignant and require aggressive treatment — for benign lesions, ovary-conserving cystectomy is preferred over oophorectomy. In a retrospective study of patterns of surgical management of benign adnexal masses in girls and teens age ≤18, investigators used a nationwide hospital discharge database to analyze characteristics of patients, physicians, surgical approaches, and hospitals …

Unexpected ovarian malignancy after conservative laparoscopic surgery: five case series in a half decade of experience

To analyse and describe cases of unexpected ovarian malignancy after conservative laparoscopic surgery for an apparent benign ovarian mass at our centre. This retrospective study was performed by collecting data from records of premenopausal women who underwent conservative laparoscopic surgery for benign ovarian mass at Siriraj Hospital over a 5 year period from 2006 to 2010. The rate of unexpected malignancy, histopathological type of the ovarian neoplasm and follow-up after surgery were reviewed. During the study period, 1,161 patients underwent conservative laparoscopic surgery. Of these, five (0.43%) had ovarian malignancy which were diagnosed after reviewing histopathological report postoperatively. The histopathological diagnosis was borderline tumour in two patients, clear cell carcinoma, granulosa cell tumour and mucinous cell adenocarcinoma in the other three patients. All patients are alive after a mean follow-up of 9-60 months with two patients developed recurrence. The main concern for laparoscopic management of ovarian masses is unexpected malignancy. However, with careful patient selection, proper technique and an experienced operator, laparoscopic treatment of ovarian masses is the best approach and should be implemented, with low risk of unexpected malignancy and recurrence.

A Novel Approach to Predict the Likelihood of Specific Ovarian Tumor Pathology Based on Serum CA-125: A Multicenter Observational Study

The CA-125 tumor marker has limitations when used to distinguish between benign and malignant ovarian masses. We therefore establish likelihood curves of six subgroups of ovarian pathology based on CA-125 and menopausal status. This cross-sectional study conducted by the International Ovarian Tumor Analysis group involved 3,511 patients presenting with a persistent adnexal mass that underwent surgical intervention. CA-125 distributions for six tumor subgroups (endometriomas and abscesses, other benign tumors, borderline tumors, stage I invasive cancers, stage II-IV invasive cancers, and metastatic tumors) were estimated using kernel density estimation with stratification for menopausal status. Likelihood curves for the tumor subgroups were derived from the distributions. Endometriomas and abscesses were the only benign pathologies with median CA-125 levels above 20 U/mL (43 and 45, respectively). Borderline and invasive stage I tumors had relatively low median CA-125 levels (29 and 81 U/mL, respectively). The CA-125 distributions of stage II-IV invasive cancers and benign tumors other than endometriomas or abscesses were well separated; the distributions of the other subgroups overlapped substantially. This held for premenopausal and postmenopausal patients. Likelihood curves and reference tables comprehensibly show how subgroup likelihoods change with CA-125 and menopausal status. Our results confirm the limited clinical value of CA-125 for preoperative discrimination between benign and malignant ovarian pathology. We have shown that CA-125 may be used in a different way. By using likelihood reference tables, we believe clinicians will be better able to interpret preoperative serum CA-125 results in patients with adnexal masses.

Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components

To evaluate differences in apparent diffusion coefficient (ADC) values for the solid component of benign and malignant ovarian surface epithelial tumors with the goal of differentiating benign versus malignant ovarian tumors preoperatively. A total of 127 patients with 131 pelvic masses identified by ultrasound between January 2006 and January 2011 were enrolled in this study. 46 patients were diagnosed with benign tumors, and 85 patients were diagnosed with malignant pathologies. For all of the patients, routine spin-echo MRI and diffusion-weighted imaging were performed. ADC values were determined for all of the masses, and the mean ADC values for the benign and malignant tumors were analyzed using Student's t test. A P value <0.05 was considered statistically significant. Mean ADC values associated with malignant ovarian surface epithelial tumors were significantly lower than the mean ADC values of the benign tumors. In addition, the range of ADC values associated with a 95% confidence interval did not overlap between the two groups. ROC analysis indicated that a cutoff ADC value of 1.25 × 10(-3) mm(2)/s was associated with 90.1% sensitivity and 89.9% specificity. ADC values determined from 1.5 T MR DWI of benign and malignant ovarian masses were found to be significantly different.

Evaluation of Proteomics-Identified CCL18 and CXCL1 as Circulating Tumor Markers for Differential Diagnosis between Ovarian Carcinomas and Benign Pelvic Masses

A lack of sensitive and specific tumor markers for early diagnosis and treatment is a major cause for the high mortality rate of ovarian cancer. The purpose of this study was to identify potential proteomics-based biomarkers useful for the differential diagnosis between ovarian cancer and benign pelvic masses. Serum samples from 41 patients with ovarian cancer, 32 patients with benign pelvic masses, and 41 healthy female blood donors were examined, and proteomic profiling of the samples was assessed by surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectroscopy (MS). A confirmatory study was also conducted with serum specimens from 58 patients with ovarian carcinoma, 37 patients with benign pelvic masses, and 48 healthy women. A classification tree was established using Biomarker Pattern Software. Six differentially expressed proteins (APP, CA 125, CCL18, CXCL1, IL-8, and ITIH4) were separated by high-performance liquid chromatography and identified by matrix-assisted laser desorption/ionization (MALDI)-MS/MS and database searches. Two of the proteins overexpressed in ovarian cancer patients, chemokine CC2 motif ligand 18 (CCL18) and chemokine CXC motif ligand 1 (CXCL1), were automatically selected in a multivariate predictive model. These two protein biomarkers were then validated and evaluated by enzyme-linked immunosorbent assay (ELISA) in 535 serum specimens (130 ovarian cancer, 64 benign ovarian masses, 36 lung cancer, 60 gastric cancer, 55 nasopharyngeal carcinoma, 48 hepatocellular carcinoma, and 142 healthy women). The combined use of CCL18 and CXCL1 as biomarkers for ovarian cancer had a sensitivity of 92% and a specificity of 97%. The multivariate ELISA analysis of the two putative markers in combination with CA 125 resulted in a sensitivity of 99% for healthy women and 94% for benign pelvic masses, and a specificity of 92% for both groups; these values were significantly higher than those obtained with CA 125 alone (p and lt;0.05). We conclude that serum CCL18 and CXCL1 are potentially useful as novel circulating tumor markers for the differential diagnosis between ovarian cancer and benign ovarian masses.

Fetal Diagnosis with Ultrasonic Actocardiogram and GLHW Tissue Characterization

ABSTRACT Actocardiogram Ultrasonic Doppler actocardiogram was simultaneous tracing of FHR and fetal movement signals on the monitoring chart, created in 1984 by Maeda. Fetal behavior was easily studied, false-positive nonreactive FHR and physiological sinusoidal FHR were differentiated, the severity of fetal CNS lesion and common fetal disorders were determined, short and long-term outcomes were diagnosed in multiple grades GLHW It is clinical tissue characterization by common ultrasonic B-mode apparatus. Placental tissue was characterized and grade-3 placenta was detected. Placental origin of FGR was diagnosed and meconium stained turbid amniotic fluid was differentiated from clear fluid. Fetal periventricular echodensity preceding neonatal PVL was analyzed; 96% of fetal lung immaturity was noninvasively detected endometrial; benign hyperplasia, carcinoma, benign ovarian mass and malignancy were differentiated.

Role of multidetector computed tomography (MDCT) in patients with ovarian masses

Objective:To evaluate the diagnostic accuracy of multidetector 64-slice computed tomography (MDCT) in the diagnosis and differentiation of benign and malignant ovarian masses using histopathology and surgical findings as the gold standard.Material and methods:This study was conducted in Aga Khan University Hospital, Karachi, Pakistan. Data was reviewed retrospectively from 1 November 2008 to 12 December 2009. One hundred patients found to have ovarian masses on CT scan were included in the study. CT scan was performed in all these patients after administration of oral and IV contrast. Ovarian masses were classified as benign and malignant on scan findings. Imaging findings were compared with histopathologic results and surgical findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MDCT were calculated.Results:MDCT was found to have 97% sensitivity, 91% specificity, and an accuracy of 96% in the differentiation of benign and malignant ovarian masses, while PPV and NPV were 97% and 91%, respectively.Conclusion:MDCT imaging offers a safe, accurate and noninvasive modality to differentiate between benign and malignant ovarian masses.

Efficacy of laparoscopic stripping for ovarian cysts: Histological and clinical findings

The aim of our study was to evaluate the efficacy of the laparoscopic stripping technique on benign ovarian masses with respect to healthy ovarian tissue. Seventy-six patients between 14 and 40 years of age were enrolled after receiving a diagnosis of mono-lateral ovarian cyst and underwent laparoscopic surgery for cyst excision with the stripping technique. Histological observations of these specimens were then performed and graded on a semiquantitative scale. The 76 samples included 36 endometriotic cysts, 18 dermoid cysts, 12 serous cysts, and 10 mucinous cysts. Only 26 of the endometriomas showed histological evidence of healthy ovarian tissue that, however, differed morphologically from normal ovarian tissue. The laparoscopic stripping technique used for the excision of different ovarian cysts is a practice that safeguards the organ.

Clinical study of autoantibody spectrum against ovarian cancer associated antigens combined with CA(125) in detecting and monitoring ovarian cancer

To evaluate the clinical value of autoantibody spectrum against ovarian cancer associated antigens combine CA(125) in detecting and monitoring ovarian cancer. Circulating IgG, IgM autoantibodies against ovarian cancer associated antigens which included TM4SF1, C1D, TIZ, OV-142, FXR1 and OV-189 were measured by indirect ELISA in serum from 126 patients with ovarian cancer (prior treatment), 42 patients with benign ovarian masses, 142 healthy women. Cut off value of IgG, IgM autoantibodies were determined by receive operating characteristic (ROC) curve. CA(125) was measured in serum by immunoradiometric assay (IRMA). We evaluated the clinical value of combining multiple autoantibodies (autoantibody spectrum), combining autoantibody spectrum with CA(125) by binary logistic regresion. The positive ratio of autoantibody spectrum in serum (prior and post treatment) of 24 synchronization patients with ovarian cancer was analyzed to evaluate the value in monitoring state of illness. Our data indicated that serum contains IgG, IgM autoantibodies against ovarian cancer associated antigens. The positive ratio of IgG autoantibodies in serum from ovarian cancer patients and cancer-free patients were 34.1% - 47.6% and 13.0% - 19.0%, respectively (P < 0.05). The positive ratio of IgM autoantibodies in serum from ovarian cancer patients and cancer-free patients were 39.7% - 53.2% and 12.0% - 33.2%, respectively (P < 0.05). The positive ratio of IgG autoantibodies against FXR1 and IgM autoantibodies against TIZ, FXR1 and OV-189 in early stage (I-II) ovarian cancer (55.3%, 63.8%, 61.7% and 66.0%) were significantly higher than those in advanced (III-IV) ovarian cancer (34.2%, 39.2%, 26.6%, 45.6%; all P < 0.05). Combining five autoantibodies (TM4SF1 IgG, TM4SF1 IgM, C1D IgG, FXR1 IgG and TIZ IgM) showed significantly improved sensitivity (75.4%, P < 0.05), lower specificity (78.3%, P < 0.05) and similar accuracy (77.1%, P > 0.05) in detecting ovarian cancer compared to those of CA(125) (61.1%, 88.0%, 77.1%). But the autoantibody spectrum showed significantly improved sensitivity in classifying early stage (76.6%), compared to those of CA(125) (51.1%, P < 0.05). Combining autoantibody spectrum with CA(125) showed significantly improved sensitivity (85.7%), specificity (90.8%)and accuracy (88.7%) in detecting ovarian cancer compared to those of autoantibody spectrum alone (all P < 0.05), while CA(125) (61.1%, P < 0.05; 88.0%, P > 0.05; 77.1%, P < 0.05). The positive ratio of combine the autoantibody spectrum with CA(125) was significantly lower in 24 post-treatment serum (42%) compared to the pairing prior treatment serum (88%, P < 0.05). Combining the autoantibody spectrum against ovarian cancer associated antigens with CA(125) can improve sensitivity, specificity and accuracy in detecting early ovarian cancer and may be used to monitoring state of illness.

The diagnostic accuracy of two human epididymis protein 4 (HE4) testing systems in combination with CA125 in the differential diagnosis of ovarian masses

Cancer antigen 125 (CA125) is the best known single tumor marker for ovarian cancer (OC). We investigated whether the additional information of the human epididymis protein 4 (HE4) improves diagnostic accuracy. We retrospectively analyzed preoperative sera of 109 healthy women, 285 patients with benign ovarian masses (cystadenoma: n=78, leimyoma: n=66, endometriosis: n=52, functional ovarian cysts: n=79, other: n=10), 16 low malignant potential (LMP) ovarian tumors and 125 OC (stage I: 22, II: 15, III: 78, IV: 10). CA125 was analyzed using the ARCHITECT system, HE4 using the ARCHITECT(a) system and EIA(e) technology additionally. The lowest concentrations of CA125 and HE4 were observed in healthy individuals, followed by patients with benign adnexal masses and patients with LMP tumors and OC. The area under the curve (AUC) for the differential diagnosis of adnexal masses of CA125 alone was not significantly different to HE4 alone in premenopausal (CA125: 86.7, HE4(a): 82.6, HE4(e): 81.6% p>0.05) but significantly different in postmenopausal [CA125: 93.4 vs. HE4(a): 88.3 p=0.023 and vs. HE4(e): 87.8% p=0.012] patients. For stage I OC, HE4 as a single marker was superior to CA125, which was the best single marker in stage II-IV. The combination of CA125 and HE4 using risk of malignancy algorithm (ROMA) gained the highest sensitivity at 95% specificity for the differential diagnosis of adnexal masses [CA125: 70.9, HE4(a): 67.4, HE4(e): 66.0, ROMA(a): 76.6 and ROMA(e): 74.5%], especially in stage I OC [CA125: 27.3, HE4(a): 40.9, HE4(e): 40.9, ROMA(a): 45.5 and ROMA(e): 45.5%]. CA125 is still the best single marker in the diagnosis of OC. HE4 alone and even more the combined analysis of CA125 and HE4 using ROMA improve the diagnostic accuracy of adnexal masses, especially in early OC.

The role of intravenous pyelography and colon barium graphy in ovarian cancers

MATERIAL AND METHOD: This study was conducted retrospectively in Karadeniz Technical University between January 2009 and January 2010. Patients who have ultrasound fi ndings suspecting an ovarian cancer were enrolled into the study. Pathology, intravenous pyelogram and barium graphy results were documented. Malign and benign ovarian mass groups were compared by using the fi ndings of intravenous pyelograpy and colon graphy. In statistical analysis, Student t and Mann Whitney tests were used appropriately. A p value <0.05 was considered signifi cant.