Benign Ovarian Masses Research Articles

Ultrasonographic evaluation of ovarian mass for predicting malignancy in pregnant women

ObjectiveThe purpose of this study is to compare ultrasonographic ovarian mass scoring systems in pregnant women. Study designThis multicenter study included women with an ovarian mass during pregnancy who were evaluated using ultrasound and underwent surgery in 11 referral hospitals. The ovarian mass was evaluated and scored using three different scoring systems(International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adnexa[IOTA ADNEX], Sassone, and Lerner). The final diagnosis was made histopathologically. Receiver operating characteristic(ROC) curves were generated for each scoring system. ResultsDuring the study period, 236 pregnant women underwent surgery for an ovarian mass, including 223 women(94.5%) with a benign ovarian mass and 13 women(5.5%) with a malignant ovarian mass. Among 10 ultrasound image findings, six findings were different between benign and ovarian masses(maximal diameter of mass, maximal diameter of solid mass, wall thickness of mass, inner wall structure, thickness of septations, and papillarity). In all three scoring systems, the ovarian mass scores were significantly higher in malignant masses than in benign masses, with the highest area under the ROC curve(AUROC) in the Sassone scoring system(AUROC: 0.831 for Sassone, 0.710 for Lerner vs 0.709 for IOTA ADNEX; p < 0.05, between the Sassone and Lerner/ IOTA ADNEX). A combined model was developed with the six different ultrasound findings, and the AUROC of the combined model was 0.883(p = not significant between the combined model and Sassone). ConclusionIn pregnant women, malignant ovarian tumors can be predicted with high accuracy using either the Sassone scoring system or the combined model.

Biomarker-based early detection of epithelial ovarian cancer based on a five-protein signature in patient\u2019s plasma \u2013 a prospective trial

BackgroundTrial on five plasma biomarkers (CA125, HE4, OPN, leptin, prolactin) and their possible role in differentiating benign from malignant ovarian tumors.MethodsIn this unicentric prospective trial preoperative blood samples of 43 women with ovarian masses determined for ovarian surgery were analyzed. 25 patients had pathologically confirmed benign, 18 malignant ovarian tumors. Blood plasma was analyzed for CA125, HE4, OPN, leptin, prolactin and MIF by multiplex immunoassay analysis. Each single protein and a logistical regression model including all the listed proteins were tested as preoperative predictive marker for suspect ovarian masses.ResultsPlasma CA125 was confirmed as a highly accurate tumor marker in ovarian cancer. HE4, OPN, leptin and prolactin plasma levels differed significantly between benign and malignant ovarian masses. With a logistical regression model a formula including CA125, HE4, OPN, leptin and prolactin was developed to predict malignant ovarian tumors. With a discriminatory AUC of 0.96 it showed to be a highly sensitive and specific diagnostic test for a malignant ovarian tumor.ConclusionsThe calculated formula with the combination of CA125, HE4, OPN, leptin and prolactin plasma levels surpasses each single marker in its diagnostic value to discriminate between benign and malignant ovarian tumors. The formula, applied to our patient population was highly accurate but should be validated in a larger cohort.Trial registrationClinical Trials.gov under NCT01763125, registered Jan. 8, 2013.

Predictor Role of Systemic Inflammation in Ovarian Cancer

Objective: The study aims to investigate the diagnostic value of hemogram derived systemic inflammation parameters in ovarian cancer.Methods: Totally, the study group consisted of 60 patients with suspected ovarian masses who underwent surgery between February 1th, 2020, and May 1th, 2021, in Ordu University Training and Research Hospital. The patients included in the study were divided into two groups according to postoperative histopathological diagnosis, benign group (consisting of 39 patients) and malign group (consisting of 21 patients). The analysis of the receiver operating characteristic (ROC) curve was used to discover the optimal cut-off values of the hemogram derived blood parameters to predict ovarian cancer.Results: In the cancer group; 85% of the patients were diagnosed with epithelial ovarian cancer and 62% at late stage. As compares with benign ovarian mass group, the ovarian cancer group had higher neutrophil counts (6.67+3.17 vs 4.64+1.94) (p=0.006), but lower lymphocyte counts (1.60+0.68 vs 2.22+0.64) (p=0.003). The high NLR values (cut-off 2.557) predict ovarian cancer with 71.4% sensitivity and 69.2% specificity (AUC 0.817, p=0.000, CI=0.712-0.922). The high dNLR values (cut- off 1.881) also predict cancer with similar sensitivity and specificity as NLR (AUC 0.814, p=0.000, CI 0.708-0.921). Significant cut-off values for the other hemogram derived parameters were 0.26, 0.0165, 159.66 and 770.611 for MLR, NPR, PLR and SII, respectively. Additionally, the high values of CA 125 (cut-off 34.45) and CA 15-3 (cut-off 16.4) was founded to be related with ovarian cancer.Conclusions: This paper revealed that high inflammatory parameters such as NLR and dNLR in patients with ovarian masses are mainly associated with ovarian cancer. In the study, it was emphasized that simple and easily accessible hemogram parameters should be used in addition to tumor biomarkers such as CA 125, CA 15-3, which are routinely used in predicting ovarian cancers. We think that more valuable results will be achieved with comprehensive studies designed prospectively.

Diagnostic measures comparison for ovarian malignancy risk in Epithelial ovarian cancer patients: a meta-analysis

Epithelial ovarian cancer has become the most frequent cause of deaths among gynecologic malignancies. Our study elucidates the diagnostic performance of Risk of Ovarian Malignancy Algorithm (ROMA), Human epididymis secretory protein 4 (HE4) and cancer antigen (CA125). To compare the diagnostic accuracy of ROMA, HE-4 and CA125 in the early diagnosis and screening of Epithelial Ovarian Cancer. Literature search in electronic databases such as Medicine: MEDLINE (through PUBMED interface), EMBASE, Google Scholar, Science Direct and Cochrane library from January 2011 to August 2020. Studies that evaluated the diagnostic measures of ROMA, HE4 and CA125 by using Chemilumincence immunoassay or electrochemiluminescence immunoassay (CLIA or ECLIA) as index tests. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We included 32 studies in our meta-analysis. We calculated AUC by SROC, pooled estimated like sensitivity, specificity, likelihood ratio, diagnostic odds ratio (DOR), Tau square, Cochran Q through random effect analysis and meta-regression. Data was retrieved from 32 studies. The number of studies included for HE4, CA125 and ROMA tests was 25, 26 and 22 respectively. The patients with EOC were taken as cases, and women with benign ovarian mass were taken as control, which was 2233/5682, 2315/5875 and 2281/5068 respectively for the markers or algorithm. The pooled estimates of the markers or algorithm were sensitivity: ROMA (postmenopausal) (0.88, 95% CI 0.86–0.89) > ROMA (premenopausal) 0.80, 95% CI 0.78–0.83 > CA-125(0.84, 95% CI 0.82–0.85) > HE4 (0.73, 95% CI 0.71–0.75) specificity: HE4 (0.90, 95% CI 0.89–0.91) > ROMA (postmenopausal) (0.83, 95% CI 0.81–0.84) > ROMA (premenopausal) (0.80, 95% CI 0.79–0.82) > CA125 (0.73, 95%CI 0.72–0.74), Diagnostic odd’s ratio ROMA (postmenopausal) 44.04, 95% CI 31.27–62.03, ROMA (premenopausal)-18.93, 95% CI 13.04–27.48, CA-125-13.44, 95% CI 9.97–18.13, HE4-41.03, 95% CI 27.96–60.21 AUC(SE): ROMA (postmenopausal) 0.94(0.01), ROMA (premenopausal)-0.88(0.01), HE4 0.91(0.01), CA125-0.86(0.02) through bivariate random effects model considering the heterogeneity. Our study found ROMA as the best marker to differentiate EOC from benign ovarian masses with greater diagnostic accuracy as compared to HE4 and CA125 in postmenopausal women. In premenopausal women, HE4 is a promising predictor of Epithelial ovarian cancer; however, its utilisation requires further exploration. Our study elucidates the diagnostic performance of ROMA, HE4 and CA125 in EOC. ROMA is a promising diagnostic marker of Epithelial ovarian cancers in postmenopausal women, while HE4 is the best diagnostic predictor of EOC in the premenopausal group. Our study had only EOC patients as cases and those with benign ovarian masses as controls. Further, we considered the studies estimated using the markers by the same index test: CLIA or ECLIA. The good number of studies with strict inclusion criteria reduced bias because of the pooling of studies with different analytical methods, especially for HE4. We did not consider the studies published in foreign languages. Since a few studies were available for HE4 and CA125 in the premenopausal and postmenopausal group separately, data were inadequate for sub-group analysis. Further, we did not assess these markers' diagnostic efficiency stratified by the stage and type of tumour due to insufficient studies.

Ovarian teratomas in bimodal age groups- Case report

Ovarian teratomas are the most common germ cell tumors and are classified as mature, immature and malignant.Mature cystic teratomas, also called dermoid cysts, are the most common germ cell tumour, accounting for upto 70% of benign ovarian masses in the reproductive years and 20% in postmenopausal women.Immature ovarian teratoma affects primarily younger patients and mature cystic teratomas seen in reproductive age groups. This case report provides a brief summary of the clinicopathological features of the ovarian teratomas such as, the immature teratoma which being a rare tumour was diagnosed in a 15 year old adolescent girl, managed surgically by laparotomy followed by chemotherapy, and the other case of a benign mature cystic teratoma in an elderly 52 year old postmenopausal woman, managed surgically although benign cystic teratomas are rare in the postmenopausal age group.

Clinical analysis of 52 adolescent patients with ovarian masses ≥10 cm in diameter.

ObjectiveTo investigate the clinical characteristics and treatment of large ovarian masses in adolescents.MethodsAdolescents with large ovarian masses (≥10 cm in diameter) who were treated in Beijing Obstetrics and Gynecology Hospital from March 2010 to December 2018 were retrospectively assessed.ResultsFifty-two female patients (mean age: 16.17±2.04 years [11–19 years]) were included and 19 (36.5%) presented with abdominal pain. The blood flow signal rate in ultrasonography was significantly different among benign, borderline and malignant ovarian masses, unlike strong echo, dotted echo and septation rates. Carbohydrate antigen 125 positivity rates were significantly different among pathological types and the endometriotic cyst group showed the highest value (75.0%). Alpha-fetoprotein positivity rates were also different among pathological types. For ovarian cystectomy, 14 and 32 patients underwent laparotomy and laparoscopy, respectively. Mass diameters were significantly higher in the laparotomy group and the operative duration was significantly shorter in the laparoscopy group. There were no significant differences in intraoperative blood loss or postoperative recurrence rates between the two groups.ConclusionTeratomas constitute the greatest group of large ovarian masses in adolescents. Benign tumors should be treated by laparoscopic resection, while borderline or malignant tumors require individualized treatment of tumors and fertility-sparing treatments.

Sonographic Advancements in Characterization of Benign and Malignant Ovarian Masses

Background: Characterization of ovarian masses is essentially required and inevitable for optimization of clinical decision making, patient care and management. The diagnosis of ovarian masses is a frequent dilemma in clinical work. Ultrasonography remains the modality of choice in the early investigation of suspected adnexal masses because of its availability and being a safe modality. Aim: To review the current literature on different patterns of manifestation of ovarian masses on ultrasound and its various modes, helping in differential diagnosis on the basis of morphologic, vascular and other characteristics as seen on ultrasound. Methods: Electronic database was searched (PubMed, Google Scholar, Science direct) with data ranging from year 2000 to 2021. Most relevant studies, relating to sonographic appearances of ovarian masses were selected. Results: Twenty five most relevant articles were found: 8 articles were regarding gray-scale ultrasound, 3 articles regarding three dimensional ultrasonography, 2 articles regarding contrast enhanced ultrasonography, 2 regarding elastography and rest were regarding combined use of gray-scale and Doppler ultrasound including color and power Doppler ultrasonography for the assessment of ovarian masses. Our results show that conventional 2D sonography, in conjunction with latest advancements helps improving the diagnosis based on typical sonographic appearances of masses. Screening for ovarian cancer also proves to be helpful for early diagnosis and improvement in survival rate. Conclusion: Ultrasonoraphy and its different modalities such as 3DUS, CEUS, elastography along with conventional 2D and Doppler studies accurately identifies morphologic, structural and vascular featuresof the adnexal masses and differential diagnosis by escapingunnecessary surgeries and improving the survival rate. Keywords: Ultrasonography, Ovarian masses, malignant ovarian masses, contrast enhanced ultrasound,

Adnexal Masses in Pregnancy.

Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians. The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy. This was a literature review using primarily PubMed and Google Scholar. Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy. Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.

Mitochondria in epithelial ovarian carcinoma exhibit abnormal phenotypes and blunted associations with biobehavioral factors

Malignant tumor cells exhibit mitochondrial alterations and are also influenced by biobehavioral processes, but the intersection of biobehavioral factors and mitochondria in malignant tumors remains unexplored. Here we examined multiple biochemical and molecular markers of mitochondrial content and function in benign tissue and in high-grade epithelial ovarian carcinoma (EOC) in parallel with exploratory analyses of biobehavioral factors. First, analysis of a publicly-available database (n = 1435) showed that gene expression of specific mitochondrial proteins in EOC is associated with survival. Quantifying multiple biochemical and molecular markers of mitochondrial content and function in tissue from 51 patients with benign ovarian masses and 128 patients with high-grade EOC revealed that compared to benign tissue, EOCs exhibit 3.3–8.4-fold higher mitochondrial content and respiratory chain enzymatic activities (P < 0.001) but similar mitochondrial DNA (mtDNA) levels (− 3.1%), documenting abnormal mitochondrial phenotypes in EOC. Mitochondrial respiratory chain activity was also associated with interleukin-6 (IL-6) levels in ascites. In benign tissue, negative biobehavioral factors were inversely correlated with mitochondrial content and respiratory chain activities, whereas positive biobehavioral factors tended to be positively correlated with mitochondrial measures, although effect sizes were small to medium (r = − 0.43 to 0.47). In contrast, serous EOCs showed less pronounced biobehavioral-mitochondrial correlations. These results document abnormal mitochondrial functional phenotypes in EOC and warrant further research on the link between biobehavioral factors and mitochondria in cancer.

OVARIAN MASSES IN WOMEN: A RETROSPECTIVE ANALYSIS IN TERTIARY CARE CENTER

Objective: To describe the presenting signs and symptoms, clinic-pathological findings of ovarian masses and to establish diagnostic value of clinical examination, ultrasonography and its correlation with histopathological diagnosis.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital, Rawalpindi Jun 2017 May 2018.&#x0D; Methodology: Women who underwent surgery for ovarian masses were included. Data was collected from hospital records including; age, presenting symptoms, duration of symptoms, changes in menstrual cycle, and the results of the physical examination. The preliminary diagnoses as well as the final diagnosis were noted.&#x0D; Results: A total of 83 patients with ovarian masses, who underwent surgery over the period of a year, were included. The most common symptom was abdominal pain in 56 (67.5%) followed by abdominal distention 9 (10.8%), dysmenorrhea 8(9.6%). When both clinical and sonological diagnosis were combined, the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign and malignant ovarian neoplasms were 87.5%, 96.7%, 70%, and 98.88%, respectively.&#x0D; Conclusion: In this study most, common symptom was abdominal pain both in benign and malignant ovarian masses. Whereas, abdominal distention was more common in malignant masses. Preoperative diagnostic approach should always include careful history taking, physical examination, imaging and evaluation of tumor markers. Early detection, thorough treatment and regular follow-up are the need of time to reduce the morbidity and mortality.

Prediction Models of Adnexal Masses: State-of-the-Art Review.

Several predictive models and scoring systems have been developed to differentiate between benign and malignant ovarian masses, in order to guide effective management. These models use combinations of patient characteristics, ultrasound markers, and biochemical markers. The aim of this study was to describe, compare, and prioritize, according to their strengths and qualities, all the adnexal prediction models. This was a state-of-the-art review, synthesizing the findings of the current published literature on the available prediction models of adnexal masses. The existing models include subjective assessment by expert sonographers, the International Ovarian Tumor Analysis models (logistic regression models 1 and 2, Simple Rules, 3-step strategy, and ADNEX [Assessment of Different NEoplasias in the adneXa] model), the Risk of Malignancy Index, the Risk of Malignancy Ovarian Algorithm, the Gynecologic Imaging Reporting and Data System, and the Ovarian-Adnexal Reporting and Data System. Overall, subjective assessment appears to be superior to all prediction models. However, the International Ovarian Tumor Analysis models are probably the best available methods for nonexpert examiners. The Ovarian-Adnexal Reporting and Data System is an international approach that incorporates both the common European and North American approaches, but still needs to be validated. Many prediction models exist for the assessment of adnexal masses. The adoption of a particular model is based on local guidelines, as well as sonographer's experience. The safety of expectant management of adnexal masses with benign ultrasound morphology is still under investigation.

87. Small Case Series of Neonatal Autoamputated Ovary Presenting as Enlarging Complex Ovarian Mass with Increasingly Elevated AFP

<h3>Background</h3> We present a case series of two girls with enlarging complex ovarian masses associated with increasing levels of alpha-fetoprotein (AFP). Both girls were found to have an autoamputated ovary. Tumor markers associated with benign ovarian masses are usually within the normal range. Abnormally elevated AFP levels in the neonates with large complex ovarian masses should be surgically evaluated. This case series could suggest an association between elevated AFP and ovarian autoamputation. <h3>Case</h3> The first patient was a term female baby delivered without complications and known to have a complex cyst in utero. She was a thriving baby girl and her physical exam was unremarkable. Post-natal pelvic ultrasound revealed a 62 × 40 mm enlarging right ovarian cyst with a vascularized nodule. Imaging was suggestive of a mature teratoma or a germinal tumor. Tumor markers were significant for elevated levels of AFP up to 373 mcg/L. Repeat ultrasound showed a persistent ovarian cyst. The second patient was a 7-month-old female with a known history of a right neonatal ovarian cyst followed with serial ultrasounds. She appeared healthy and her exam was unremarkable. A pelvic ultrasound revealed a 44 × 53 mm ovarian cyst with echogenic debris. Tumor markers were significant for an elevated AFP level of 695 mcg/L. Given the elevated AFP and persistence of the cysts, surgical excision were performed. Both diagnostic laparoscopies revealed autoamputated right ovary and fallopian tube and right salpingoophorectomies were performed. Surgeries were uneventful. The pathology exam of the first specimen showed necrotic ovarian tissue with benign cystic lesion of unknown origin, without neoplasia. The second pathology specimen analysis showed a torsed hemorrhagic cyst with no evidence of malignancy. The AFP levels normalized subsequently. <h3>Comments</h3> Prenatal ovarian cysts are frequent and tend to regress in the first months of life. Complex cysts require follow-up with serial ultrasounds and tumor marker measurements. Large or complex cysts may require surgical intervention due to suspicion of ovarian torsion or malignancy. Perinatally, increased AFP levels are associated with hepatic or germ cell tumors. Suggested reference level of AFP is 15.7 to 146.5 mcg/L. Although autoamputated ovaries are thought to be normal, on pathology, it is difficult to identify ovarian tissue. Elevated AFP levels found in this case series are somewhat difficult to interpret since pathology analysis was limited by necrosis. Nonetheless, abnormally elevated AFP levels in the neonates with large complex ovarian masses should be surgically evaluated. Further research is needed to investigate the possible association of elevated AFP levels and ovarian autoamputation.

Clinical and CT features of ovarian torsion in infants, children and adolescents.

To investigate the clinical features and computed tomography (CT) findings of pediatric ovarian torsion. A retrospective analysis of the clinical and CT data of 61 newborns, infants, children, and adolescents with ovarian torsion confirmed by histopathology was performed. Clinical features included abdominal mass, abdominal pain, nausea and vomiting, and fever. The tumor marker α-fetoprotein was increased in five cases. Ovarian enlargement was found in 26 cases, and follicles were detected in the peripheral region of the ovary in 21 cases. Twenty-one cases presented as solid mixed-density masses on CT images. A total of 30 cases of ovarian torsion were associated with a benign ovarian mass. Among 27 cases of cystic or predominantly cystic masses, the mass had a thickened wall in 26 cases and showed an uneven density in 23 cases. Among all 61 patients, a torsed pedicle was detected in 47 cases. A torsed ovary or mass exhibited mild contrast enhancement in seven cases. Uterine deviation toward the involved side, blurred fat space around lesions, and pelvic free fluid were also found. Pediatric ovarian torsion presents a relatively characteristic CT appearance. Correct diagnosis can be established based on clinical and imaging features.

An Evaluation of the Effectiveness of Image-based Texture Features Extracted from Static B-mode Ultrasound Images in Distinguishing between Benign and Malignant Ovarian Masses

Significant successes in machine learning approaches to image analysis for various applications have energized strong interest in automated diagnostic support systems for medical images. The evolving in-depth understanding of the way carcinogenesis changes the texture of cellular networks of a mass/tumor has been informing such diagnostics systems with use of more suitable image texture features and their extraction methods. Several texture features have been recently applied in discriminating malignant and benign ovarian masses by analysing B-mode images from ultrasound scan of the ovary with different levels of performance. However, comparative performance evaluation of these reported features using common sets of clinically approved images is lacking. This paper presents an empirical evaluation of seven commonly used texture features (histograms, moments of histogram, local binary patterns [256-bin and 59-bin], histograms of oriented gradients, fractal dimensions, and Gabor filter), using a collection of 242 ultrasound scan images of ovarian masses of various pathological characteristics. The evaluation examines not only the effectiveness of classification schemes based on the individual texture features but also the effectiveness of various combinations of these schemes using the simple majority-rule decision level fusion. Trained support vector machine classifiers on the individual texture features without any specific pre-processing, achieve levels of accuracy between 75% and 85% where the seven moments and the 256-bin LBP are at the lower end while the Gabor filter is at the upper end. Combining the classification results of the top k (k = 3, 5, 7) best performing features further improve the overall accuracy to a level between 86% and 90%. These evaluation results demonstrate that each of the investigated image-based texture features provides informative support in distinguishing benign or malignant ovarian masses.

Evaluating hematological parameters in women with endometriosis

In the present study, we aimed to evaluate the relationship between the level of hematological parameters and the presence and stage of endometriosis. We included medical records of patients diagnosed with endometriosis (endometriosis group) and patients diagnosed with benign non-endometriotic ovarian masses (control group), who were eligible based on inclusion and exclusion criteria and compared the preoperative level of hematological parameters between the two groups. According to our findings, neutrophil and WBC counts, mean platelet volume, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were significantly higher, and the haemoglobin concentration, platelet count, and absolute lymphocyte count were lower in women diagnosed with endometriosis compared to the control group. There was no significant difference in hematological parameters of patients with endometriosis stages III and IV. Finally, we found that the preoperative level of hematological parameters lacked sufficient power for the diagnosis of endometriosis. Also, our results indicate that endometriosis is associated with an inflammatory processes. IMPACT STATEMENT What is already known on this subject? Inflammatory factors are believed to be involved in the pathogenesis of endometriosis; however, there are inconsistent reports on the association between blood inflammatory markers and endometriosis. What do the results of this study add? The results of this study indicate that endometriosis is associated with inflammatory processes that lead to changes in hematological parameters; however, preoperative measurement of these parameters has not sufficient power for the diagnosis of endometriosis. What are the implications of these findings for clinical practice and/or further research? The preoperative level of hematological parameters lacks sufficient power for the diagnosis of endometriosis, but they may help doctors make a diagnosis in the clinical setting as auxiliary findings.

Utility of Preoperative Inflammatory Markers to Distinguish Epithelial Ovarian Cancer from Benign Ovarian Masses.

Background: Inflammatory markers have been reported to be predictors for the presence of epithelial ovarian cancer (EOC), however, the cut-off value of each marker remains unclear and predictive capability of the markers in different histology types of EOC is still unknown.Methods: A total of 207 patients with benign ovarian masses and 887 EOC patients who underwent surgical resection, and were pathologically diagnosed were included. We compared the difference of preoperative inflammatory markers between benign ovarian masses and EOC patients. Stratified analysis by histology subtype was further conducted. Logistic regression analyses and receiver operating characteristic (ROC) curves was used to evaluate the predictive capability of the markers.Results: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were significantly associated with all stages and subtypes of EOC (P<0.001). The optimal cut-off points based on ROC curve analyses for NLR, PLR, and LMR were found to be 2.139 (AUC=0.749, P<0.001), 182.698 (AUC=0.730, P<0.001), and 3.619 (AUC = 0.709, P<0.001), respectively. In low CA125 level patients, high level of NLR and PLR increase the risk of endometrioid EOC, while low level of LMR were significantly associated with an increased risk of serous EOC.Conclusions: In addition to CA125, NLR, PLR, and LMR could be used as predictors of EOC and preoperative inflammatory markers may be used as a potential biomarker for predicting different histotypes of EOC.

Role of HE4 and ROMA Score in Diagnosis of Ovarian Cancer in Egyptian Women

Background: Risk of ovarian malignancy algorithm (ROMA) combining human epididymis secretory protein 4 (HE4) and CA125 is a novel score, specific for epithelial ovarian cancer (EOC). Method: Our cohort prospective study aimed to evaluate the role of HE4 and ROMA score in the diagnosis of EOC. We determined CA125 and HE4 serum levels in 56 premenopausal women with ovarian mass (38 women with benign ovarian mass and 18 women with malignant ovarian mass), 56 postmenopausal women with ovarian mass (20 women with benign ovarian mass and 36 women with malignant ovarian mass), and 56 healthy women as control. Results: Serum CA125 and HE4 and ROMA score were significantly higher among postmenopausal group compared with premenopausal and control groups (P< 0.001), and the median serum CA125 and HE4 and ROMA levels were statistically higher among malignant lesions compared with benign lesions and control group (P< 0.001). The sensitivity and specificity of HE4 and ROMA vs. CA125 in discriminating ovarian cancer from benign ovarian tumor was (88% and 98% vs. 90%) and (97% and 99% vs. 80%), respectively. ROMA had better sensitivity and specificity compared to CA125 and HE4 in premenopausal and postmenopausal women (P <0.001) In premenopausal patients, there was a statistically significant difference regarding the area under the curve (AUC) of ROMA vs. CA125 (P=0.004) and ROMA vs. HE4 (P =0.02). Conclusion: ROMA score showed a better performance in comparison with either CA125 or HE4 alone in premenopausal patients. HE4 and ROMA score significantly differentiated early from late stage ovarian cancer.

Evaluation of Risk of Malignancy Index in the Preoperative Assessment of the Patients with Ovarian Mass

Background: Adnexal masses indicate a variety of gynecological and non-gynecological disorders, which may be benign or malignant. Early detection of malignancy is crucial to a proper planning of treatment and improvement of survival. Objective: The purpose of the study was to evaluate predictive value of risk of malignancy index (RMI) in differentiating between benign and malignant ovarian masses preoperatively. Study Design: Cross sectional (Validation) study. Settings: Obstetrics &amp; Gynecology Department of Madinah Teaching Hospital affiliated with University Medical &amp; Dental College Faisalabad Pakistan. Duration: One year from January 2018 to December 2018. Methodology: Total 86 patients were included in the study. Ultrasound was performed then staging laparotomy done followed by histopathological examination. Results: A total of 86 patients were included in the study. Out of which 50 patients (58.1%) were premenopausal and 36 patients (41.9%) were menopausal. The mean age of the patients was 55.79 years. According to histopathological examination of the specimens 44 were malignant and 42 were benign. The sensitivity of the RMI for malignant ovarian tumor is 70.45% and specificity is 69.05%. Conclusion: RMI was considered to have significant importance in preoperative evaluation and treatment of women with an adnexal mass, and was helpful in-patient referral to higher Centre for suitable and effective surgical intervention.

HE4 in Various Body Fluids: A Prospective Pilot Study

Introduction: Human epididymis protein 4 (HE4) is a glycoprotein that is a sensitive and specific serum biomarker for patients with suspected ovarian cancer. HE4 is also secreted in different body fluids such as cervical mucus or urine, which could provide an easy alternative for screening purposes. HE4 protein secretion in different body fluids was analysed in 11 healthy controls and in 10 patients with a benign, 10 with a borderline and 22 with a malignant ovarian tumor. Materials and Methods: Preoperative samples of serum, urine, cervical mucus, saliva, and ascites were collected to measure HE4 with an ELISA assay. Urinary creatinine concentration and cervical total protein concentrations were used as reference analytes, and ratios with HE4 were calculated. Results: Median HE4 concentration in urine was higher in patients with epithelial ovarian cancer (EOC) compared to healthy controls and patients with a benign or borderline mass (p=0.02). HE4/creatinine ratio could differentiate healthy controls from EOC and benign ovarian disease from EOC (AUC 0.76, 95% CI 0.58-0.94 and AUC 0.71, 95% 0.52-0.89, respectively). HE4 in ascites was significantly higher in patients with EOC or borderline ovarian mass compared to patients with a benign ovarian mass (p=0.04). HE4 concentrations in cervical mucus and saliva were not significantly higher in patients with EOC. Conclusion: This study shows that HE4 is abundant in body fluids other than blood and suggests that urinary HE4 levels can be used as a non-invasive diagnostic alternative to detect EOC.

How should the management of ovarian masses in children?

Introduction: Prevalence of ovarian masses in children increase due to easy access to imaging techniques. There are conflicting views about evaluation and classification of ovarian masses for neoplasia in such age group in the literature. Material and methods: The patients who were monitored and treated because of ovarian mass in pediatric surgery and obstetrics and gynaecology clinics were reviewed retrospectively. Demographic data, symptoms, dimensions and lateralization of the mass, serum tumour markers, histopathological evaluation results, and treatment outcomes of the patients enrolled in were recorded. Ovarian masses of the participants were divided into two groups as non-neoplastic group (NNG) and neoplastic group (NG) depending on imaging techniques, serum tumour markers and histopathological analysis results. Results were statistically reviewed. Results: There was not any statistical difference between NG and NNG for age, body mass index, mass diameter, initial symptoms, and mass lateralization (p>0.05). Review of ovarian masses reported by imaging techniques revealed that pure cystic appearance was statistically significant for NNG (p=0.012). Duration of the surgery and hospitalization were detected shorter in NNG treated laparoscopically (p=0.023). Conclusion: Surgical treatment of ovarian masses in children should be ovarian protective as much as possible. However, there is not any reliable and proven marker that may differentiate a benign ovarian mass from a malignant ovarian mass in paediatric patients like adult population. A detailed medical history, physical examination, imaging methods, and adequate tumour markers should be used for preoperative evaluation of adnexial masses.