Borderline Masses Research Articles

Performance of the IOTA ADNEX model combined with HE4 for identifying early-stage ovarian cancer

ObjectiveThis work was designed to investigate the performance of the International Ovarian Tumor Analysis (IOTA) ADNEX (Assessment of Different NEoplasias in the adneXa) model combined with human epithelial protein 4 (HE4) for early ovarian cancer (OC) detection.MethodsA total of 376 women who were hospitalized and operated on in Women and Children’s Hospital of Chongqing Medical University were selected. Ultrasonographic images, cancer antigen-125 (CA 125) levels, and HE4 levels were obtained. All cases were analyzed and the histopathological diagnosis serves as the reference standard. Based on the IOTA ADNEX model post-processing software, the risk prediction value was calculated. We analyzed receiver operating characteristic curves to determine whether the IOTA ADNEX model alone or combined with HE4 provided better diagnostic accuracy.ResultsThe area under the curve (AUC) of the ADNEX model alone or combined with HE4 in predicting benign and malignant ovarian tumors was 0.914 (95% CI, 0.881–0.941) and 0.916 (95% CI, 0.883–0.942), respectively. With the cutoff risk of 10%, the ADNEX model had a sensitivity of 0.93 (95% CI, 0.87–0.97) and a specificity of 0.73 (95% CI, 0.67–0.78), while combined with HE4, it had a sensitivity of 0.90 (95% CI, 0.84–0.95) and a specificity of 0.81 (95% CI, 0.76–0.86). The IOTA ADNEX model combined with HE4 was better at improving the accuracy of the differential diagnosis between different OCs than the IOTA ADNEX model alone. A significant difference was found in separating borderline masses from Stage II–IV OC (p = 0.0257).ConclusionsA combination of the IOTA ADNEX model and HE4 can improve the specificity of diagnosis of ovarian benign and malignant tumors and increase the sensitivity and effectiveness of the differential diagnosis of Stage II–IV OC and borderline tumors.

Comparison of O-RADS, GI-RADS, and ADNEX for Diagnosis of Adnexal Masses: An External Validation Study Conducted by Junior Sonologists.

To externally validate the Ovarian-adnexal Reporting and Data System (O-RADS) and evaluate its performance in differentiating benign from malignant adnexal masses (AMs) compared with the Gynecologic Imaging Reporting and Data System (GI-RADS) and Assessment of Different NEoplasias in the adneXa (ADNEX). A retrospective analysis was performed on 734 cases from the Second Affiliated Hospital of Fujian Medical University. All patients underwent transvaginal or transabdominal ultrasound examination. Pathological diagnoses were obtained for all the included AMs. O-RADS, GI-RADS, and ADNEX were used to evaluate AMs by two sonologists, and the diagnostic efficacy of the three systems was analyzed and compared using pathology as the gold standard. We used the kappa index to evaluate the inter-reviewer agreement (IRA). A total of 734 AMs, including 564 benign masses, 69 borderline masses, and 101 malignant masses were included in this study. O-RADS (0.88) and GI-RADS (0.90) had lower sensitivity than ADNEX (0.95) (P < .05), and the PPV of O-RADS (0.98) was higher than that of ADNEX (0.96) (P < .05). These three systems showed good IRA. O-RADS, GI-RADS, and ADNEX showed little difference in diagnostic performance among resident sonologists. These three systems have their own characteristics and can be selected according to the type of center, access to patients' clinical data, or personal comfort.

Benign, Borderline, and Malignant Pediatric Adnexal Masses: A 10-Year Review.

To investigate the incidence, clinical features, tumor markers, radiologic findings, types of surgeries, and histologies for adnexal masses in female pediatric and adolescent patients. Retrospective chart review. Children's Health in Dallas and Plano, Texas from 2009 to2018. Female patients younger than 19years old who underwent surgical management of an adnexal mass. None. Imaging characteristics, tumor markers, surgical procedures, and histopathology. In total, 752 patients (mean age, 13.7years) underwent 756 surgical procedures for 781 adnexal masses. Of these, 732/781 (93.7%) were benign, 7/781 (0.9%) were borderline, and 42/781 (5.4%) were malignant. Of all 781 masses, 520/781 (66.6%) were ovarian and 261/781 (33.4%) were paratubal or tubal. Benign masses were associated with Hispanic race, pain, simple or cystic characteristics on imaging, and negative tumor markers. Borderline and malignant masses were associated with white race, pain, mass or distension, larger size, and heterogeneous appearance on imaging. Borderline masses were associated with negative tumor markers. Malignant masses were associated with elevated alpha fetoprotein, beta human chorionic gonadotropin,cancer antigen 125, and lactate dehydrogenase. Most adnexal masses in the pediatric and adolescent population are benign. Benign masses were significantly smaller, more likely to have negative tumor markers, and appear simple or cystic. There is little standardization with respect to preoperative tumor markers for adnexal masses. High-yield tumor markers for malignancy include alpha fetoprotein, beta human chorionic gonadotropin, cancer antigen 125, and lactate dehydrogenase. Low-yield tumor markers include inhibin A and B. Gynecologists performed more fertility-preserving surgeries including mini-laparotomies and fewer laparotomies for benign masses than pediatric surgeons.

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.

Dynamic Contrast - Enhanced Magnetic Resonance Imaging : A Useful Tool for Characterization and Assessment of Ovarian Masses

Objectives: To evaluate the diagnostic performance of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) for the characterization of complex ovarian tumors, by using histologic findings as the reference standard. Patients and methods: 25 patients (age range from 24 to 60) with complex ovarian masses underwent DCE-MRI before surgical excision. The study included 8 benign, 3 borderline & 14 malignant masses. The following kinetic parameters were analyzed: enhancement amplitude (EA) in the form of MRE%, time to peak in the form of T max & maximal slope (MS) & correlated with histopathological results. Results: DCE-MRI achieved higher overall accuracy (85.7%) & specificity (86.5%) than conventional MRI. MRE% was higher for malignant than for benign (p0.001) & borderline masses (p0.002). T max was of shorter duration in malignant than in benign (p, < 0.001) and borderline (p, 0.018) masses. Type III curve was specific for invasive malignant tumors. Conclusion: DCE-MRI can be a useful tool in characterization of complex ovarian masses & in differentiating between borderline & invasive malignant neoplasms.

A Comparative Study of RMI and ROMA in Women Presenting with an Adnexal Mass

Differentiation between benign and malignant ovarian neoplasms is essential to create a system for patient referrals. Therefore, tumor markers such as CA-125 and human epididymis protein 4 (HE-4) 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 in referral of women at a high risk of having an ovarian malignancy to cancer centers where multidisciplinary input is available. Patients who were diagnosed with an adnexal mass through imaging analyses or clinically (n = 35) were assessed for their expression of the tumor markers CA-125 and HE-4 and were finally compared to the histopathology of the tumor after surgery which has been taken as the gold standard. The ROMA and RMI values were also determined. The sensitivity, specificity, PPV, NPV, PLR and NLR of each parameter were calculated. Two different sets of analysis were made: one including benign and borderline masses together and the other including malignant and borderline masses together. The sensitivity of ROMA (91%) was highest when compared to RMI, CA-125 and HE-4. Specificity and positive likelihood ratio of HE-4 were highest at 87.5% and 5.1, respectively, when compared to all other parameters considered in our study. CA-125 had the least sensitivity and specificity (45 and 54%, respectively). Diagnostic accuracy of all the parameters was better in diagnosing malignant lesions than borderline tumors. Diagnostic accuracy using ROMA was better than RMI in differentiating malignant from benign lesions. Determination of HE-4, CA-125, RMI and ROMA algorithm was not helpful in differentiating patients with borderline tumors from benign lesions. ROMA had the best sensitivity of all the parameters considered.

The role of dynamic contrast enhanced MR imaging in the assessment of inconclusive ovarian masses

ObjectivesTo evaluate the diagnostic accuracy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in characterization of inconclusive ovarian tumors, with histologic findings as the reference standard. Patients & methodsDCE-MRI was done in 30 patients with 32 complex ovarian masses, prior to surgical excision. We analyzed the following kinetic parameters: enhancement amplitude (EA) in the form of MRE%, time to peak in the form of T max and maximal slope (MS) and correlated them with histopathology. ResultsDCE-MRI showed higher overall accuracy (96%) and specificity (100%) than conventional MRI. Malignant masses showed higher MRE% than benign (p = .004) or borderline masses (p = .036). A shorter T max was found in malignant compared to benign (p = .0002) and borderline (p = .049) masses. MS was best at discrimination between benign, borderline and malignant tumors. Finally, Type III curve showed 100% specificity for invasive malignant tumors. ConclusionDCE-MRI sequence is a helpful adjunct to conventional MRI for discrimination of inconclusive ovarian masses into benign, borderline and invasive malignant tumors.

EP25.18: Risk of borderline malignancy and ultrasonic assessment

Assess the correlation between the ultrasonographic findings of ovarian masses after calculating the inversion volume and the risk of a borderline mass. A study of 18 cases of a histopathologically confirmed borderline tumour in relation to the ultrasonographic inversion data of the mass. The main image was isolated from the surrounded noise and inverted. The inversion volume of the mass was calculated via 3D rendering software ranging from 3.75mm3 to 170.39mm3 with a mean inversion volume of 50.64mm3. The data obtained from the calculation of the inversion volume were correlated to the risk of borderline malignancy each patient had and from the attached graph we can notice the peak risk is observed in smaller masses. Of course the results depend also on analysing the masses morphology as well, before and after the inversion, in order to increase the diagnostic accuracy. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Proliferation and maturation of intratumoral blood vessels in women with malignant ovarian tumors assessed with cancer stem cells marker nestin and platelet derived growth factor PDGF-B.

Platelet-derived growth factor B (PDGF-B) and nestin have been suggested to be useful in the assessment of neoangiogenesis in malignant ovarian masses. We aimed to investigate a possible association of these markers with newly formed microcapillaries and perivascular cells in ovarian tumors. Microvessel density (MVD) and pericytes were studied in 82 women with ovarian neoplasms, including 7 benign cysts, 7 borderline masses, 64 epithelial ovarian cancers and 4 other malignant ovarian tumors. Immunohistochemical staining included antibodies to CD34, PDGF-B and nestin. Median values of CD34-positive and nestin-positive MVD were: 24,5 (range:17-32) and 21 (range: 12-31), respectively. No significant correlation between intratumoral CD-34 positive MVD and nestin-positive MVD was found. Benign and borderline lesions more frequently than malignant tumors displayed low or medium values of nestin-positive MVD (p = 0.01). Histological grading of malignant tumors was associated with nestin-positive MVD (p = 0.01). Nestin expression in tumor cells was not correlated with tumor grade or histological subtype. PDGF-B expression was found in tumor microves-sels in 72% of cases (59/82). High expression of PDGF in pericapillary cells was strongly associated with high expression of this marker in cancer cells (p = 0.007). Significant correlations between PDGF-B and nestin expression in malignant tumor microvessels were also found (p = 0.04). Nestin and PDGF-B expressions were strongly associated with high grade tumors when compared to low grade or benign masses. We conclude that the assessment of PDGF-B and nestin-positive MVD could be used to identify only highly active, angiogenic malignant ovarian masses, where tumor vasculature is formed.

Semi-quantitative contrast-enhanced MR analysis of indeterminate ovarian tumours: when to say malignancy?

To evaluate the ability of dynamic post-contrast sequence to specify indeterminate ovarian masses with inconclusive MR features of malignancy. Since management is dramatically different, special focus on the ability to differentiate borderline from invasive malignancy was considered. 150 ovarian masses were detected by pelvic ultrasound in 124 patients. Masses had been considered for dynamic post-contrast MRI. We expressed the kinetic parameters (i.e. enhancement amplitude, time peak of maximal uptake and maximal slope) in the form of maximum relative enhancement percentage (MRE%), time of maximal peak of contrast uptake (Tmax) and slope enhancement ratio (SER) curves. Histological findings were the gold standard of reference. Malignant ovarian masses showed higher MRE% than benign and borderline masses (p < 0.001). Tmax was shorter for malignant than benign (p < 0.01) and borderline (p < 0.001) ovarian masses. SER curves were the most suggestive of malignancy with a specificity and accuracy of 85.7% and 84.7%, respectively. Dynamic contrast-enhanced MRI could be a specific sequence to differentiate ovarian masses with indeterminate MR morphology with a special discrimination for low potential from invasive ovarian malignancy. The study evaluated the diagnostic performance of the individual parameters of dynamic post-contrast MR sequence in evaluating ovarian masses. Management divert between benign, borderline and invasive malignant masses; our work presented a cut-off value for the peak of contrast uptake of 120%, which helped in the differentiation between benign and malignant tumours; the SER curves with Type III (early washout) pattern that was indicative of invasive malignancy was more specific than borderline malignancy.

OC23.04: Does spherical sample size affect the performance of 3D power Doppler indexes for predicting malignancy in vascularized adnexal masses?

Methods: Patients with persistent adnexal mass with a risk of major malignancy of 3%, based on ultrasound examination were included in this prospective study. Predefined ultrasound morfological and Doppler characteristics were used by an expert sonologist to determine the nature (benign o malignant) of the mass. Border-line masses were considered as malignant. All patients underwent combined PET/CT with F-fluorodeoxyglucose (FDG). The ultrasound and PET/CT findings were correlated with final hystological diagnosis. Results: Sixty one patients were included in this series. Hystologically there were 25 benign, 27 malignant and 9 border-line masses. All malignant masses were correctly classified at transvaginal sonography, while at PET/CT 25 of those demonstrated metabolic activity and 2 lesions resulted false negative. Among hystologically benign lesions transvaginal ultrasound was accurate in 21 (4 false positive), the same as PET/CT. The borderline tumours were correctly identified at sonography as suspected malignant, though PET/TC was predictive in only 1 of 9. Moreover, 2 malignant and 7 border-line masses revealed silent at PET/CT were mucinous tumours. Conclusions: These data show that PET/CT does not provide additional information compared with expert transvaginal ultrasound. It is likely that some malignant mucinous lesions and especially border-line tumours do not show FDG uptake.

Color Doppler ultrasound in the preoperative assessment of adnexal masses.

To differentiate benign from malignant ovarian tumors preoperatively by means of transvaginal color Doppler ultrasound and to compare the sensitivity and specificity of this technique with that of conventional transvaginal ultrasound and CA 125 serum levels. Different indicators of blood flow resistance (pulsatility index and resistance index) within intratumoral vessels were evaluated preoperatively in 80 adnexal masses by means of color Doppler ultrasound. Results were compared to CA 125 levels, conventional ultrasound and histopathologic findings. Forty-seven benign, 29 malignant and four borderline masses were studied. Mean PI and RI were significantly higher in benign than in malignant masses but an overlap was observed. Sensitivity, specificity and accuracy of color Doppler in predicting malignancy were 85%, 91% and 89% by using a cut-off value of 0.56 for resistance index and 97%, 87%, 91% by using a cut-off value of 1.0 for pulsatility index. The accuracy of both indexes in differentiating benign from malignant tumors was superior to that obtained by using conventional ultrasound and CA 125. In eight of nine masses where disagreement existed between color Doppler ultrasound and conventional ultrasound, pathologic examination confirmed the nature suggested by color Doppler ultrasound. Compared to conventional ultrasound and CA 125, color Doppler ultrasound was more accurate in discriminating malignancies from benign tumors. The best use for this technique seems in giving further preoperative information about masses with uncertain sonographic characteristics, allowing better timing and tailoring of surgery.