Detection Of Ovarian Malignancy Research Articles

Comparison of 68 Ga-FAPI-04 and fluorine-18-fluorodeoxyglucose PET/computed tomography in the detection of ovarian malignancies.

Currently, fluorine-18-fluorodeoxyglucose ( 18 F-FDG) is the most frequently used diagnostical radiotracer for PET/computed tomography (PET/CT) in ovarian malignancies. However, 18 F-FDG has some limitations. The fibroblast activation protein inhibitor (FAPI) previously demonstrated highly promising results in studies on various tumor entities and 68 Ga-labeled FAPI presents a promising alternative to 18 F-FDG. This study aimed to compare the performance of 68 Ga-FAPI and 18 F-FDG PET/CT for imaging of ovarian malignancies. A total of 27 patients were included in this retrospective study conducted at the Affiliated Hospital of Southwest Medical University between June 2020 and February 2022. The 18 F-FDG and 68 Ga-FAPI uptakes of tumors, lymph nodes, and distant metastases were quantified using the maximum standardized uptake values, and the tumor-to-background ratios were also evaluated and calculated by using the Wilcoxon signed-rank test. Twenty-one patients with suspected ( n = 11) and previously treated ovarian malignancies ( n = 10) were in statistical analysis finally. For detecting tumors, 68 Ga-FAPI PET/CT was more sensitive than 18 F-FDG PET/CT [14 of 14 (100%) vs. 11 of 14 (78%)], lymph node metastases [75 of 75 (100%) vs. 60 of 75 (80%)] and superior to 18 F-FDG PET/CT in terms of the peritoneal and pleural metastases [9 of 9 (100%) vs. 5 of 9 (56%)]. For four of the newly diagnosed patients ( n = 11), 68 Ga-FAPI PET/CT upstaged the clinical stage compared to 18 F-FDG PET/CT. 68 Ga-FAPI PET/CT has superior potential in the detection of ovarian cancers, especially in peritoneal carcinomatosis. 68 Ga-FAPI PET/CT may be a promising supplement for staging and follow-up of ovarian malignancies.

Efficacy of Doppler Ultrasound in Detection of Ovarian Malignancy

Objective: To evaluate the accuracy of colour Doppler USG and b-mode USG preoperatively in detection of ovarian malignancy using histopathological diagnosis as gold standard Methodology: This cross-sectional study was conducted at Fauji Foundation hospital Rawalpindi from June, 2017 to Jan, 2020 after seeking the ethical approval from the hospital ethical committee A total of 96 female patients having adnexal masses on ultrasound were included in study. Enrollment in the study was subjected to written informed consent. Patients having adnexal mass of non-ovarian origin, patients not fit for surgery and lost to follow up were excluded from study. History taking and examination was followed by ultrasound and color-doppler of each patient. Color Doppler sonography was carried out with real-time ultrasound and Doppler scanner unit. All the included patients were undergone laparotomy after pre op workup. Histopathologies of all patients were traced. To avoid observer error, a designated trained operator performed doppler ultrasound from hospital own resource by using Toshiba Xario colour Doppler .Histopathology was also performed by hospital pathology laboratoty by trained histopathologist. All the included patients were undergone laparotomy after pre op workup. Histopathologies of all patients were traced .All the relevant findings were recorded in the pre-designed proforma. Data was entered and analysed in SPSS Version-26. Result: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Doppler with grayscale USG in detecting ovarian malignancy were calculated. The specificity was found to be 90.3% and sensitivity was 79.2%. Positive and negative predicative values were 92.9% and 73.1% respectively. Conclusion: Based upon the study findings, the Doppler USG’s reliability can be established for detection of ovarian malignancies. Keywords: Adnexal mass, Doppler, Ultrasonography, Ovarian malignancy

Does CA-125 have a Role in Early Diagnosis of Ovarian Malignancy in Non-Menopausal Women?

Objective: Aim of this study is to assess the role of Cancer Antigen (CA-125) in detection of ovarian malignancy in premenopausal women with ovarian mass. Methods: This observational study was carried out in (blinded). It included 200 women who had preliminary diagnosis of adnexal mass whatever its nature. Adnexal masses were detected either clinically or by ultrasound. Results: The study shows distribution of different pathologies of malignancy, stage of malignancy at diagnosis and benign spectrum in investigated population. The study also reveals CA-125 cutoff point 35.1 and sensitivity and specificity reached 93.1% and 92.2% respectively. Area under the Curve (AUC) was 0.998, Positive Prediction Value (PPV) was 91.7% and Negative Prediction Value (NPV) was 92.1. Conclusion: According to our results CA-125 could be suitable as an ovarian cancer detection marker.

Ethnic disparity in clinical performance between multivariate index assay and CA125 in detection of ovarian malignancy.

Aim: Based on evidence that African-American (AA) women have lower CA125 values than Caucasian (C) women, we investigated this to see if this disparity would have an impact on ovarian cancer detection using CA125 and multivariate index assay (MIA). Materials & methods: Serum from two prospective trials of 1029 (274 malignancies [250 C/24AA]) were analyzed for CA125 and MIA results. Clinical performance was calculated. Results: Sensitivity of MIA in Caucasian women was 93.2%, 74.4% for CA125 at the ACOG approved cut-off level of 200 U/ml cutoff, and 80.4% using the 2007, Dearking 67 U/ml cutoff. In AA American women, MIA sensitivity was 79.2%, 33.3% for CA125 at the ACOG approved cut-off levels and 62.5% at the 2007, Dearking 67 U/ml cutoff. Conclusion: Our results support that CA125 in AA women with adnexal masses has lower sensitivity than MIA no matter what the cutoff value is. Implementation of MIA in evaluation of adnexal masses should increase sensitivity of detection of malignancy compared with CA125, particularly in AA women.

Multivariate Index Assay Is Superior to CA125 and HE4 Testing in Detection of Ovarian Malignancy in African-American Women.

Objective:To review and analyze the serum values of risk of ovarian malignancy algorithm (ROMA) and multivariate index assay (MIA) in subgroups of women who underwent surgery for adnexal masses to determine sensitivity, specificity, and positive and negative predictive values for the detection of malignancy in different ethnic populations.Methods:Serum samples from 2 prospective trials of 1029 women in which 274 women diagnosed with malignancy were analyzed for ROMA scores and MIA results. Biomarker data were obtained from the previous prospective studies that validated the MIA test. Of these, 250 women were Caucasian (C) and 24 were African-American (AA). Sensitivity, specificity, positive and negative predictive values, and confidence intervals for preoperative test results were calculated using DTComPair package of the R programming language. In premenopausal women, a ROMA value equal to or greater than 1.14 indicates a high risk of finding epithelial ovarian cancer. In premenopausal women, MIA values greater than 5.0 are associated with a greater risk of malignancy. In postmenopausal women, a ROMA value equal to or greater than 2.99 indicates a high risk of finding epithelial ovarian cancer. In postmenopausal women, MIA values greater than 4.4 are associated with a greater risk of malignancy.Results:Primary ovarian malignancy was diagnosed in 179 cases (167 C/12 AA) and metastatic disease to the ovary in an additional 27 cases (22 C/5 AA). Overall results are shown below.Conclusions:Our results demonstrate that ROMA in AA women with adnexal masses have lower sensitivity for the detection of malignancy than does MIA. Implementation of MIA in the evaluation of adnexal masses will increase the sensitivity of the detection of malignancy compared with ROMA, with the most marked results in AA women.

ОНКОГІНЕКОЛОГІЧНА ПАТОЛОГІЯ В СТРУКТУРІ ЗАХВОРЮВАНОСТІ ТА СМЕРТНОСТІ НАСЕЛЕННЯ УКРАЇНИ

У статті представлено аналіз захворюваності та смертності жіночого населення України від онкогінекологічної патології. Встановлено зростання захворюваності на злоякісні новоутворення репродуктивної системи у жінок. Визначено основні тенденції захворюваності та смертності у різних вікових групах та в різних регіонах.Мета роботи – встановити основні динамічні зміни онкогінекологічної захворюваності в України та дати оцінку стану організації онкологічної допомоги жіночому населенню.Матеріали і методи. Матеріалами дослідження стали дані Національного канцер-реєстру України за період 2008–2016 рр. У ході дослідження використано статистичний та бібліосемантичний методи дослідження.Результати досліджень та їх обговорення. Результати проведених епідеміологічних досліджень захворюваності й смертності жіночого населення України від злоякісних новоутворень статевої сфери встановили, що за останнє десятиліття відбулися суттєві зміни як у структурі захворюваності, так і поширеності даної патології. Захворюваність на рак тіла матки переважає у структурі загальної захворюваності на злоякісні новоутворення, а рак шийки матки – на 34,4 %. Значно рідше серед жіночого населення України, порівняно з раком шийки матки та раком тіла матки, виявляються злоякісні новоутворення яєчників. Серед питомої частки злоякісних новоутворень вони становлять 4,9 %. Показники смертності при злоякісних новоутвореннях яєчників є значно вищими порівняно з показниками смертності при раку шийки матки та раку тіла матки. У різних регіонах України стан онкогінекологічної захворюваності та смертності має характерні відмінності. Кожна локалізація злоякісних новоутворень характеризується тенденцією до зростання захворюваності у певному віковому періоді. Для дитячого віку характерними є злоякісні новоутворення яєчників.Висновки. Захворюваність на злоякісні новоутворення репродуктивної системи у жінок характеризується тенденцією до збільшення. Високі показники відношень смертності/захворюваності при онкогінекологічній патології вимагають розробки нових підходів до діагностики, лікування та профілактики злоякісних новоутворень репродуктивної системи у жінок. В осіб працездатного та фертильного віку визначається високий рівень захворюваності та смертності від злоякісних новоутворень шийки матки, тіла матки, яєчників. Виявлення злоякісних новоутворень яєчників у різні періоди дитячого віку вимагають розробки комплексу заходів онкологічної настороженості.

Value of (18)F-FDG PET/CT in the Detection of Ovarian Malignancy.

Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20% of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment. A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by (18)F-FDG PET/CT, and an additional 2-h delayed (18)F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial (18)F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters. In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h (18)F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions. Although further study with a larger patient population is needed, the visual assessment of (18)F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.

Sonographic Quantification of Ovarian Tumor Vascularity

The purpose of this study was to assess the diagnostic accuracy of quantitated color Doppler sonography in differentiating benign from malignant ovarian tumors, with the use of tumor histologic examination as a reference standard. The vascularity of 38 ovarian masses (30 benign and 8 malignant) as quantitatively depicted with color Doppler sonography was analyzed with a readily available software program (ImageJ; National Institutes of Health, Bethesda, MD). The following quantitative sonographic criteria for tumor vascularity were analyzed: the vascularity index (VI) quantified the difference between the total number of pixels and the number of pixels containing no color/totalx100, whereas the power-weighted pixel density (PWPD) weighted the strength of the signal/total. The accuracy of sonographic criteria for malignant ovarian tumors was evaluated with univariate analysis. Results of tumor histologic examination were used as proof of the final diagnosis. The mean values of VI and PWPD were significantly different in benign versus malignant ovarian lesions (VI, 1.3+/-1.6 versus 4.7+/-3.9; P<.01; PWPD, 2338+/-3305 versus 9403+/-9946; P<.05). With a VI of greater than 2.3, sensitivity of 75% and specificity of 90% were obtained. When combined with a PWPD of greater than 4555, sensitivity improved to 88%, and specificity improved to 93%. Morphologic analysis had sensitivity of 72% and specificity of 76% for malignancies. Quantitated color Doppler sonography was found to be helpful for distinguishing benign from malignant ovarian masses. However, the wide range in values makes it most useful as an adjunct to morphologic assessment. It is anticipated that quantitated color Doppler sonography could result in a slight improvement in detection of ovarian malignancies.