Malignant Ovarian Masses Research Articles

Ultrasound features and clinical outcome of patients with malignant ovarian masses diagnosed during pregnancy: experience of a gynecological oncology ultrasound center

ObjectiveThe number of women diagnosed with ovarian masses during pregnancy has increased in recent years and the management of these women can be controversial. We aim to describe ultrasound characteristics...

Proton MR spectroscopy and the detection of malignancy in ovarian masses.

To assess the impact of MR spectroscopy (MRS) on the detection of malignancy in ovarian masses. This prospective work included 230 females that had 245 adnexal/ovarian masses. Tumours were spotted by preliminary pelvic ultrasound. Masses assessed by MRI, multi- or single-voxel spectroscopy. Patients' spectra were assessed for peaks of lactate (Lac, 1.31 ppm), lipid (Lip, 1.33 ppm), N-acetyl aspartate (2.0 ppm), acetone (A, 2.05 ppm), choline (Cho, 3.23 ppm) and creatinine (Cr, 3.4 ppm) and the mean values of the (Cho/Cr) ratios were performed by a semi-quantitative approach. The operative pathology served as the standard of reference. Cho peak twofold higher than the average noise level was detected in 72% of the malignant and only 5.4% of the benign masses with an accuracy of 83%. Adding lactate to the choline enhanced the accuracy to 93%. The mean Cho/Cr ratios of the malignant ovarian masses (2.8) were significantly higher than that of the benign ones (1.2) . We used a receiver operating characteristic curve to determine the best cut-off value (1.7) for the mean Cho/Cr ratio to discriminate malignancy with sensitivity: 81.2%, specificity: 93.3 %, positive-predictive value: 92.9 %, negative-predictive value: 82.4% and accuracy: 87.1%. The simultaneous presence of choline and lactate peaks in MRS examination of the ovarian masses minimizes the overlap between benign and malignant categories. N-acetyl aspartate and acetone are the metabolites for diagnosing complex cystic masses as benign teratoma, endomterioma and tubo- ovarian abscess. MRS is a non-contrast based and fast MR sequence that gives an idea about tissue components could be used to improve the sensitivity and the accuracy of detecting malignancy in ovarian masses.

Ultrasonography guided fine needle aspiration cytology of benign and malignant ovarian masses with histopathological correlation

Background: In recent past image guided fine needle aspiration cytology of ovarian masses is being used for the pre-operative diagnosis of neoplastic ovarian lesions, The imaging may be in the form of routinely performed ultrasonography and fine needle aspiration cytology is done from the solid component of lesion. Material and Methods: A prospective study was conducted at our tertiary care center over the period of two years. The 32 patients with ovarian masses encountered. The sensitivity, specificity and diagnostic accuracy of FNAC was calculated. Pitfalls and limitations of cytological evaluation and histopathological diagnosis has been highlighted.Results: The sensitivity of fine needle aspiration cytology in this study is 81.81%, Specificity is 95.23% and diagnostic accuracy is 90.60%.Conclusion: The Ultrasonography guided FNAC is less invasive, economic, rapid diagnostic mode of early evaluation of benign and malignant ovarian tumors and helps in early management.

Does risk of malignancy algorithm (ROMA) discriminate more efficiently than HE4 OR CA125 in the diagnosis of pelvic masses?

To evaluate the diagnostic accuracy of serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in the prediction of malignant ovarian masses then to analyze the effect of personal criteria and medical diseases on this accuracy.This prospective study was performed in Zagazig University Hospital. The eligibility criteria for inclusion were; consecutive women, at any age ≥18 years, with established diagnosis of ovarian mass based on symptoms, signs, and imaging techniques. All patients underwent personal and medical history taking, preoperative serum CA125 and HE4 (cutoff 35 IU/mL and 150 pmol/L, respectively) assessment then postoperative histopathologic examination of lesions as a reference standard.Among the included 140 patients, 62 were confirmed to have ovarian malignancy and 78 had benign lesions. Serum CA125 ≥35 IU/mL was associated with ovarian malignancy at sensitivity 91.9%, specificity 53.8%, and accuracy 70.7%. Raising its cutoff to 67.5 IU/mL decreased the sensitivity 83.9%, increased the specificity 80.7% with accuracy 82.1%. The combination of HE4 and CA125 showed sensitivity 75.8%, specificity 93.5%, and accuracy 85.7%. Women suffering from both diabetes mellitus and hypertension showed a significant decrease in CA125 concentration P = 0.02 with false negative results in (5/11) of them, making its sensitivity 54.5% in this condition.The performance of CA125 in cancer ovary prediction can be improved by increasing its cutoff or by combining CA125 with HE4. Diabetes mellitus and hypertension can influence CA125 performance while HE4 is independent on these factors. This can be an additional value of the introduction of HE4 in cancer ovary prediction protocols.

Diagnostic Performance of Serum Human Epididymis Protein 4 (HE4) for Prediction of Malignancy in Ovarian Masses

Background:Early diagnosis of ovarian cancer is essential for long term disease control and mortality reduction. This has been achieved using tumor markers like cancer antigen 125 (CA-125) which is elevated in malignant as well as non-malignant conditions. This dilemma led to efforts towards development of newer markers like serum human epididymis secretory protein E4 (HE4). Present study aimed to evaluate role of HE4 in diagnosing ovarian cancers and comparing it with CA-125. Methods:Serum samples from 67 patients with ovarian cancer, 42 with benign ovarian masses and 26 healthy controls were collected preoperatively and tested for serum HE4 levels and CA-125 levels. Diagnostic performance of both tumor markers (HE4/CA-125) to diagnose malignancy in ovarian masses was calculated and compared to each other. Results:Mean CA-125 and HE4 levels were significantly higher in patients with ovarian cancer than in those with benign disease (p<0.001) or healthy controls (p< 0.001). Serum HE4 levels significantly increased in epithelial ovarian cancers when compared to non-epithelial ovarian cancers (p<0.01). Using benign control as comparison, receiver operating characteristic curve (ROC) was generated to predict a cut-off value for diagnosing malignancy for serum HE4 and CA-125. Compared to CA-125, HE4 had a similar sensitivity (83.6% vs. 85.10%) and higher specificity (100% vs. 90.48%); combination of serum HE4 and CA-125 improved the sensitivity to detect ovarian cancer to 92.54%. Sensitivity of HE4 to detect early stage ovarian cancer was superior to CA-125 (92.61% vs. 63.41%). Conclusion:Serum HE4, a novel tumor marker, discriminated epithelial ovarian cancer from benign ovarian masses. HE4 levels were related to the stage and histological types with the lowest levels in mucinous epithelial ovarian cancer and non-epithelial malignancy. Measuring serum HE4 levels alongwith CA-125 may provide higher accuracy for detecting epithelial ovarian cancer particularly in the early stages.

Evaluation of lysophosphatidic acid in vaginal fluid as a biomarker for ovarian cancer: A pilot study

There remains a need to differentiate between women with a benign or a malignant adnexal mass prior to surgery. As part of an ongoing evaluation of vaginal fluid compounds as potential tumor biomarkers we evaluated whether vaginal lysophosphatidic acid (LPA) predicted the subsequent diagnosis of a malignant adnexal mass. In this prospective pilot study vaginal fluid was obtained from 100 post-menopausal women referred for evaluation of a suspicious adnexal mass and tested for LPA by ELISA. Clinical data and serum CA125 results were obtained only after completion of all laboratory testing. Twenty eight of the women were subsequently diagnosed with an ovarian malignancy, four had a borderline tumor and 68 had a benign diagnosis. Among women with a malignant ovarian mass, 11 (39.3%) had an endometrioid adenocarcinoma +/− Clear cell tumor components, 6 (21.4%) had a high grade serous carcinoma, 3 (10.7%) had a mucinous tumor, 2 each (7.1%) had a malignant mixed mesodermal or a granulosa tumor and 1 each (3.6%) had a Clear cell tumor, a mixed cell tumor, leimyosarcoma or metastatic adrenal tumor. Compared to the median vaginal LPA level in women with benign lesions (1.5 μM), LPA was significantly elevated only in women with endometrioid ovarian cancer (7.9 μM) (p = 0.0137). Of the 6 endometrioid tumors in which values for both plasma CA125 and vaginal LPA were available 5 were positive only for LPA while one was only CA125 positive. Detection of LPA in vaginal secretions may be of value for the noninvasive diagnosis of endometrioid ovarian malignancies in post-menopausal women.

A rare case of ovarian lymphangioma with elevated CA-125 causing pseudo-Meigs’ syndrome

Lymphangiomas are benign congenital malformations of the lymphatic system, thought to occur as a result of obstruction of the local lymph flow system. They can occur anywhere in the skin and mucous membranes. The most common sites are the head and neck, but sometimes they are found in the intestines, pancreas and mesentery. Lymphangioma of the ovary is an extremely rare lesion. It was first described in 1908. Clinical manifestations can vary, from an asymptomatic ovarian mass to an acute abdomen. These may be confused with malignant ovarian masses, resulting in extensive surgery. A 34-year-old woman presented with dull aching pain localised to the lower abdomen, present for the previous 6 months. Ultrasound and a contrast-enhanced computed tomography scan of the abdomen were suggestive of an enlarged right ovary with massive ascites. The cancer antigen 125 (CA-125) level was 685 units/mL. Diagnostic laparoscopy revealed chylous ascites, and further, a frozen section revealed a few atypical cells, additionally strengthening the diagnosis of a malignant tumour. Staging laparotomy with total abdominal hysterectomy and salpingo-oophorectomy was finally performed. Histopathology revealed lymphangioma, with no evidence of malignancy. CA-125 also showed a rapid decline following surgery. Lymphangiomas should be included in the differential diagnosis of ovarian cystic masses, especially in patients with chylous ascites. It is very important to discriminate such cases from other malignant tumours in order to avoid overtreatment. However, a careful follow-up for at least 2 years is needed for patients with lymphangioma of the ovary, to exclude recurrence.

Role of MRI diffusion weighted imaging in differentiation between benign and malignant ovarian masses

Background: Characterization of the ovarian masses preoperatively is important to inform the surgeon about the possible management strategies. MRI may be of great help in identifying malignant lesion before surgery. Diffusion Weighted Imaging (DWI) is a sensitive method for changes in proton of water mobility caused by pathological alteration of tissue cellularity, cellular membrane integrity, extracellular space perfusion, and fluid viscosity.&#x0D; Objective: to study the diagnostic accuracy of DWI in differentiation between benign and malignant ovarian masses.&#x0D; Type of the study:Cross-sectional study.&#x0D; Methods: this study included 53with complex ovarian mass or masses ,Diffusion Weighted Imaging was obtained to all these patient with correlation to the histopathological results; the Signal Intensity (SI) of the solid and cystic part of the lesions was evaluated on T2 and Diffusion Weighted Imaging ,with Apparent Diffusion Coefficient (ADC) values were also obtained .&#x0D; Results: 22 masses out of the total 53 were malignant and 31 were benign .On DWI the high SI intensity observed more frequently in the malignant lesions than the benign lesions (p value 0.0293) .There was significant difference between the mean ADC value of the malignant and benign ovarian lesions, with the mean ADC value for the benign lesions solid component =1.05 x10 -3, and the mean ADC value for the malignant lesions solid component =0.91 x10-3. The ROC study reveals that 0.926 x 10 -3 may be the optimal cutoff value with sensitivity 54.8 %, specificity 59.1%, NPV 48.15 %, PPV 63.39% , Accuracy 56.6%. With exclusion of the teratoma and endometriomas from statistical analysis the ROC reveals that 0.99 x10 -3 may be the optimal cut off value with sensitivity 76.9 % , specificity 77.3% , PPV 66.67% , NPP 85% and accuracy 77.14% Conclusions: Combined with conventional pelvic MRI, DWI is a helpful tool in differentiation between benign and malignant ovarian masses, with high signal intensity on DWI more frequently observed in the malignant than benign ovarian lesions.

Diagnostic accuracy of CA125 and HE4 in ovarian carcinoma patients and the effect of confounders on their serum levels

ObjectivesTo evaluate the diagnostic accuracy of serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in the prediction of malignant ovarian masses then to analyze the effect of personal criteria and medical diseases on this accuracy. Study DesignThis prospective study was performed in Zagazig University Hospital. The eligibility criteria for inclusion were; consecutive women, at any age ≥18 years, with established diagnosis of ovarian mass based on symptoms, signs, and imaging techniques. All patients underwent personal and medical history taking, preoperative serum CA125 and HE4 (cutoff 35 IU/mL and 150 pmol/L, respectively) assessment then postoperative histopathologic examination of lesions as a reference standard. ResultsAmong the included 140 patients, 62 were confirmed to have ovarian malignancy and 78 had benign lesions. Serum CA125 ≥35 IU/mL was associated with ovarian malignancy at sensitivity 91.9%, specificity 53.8%, and accuracy 70.7%. Raising its cutoff to 67.5 IU/mL decreased the sensitivity 83.9%, increased the specificity 80.7% with accuracy 82.1%. The combination of HE4 and CA125 showed sensitivity 75.8%, specificity 93.5%, and accuracy 85.7%. Women suffering from both diabetes mellitus and hypertension showed a significant decrease in CA125 concentration P = 0.02 with false negative results in (5/11) of them, making its sensitivity 54.5% in this condition. ConclusionsThe performance of CA125 in cancer ovary prediction can be improved by increasing its cutoff or by combining CA125 with HE4. Diabetes mellitus and hypertension can influence CA125 performance while HE4 is independent on these factors. This can be an additional value of the introduction of HE4 in cancer ovary prediction protocols.

Cancer Antigen 125 (CA125), Human Epididymis Protein 4 (HE4), Risk of Malignancy Index (RMI), and Risk of Ovarian Malignancy Algorithm (ROMA) as Diagnostic Tests in Ovarian Cancer

Background: Distinguishing between malignant and benign ovarian masses is necessary to refer patients to centers with experience in the surgical. Objectives: The aim of this study was to analyze the diagnostic value of the tumor markers, including risk of malignancy index (RMI), human epididymis protein 4 (HE4), cancer antigen125 (CA125), and risk of ovarian malignancy algorithm (ROMA) in ovarian mass. Methods: One hundred patients with ovarian masses were assessed for the tumor markers ROMA, HE4, RMI, and CA125. The sensitivity and specificity of each parameter were calculated, using receiver-operating characteristic curves (ROCs) according to the area under the curve (AUC) for each method. Results: The median CA125, HE4, RMI, and ROMA serum levels had significant difference between malignant and benign masses in the overall assessment (P < 0.001). The AUCs were 0.83 (CA125), 0.88 (HE4), 0.85 (RMI), and 0.92 (ROMA) for benign vs. malignant masses in all the patients. The comparison of ROC curves was carried out, using a pairwise comparison method, and no differences were found among 4 methods. Conclusions: The results based on the AUC markers of CA125, HE4, RMI, and ROMA revealed that the accuracy trend of ROMA was higher than that of CA125, HE4, and RMI in all the patients and each group of pre- and post-menopausal patients.

Efficacy of Color Doppler Ultrasonography in Differentiation of Ovarian Masses.

Aim:Early and correct diagnosis of ovarian masses has great impact on the ultimate survival. The present study was done to know the role of color Doppler studies in characterization of ovarian masses and to evaluate its efficacy in diagnosis and differentiation of these neoplasms when used along with grayscale (B-mode) ultrasonography (USG).Materials and Methods:Over 2 years, in total, 98 patients with adnexal masses were examined, of which only 60 patients who had ovarian masses and were satisfying inclusion criteria were evaluated sonographically. Grayscale transabdominal and transvaginal sonography was followed by color Doppler with fixed parameters and indices. The results differentiated on sonographic and color Doppler examination were compared with the final diagnosis, based on histopathological examination.Results:Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of grayscale ultrasound in detecting malignancy in ovarian masses in the current study were calculated to be 51.85%, 75.75%, 63.63%, and 65.78%, respectively. By combining grayscale and color flow finding, the current study was able to differentiate malignant tumors from benign tumors with a sensitivity of 81.48%, specificity of 93.93%, PPV of 91%, and NPV of 86.11%.Conclusion:The present study demonstrates a significant increase in the sensitivity, specificity, PPV, and NPV in establishing the preoperative diagnosis of ovarian masses in terms of benign and malignant nature, when color and spectral Doppler was used in combination with USG as compared to grayscale (B-mode) USG alone.

Serum exosomal miRNA-145 and miRNA-200c as promising biomarkers for preoperative diagnosis of ovarian carcinomas.

Background: Exosomes are extracellular microvesicles that are released by most cells and widely distributed in various body fluids. Malignant cells secrete large amounts of exosomes containing various molecular constituents reflecting the originating tumor. We investigated the difference in microRNA (miRNA) expression in serum exosomes from the patients with benign, borderline and malignant ovarian masses to assess the diagnostic relevance of serum exosomal miRNAs as biomarkers for preoperative diagnosis of ovarian carcinoma.Methods: A total of 68 cases of ovarian masses were enrolled, comprising benign ovarian cysts (benign; n=10), borderline ovarian tumors (BOT, n=10), high-grade serous ovarian carcinomas (HGSOC, n=39) and non-HGSOCs (n=9). Exosomal RNA was extracted from the serum, and expression levels of seven miRNAs (miRNA-21, -93, -141, -145, -200a, -200b and -200c), which were reportedly dysregulated in serous ovarian cancer in previous studies, were quantified by real-time PCR, and compared between the four groups.Results: MiR-93, -145, and -200c, showed significantly higher expression in serum exosomes of the cancer group (HGSOC and non-HGSOC) than of the non-cancer group (benign and BOT; all p<0.05). The remaining three miRs (miR-141, -200a, and -200b) were expressed at extremely low levels, and not appropriate as serological biomarkers. To test discrimination of cancer from non-cancer, the area under the receiver operating characteristic curves determined for cancer antigen 125 (CA125), miR-145, miR-200c, miR-21, and miR-93 were 0.801 (p<0.001), 0.910 (p<0.001), 0.802 (p<0.001), 0.585 (p=0.303), and 0.755 (p=0.002), respectively. MiR-145 showed superior sensitivity (91.6%), and miR-200c showed superior specificity (90.0%), compared with CA125.Conclusion: Expression of exosomal miR-93, miR-145 and miR-200c was significantly elevated in the serum of ovarian cancer patients. Serum exosomal miR-145 in particular appeared to be the most promising biomarker for preoperative diagnosis of ovarian cancer.

Evaluation of Risk of Malignancy Index 5&amp;mdash;A New Indicator in Differentiating Benign and Malignant Ovarian Masses

Evaluation of Risk of Malignancy Index 5&amp;mdash;A New Indicator in Differentiating Benign and Malignant Ovarian Masses

OP08.04: Clinical and ultrasound characteristics of malignant ovarian masses in pregnant women

OP08.04: Clinical and ultrasound characteristics of malignant ovarian masses in pregnant women

Diagnostic accuracy of diffusion weighted imaging & dynamic contrast enhanced MRI in differentiating benign & malignant ovarian masses for optimum possible surgical strategies

Diagnostic accuracy of diffusion weighted imaging & dynamic contrast enhanced MRI in differentiating benign & malignant ovarian masses for optimum possible surgical strategies

DWI in characterization of complex ovarian masses, would it help?

ObjectiveTo define the role ofdiffusion-weightedimaging& apparent diffusion coefficient (ADC) in characterizingcomplexovarian masses, with particular concern to differentiating benign versus malignant masses. Materials and methodsWe enrolled in this prospective study 30 patients with complex cystic ovarian masses between June 2014 and July 2015. Pelvic MRI and diffusion weighted images at b value of 0, 500, 1000 and 1500 s/mm2 at 1.5 T unit were performed for all patient. The mean ADC values were calculated for both solid & cystic component of the masses. The final diagnoses were confirmed by either pathological examination or culture of aspiration material. ResultsIncluded masses proved benign in 17 (56%) and malignant in 13 (44%). ADC of solid component of malignant showing no statistically significant difference from that of the benign lesions, while ADC values of cystic component in malignant masses were significantly higher than those in benign masses (p < 0.05). The Receiver operator characteristic (ROC) analysis indicated that a cutoff ADC value of 1.97 × 10−3 mm2/s may be the optimal one for differentiating between benign and malignant masses. ConclusionThe combination of DWI with ADC value measurement and conventional MRI is useful for differentiating benign and malignant ovarian masses.

Diagnostic accuracy of inflammatory markers for distinguishing malignant and benign ovarian masses.

Objective: To evaluate the role of inflammatory markers for distinguishing malignant and benign ovarian masses.Methods: Preoperative demographic, clinicopathologic, and laboratory variables were reviewed in patients with an ovarian mass that was subsequently diagnosed as either epithelial ovarian cancer (EOC) or a benign ovarian mass on histologic analysis. The differences between variables of the two groups were further evaluated. Logistic regression analysis was applied to evaluate variables to predict the presence of EOC.Results: According to the analysis of 229 patients with EOC, 120 (52.4%) patients had serous adenocarcinoma. Of the 229 patients, 110 (48.1%) patients had stage I or II disease and 119 (52.0%) had stage III or IV disease. There was a significant difference between EOC and benign ovarian mass in median values of variables such as age, white blood cell (WBC) count, hemoglobin concentration, platelet count, cancer antigen 125 (CA125) levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) (all P < 0.001, except for WBC count [P = 0.009]). In addition, there was significant difference in median values of these continuous variables among early-stage EOC, advanced-stage EOC, and benign ovarian mass (P < 0.001 for all variables). On multivariate logistic regression analysis, age (odds ratio [OR] = 4.14, P < 0.001), CA125 levels (OR = 9.87, P < 0.001), NLR (OR = 1.76, P = 0.049), PLR (OR = 2.41, P = 0.004), and LMR (OR = 0.51, P = 0.024) were found to significantly predict the presence of EOC.Conclusion: The three LMR, NLR, and PLR markers were found to be predictors for the presence of EOC. Further prospective studies to assess these markers as screening tools for the presence of EOC are required.

Is There Any Difference in Platelets Indices Between Benign and Malignant Epithelial Tumors of the Ovary?

Ovarian cancer is the most common cause of death among gynecologic malignancies around the world, and there are numerous criteria in preoperative differentiation between benign and malignant ovarian mass. The interaction between cancer and platelets is not yet properly known. Here in, we decided to perform a study about platelets indices in benign and malignant ovarian neoplasm to be the basis for the next conclusion. This study is a descriptive and analytic cross-sectional study and the community consists of patient with epithelial ovarian mass who referred to our Gynecology Oncology center of Imam Hospital of Iran. The information about platelet indices in pre-operational period, extracted from the patients files. Then data were analyzed and descriptive statistics using SPSS software were performed on them. To compare variables between two groups, patients with benign and patients with malignant epithelial ovarian tumors, we used t test. Considering the significance of P value below 0.05, there was a significant difference between two groups in WBC count, MCV and Hb, but in platelet count and platelet indices, there were no significant differences. According to our knowledge, our study is the first one about platelet indices difference, between malignant and non-malignant neoplasm of the ovary. In our research, the mean of platelets count and platelets indexes did not differ between the two groups. In most studies, the mean of Hb, MCV, and WBC count were lower in malignant tumors that our results were the same. Further research is needed to confirm our results so that criteria to differentiate benign and malignant tumors and prognostic factors can be completed.

Mig-7 expression and vasculogenic mimicry in malignant ovarian tumors.

To investigate the possible association of vasculogenic mimicry (VM), VE-cadherin and MIG-7 expression with clinicopathological features of women with malignant ovarian masses. VM was studied with the PAS reaction and VE-cadherin was assessed with immunohistochemistry in 108 women with malignant ovarian tumors. Additionally, quantitative expression of MIG-7 mRNA was performed in 52 ovarian cancers with qRT-PCR. VM was found in 48/108 cases (44%), more often in higher FIGO stage tumors (83% cases; 40 vs. 8; p = 0.01). High expression of VE-cadherin was present in 37% of all ovarian masses. Ovarian tumors without VM more often expressed low levels of VE-cadherin than tumors where VM was found (37.6% vs.14.6%). No expression or very low expression of MIG-7 mRNA was found in all normal ovarian tissues and in 32 cancer samples. Median RQ of MIG-7 mRNA in tumor samples was higher than in normal ovarian tissue (RQ = 0.29 vs. RQ = 0.05, respectively; p < 0.005) and higher than in non-malignant ovarian masses (0.98 vs. 0.05 respectively; p = 0.03). Expression of MIG-7 mRNA was significantly correlated with VM (p = 0.039). In tumors with PAS-positive structures median RQ MIG-7 mRNA was higher than in tumors with PAS-negative findings (1.89 vs. 0.13 respectively). VE-cadherin expression was more frequently found in tumors where MIG-7 mRNA was present (p = 0.004). Vasculogenic mimicry exists in malignant ovarian tumors and advanced clinical stages of malignancy are accompanied by a high incidence of VM formation. MIG-7 mRNA and VE-cadherin expression may serve as additional molecular markers of VM in ovarian malignancies.

Preoperative evaluation of patients with ovarian masses using the risk of malignancy index 4 model

Objective: To evaluate the performance of the RMI 4 in discriminating benign from malignant ovarian masses. Study Design: Cross-sectional study. Setting: Assiut Women Health Hospital- Egypt. Materials and methods: This was an observational cross-sectional study involving 91 patients at Women's Health Hospital, Assiut University, Egypt during the period between January, 2016 and January, 2017. Women with ovarian masses planned for surgical management were recruited from the outpatient gynecology clinic of the hospital. Risk of malignancy index (RMI 4) was calculated for all study participants. Biopsies obtained from the ovarian masses after surgical intervention were sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses is considered the gold standard for diagnosis. Results: The mean age of patients in the benign group was 34.83±16.28 years versus 43.43±15.91 in the malignant group. There were 12 postmenopausal patients (15.6%) in the benign group versus 4 postmenopausal patients (28.6%) in the malignant group (p=0.0001). An ultrasound score of 4 was recorded in 85.7% of patients in the malignant group versus only 6.5% in the benign group (p=0.0001). Additionally, tumor size ≥ 7 cm was observed in 85.7% of patients in the malignant group versus 55.8% in the benign group (p=0.0001). The mean value of CA-125 was significantly higher in malignant group than the benign group (142.09±41.50 versus 54.51±32.86 ml, respectively) with p=0.01. RMI 4 had a sensitivity of 75%, specificity of 97.3%, PPV of 85.7%, NPV of 94.8 % and an overall accuracy of 93.4%. Conclusions: RMI 4 is a simple and reliable tool in the primary evaluation of patients with ovarian masses. It can further be used to discriminate benign from malignant ovarian masses with high sensitivity and accuracy.