Epitranscriptomic signatures of malignancy: how RNA modifications shape breast and ovarian tumor progression.

Impact of lymphadenectomy on survival outcomes for stage I malignant ovarian germ cell tumors.

Ultrasound-guided transvaginal tru-cut biopsy is used for histological confirmation of ovarian malignancy in selected clinical settings. Although multiple cores are routinely obtained to improve diagnostic yield, the distribution of malignant tissue across cores obtained during a single biopsy session has not been systematically evaluated. This question is particularly relevant for translational workflows, such as tissue cryopreservation, where histological verification of each individual core is impractical. We present a prospective feasibility study evaluating intra-procedural concordance of malignant tissue across ultrasound-guided transvaginal tru-cut biopsy cores of ovarian lesions. Twenty-one patients undergoing ultrasound-guided transvaginal tru-cut biopsy of ovarian lesions were included in the final analysis. Tru-cut biopsy yielded a diagnostic result in 20 of 21 procedures (95.2%; Wilson 95% confidence interval 78.1%-99.4%). In all biopsy procedures in which malignant tissue was identified in at least one core, malignant tissue was consistently present in all other evaluable cores obtained during the same session, with no discordant cases observed. When tissue fragments were present, malignant tissue was also consistently identified in fragments whenever malignant tissue was present in cores. One procedure, involving a mucinous adenocarcinoma arising in the background of a borderline tumor, yielded no malignant in any submitted material. Overall, these findings demonstrate a high degree of intra-procedural concordance of malignant tissue across biopsy cores and support the feasibility of biopsy workflows relying on confirmation of malignant tissue in a single core.

Ovarian cancer is a significant global health concern, with high mortality rates and limited early detection methods. Accurate assessment of the risk of malignancy in ovarian tumors is crucial for guiding treatment decisions. To assess the accuracy and applicability of the Risk of Malignancy Index (RMI) in predicting histopathologic diagnoses of ovarian malignancy among patients at Saint Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, 2024. An institution based a two-year retrospective cohort study (2022-2023) was conducted Data were collected from March to April 2024, including 230 cases through census sampling. Sensitivity and specificity analyses assessed the diagnostic performance of the Risk of Malignancy Index (RMI) against histopathology as the gold standard. Correlation analysis was done to evaluate the risk of malignancy with histopathology of ovarian tumor. Multivariate analysis used to evaluate the associated factors with Risk of malignancy index with significance set at p < 0.05. The risk of malignancy index has strong correlation (r = 0.701) with histopathology of ovarian tumour. The sensitivity, specificity, PPV, NPV and accuracy of risk of malignancy index in the current study were 86.4%, 78%, 76%, 87.6% and 81.7% respectively. Being at premenopausal stage [AOR = 0.05; 95%CI (0.002-0.98), serum CA125 ≤ 35 [AOR = 0.002; 95%CI (0.00-0.02)] and absence of solid area are in Ultrasound [AOR = 0.03; 95%CI (0.005-0.16)] were also significantly associated with accuracy of risk of malignancy index. The correlation between RMI and histopathology of ovarian tumors is found to be strong. The accuracy of RMI is 81.7% and reasonably good. The menopausal status, serum level of CA-125 and presence of solid echotexture during ultrasound examination are factors significantly associated with the accuracy of risk of malignancy index. Physicians shall better use the risk of malignancy index for diagnosing the ovarian tumors.

Ovarian cancer (OC) accounts for a significant percentage of cancer-related deaths in women worldwide. A small proportion of ovarian cancers, usually in women under 40, originate from germ cells and stromal cells within the ovary, but the vast majority are epithelial malignancies. The preferred treatment for ovarian malignancies consists of platinum-based chemotherapy and surgical intervention.Chemoresistance in ovarian cancer is a complex problem that significantly impedes tratment efficacy. Many pathways contribute to this resistance, including genetic factors, tumor microenvironment interactions, and lifestyle variables such as obesity. Understanding these mechanisms is crucial for developing effective treatment solutions. The circadian rhythm, or circadian clock, regulates the sleep-wake cycle, body temperature, hormone secretion, metabolism, and many physiological processes. Circadian genes are highly expressed in the ovaries, which regulate ovulation. Disruption of circadian rhythm asociated with many risk factors for ovarian cancer. This article examines the relationship between circadian rhythm and chemotherapy resistance in ovarian cancer, and reviews circadian rhythm to reduce chemotherapy resistance in this context.

ObjectiveThe prognostic implications of surgical outcomes in older adults with ovarian cancer remain unclarified. This study aimed to describe temporal trends in surgical management and examine the association between surgical outcomes and survival among older patients with ovarian cancer.MethodsThis population-based retrospective study analyzed data from the Osaka Cancer Registry from patients diagnosed with ovarian cancer between 2004 and 2018. During this period, 10,033 women were diagnosed with malignant ovarian tumors in Osaka Prefecture, of whom 7,285 were classified as epithelial ovarian malignancies. Among them, 1,441 patients aged ≥70 years were identified. After excluding 39 patients with unknown surgical outcomes and 40 with insufficient chemotherapy data, 1,365 patients were included. Based on the surgical outcomes, patients were classified as having complete resection with no residual tumor, residual macroscopic tumor-present, or no surgery. Disease extent was categorized as localized, regional, or distant. Overall survival was assessed using univariate and multivariate models.ResultsThe proportion of patients managed without surgery increased over the study period, from 20.9% in 2004–2007 to 29.0% in 2016–2018, although this trend did not reach statistical significance (p = 0.11). This shift was most evident among patients with advanced disease (p < 0.001), indicating a temporal change in surgical management among older patients. A stepwise survival gradient was observed according to surgical outcome. The 5-year overall survival rates were 63.9%, 27.9%, and 9.9% for complete resection, residual macroscopic tumor, and no surgery, respectively. Compared with complete resection, the hazard ratios for mortality were 2.63 (95% CI, 2.22–3.10) for residual macroscopic tumor and 5.37 (95% CI, 4.55–6.34) for no surgery. In multivariate analysis, surgical outcome remained associated with overall survival after adjustment for available clinical variables.ConclusionIn this registry-based cohort of patients aged ≥70 years, the proportion of patients managed without surgery increased over time, particularly among those with advanced disease, and receipt of surgery was associated with longer overall survival. However, as comorbidity and frailty data were unavailable in the registry, residual confounding related to treatment selection cannot be excluded.

Development and characterization of monoclonal antibodies against inhibin α subunit as a potential cancer biomarker.

Ovarian cancer is a particularly lethal malignancy often diagnosed at advanced stages, highlighting the urgent need for novel therapeutic strategies. This study investigates the expression and functional role of LINC00240, miR-30c-5p, and P4HA2 in ovarian cancer pathogenesis. Using datasets GSE66957 and the GEPIA database, we assessed LINC00240 expression levels and employed quantitative real-time polymerase chain reaction (qRT-PCR) to evaluate the expression of LINC00240, miR-30c-5p, and P4HA2 in ovarian cancer samples. Bioinformatics analysis via TargetScan software predicted interactions between these molecules, which were validated through dual-luciferase reporter assays. Functional assays, including colony formation and Transwell assays, assessed the impact of LINC00240 and miR-30c-5p on cell proliferation, migration, and invasion. Our results indicate that LINC00240 and P4HA2 are significantly overexpressed, while miR-30c-5p is downregulated in ovarian cancer. Furthermore, LINC00240 modulates ovarian cancer malignancy by regulating P4HA2 expression through binding with miR-30c-5p. These findings elucidate the role of the LINC00240/miR-30c-5p/P4HA2 axis in ovarian cancer and suggest new avenues for targeted therapeutic interventions.

Abstract Ovarian and endometrial malignancies provide significant therapeutic hurdles owing to their molecular variability and inconsistent treatment responses. Identifying non-invasive predictive biomarkers is essential for tailoring treatment and improving patient care. Radiomics has emerged as a promising methodology, facilitating the systematic extraction of quantitative features from computed tomography (CT) images to assess tumor heterogeneity, genetic changes, and microenvironmental properties that may affect prognosis and therapy response. Nonetheless, the evidence substantiating radiomics as a validated prognostic biomarker for targeted therapy is still limited. Most contemporary models should be regarded as prognostic or hypothesis-generating tools, rather than as instruments intended to guide therapeutic decision-making. Recent studies integrating CT-derived radiomic characteristics with clinical and genetic data have demonstrated improved predictive accuracy, especially in stratifying patients likely to benefit from targeted therapies, including poly-ADP-ribose polymerase (PARP) inhibitors and immunotherapy. In gynecologic oncology, the application of diverse methodologies indicates that radiomics holds promise for enhancing existing biomarkers and propelling precision oncology forward. The primary obstacles to widespread implementation encompass variations in feature extraction and analysis techniques, the utilization of different imaging modalities, and the absence of comprehensive validation across diverse patient populations. To enable clinical adoption, these issues must be addressed through extensive, multi-institutional studies and the establishment of standardized methodologies. This review examines the current status of CT-based radiomics in ovarian and endometrial cancers, evaluating its role as a prognostic biomarker and its potential to guide customized therapy approaches. Further investigation to integrate radiomics into treatment protocols, with the aim of improving prognoses for women diagnosed with gynecologic cancers is needed.

This narrative review integrates recent literature and representative, non-consecutive, cases from the International Ovarian Tumor Analysis (IOTA) database (University Hospitals Leuven) to illustrate macroscopic-sonographic correlations in epithelial and non-epithelial ovarian malignancies. The main objective was to explore the correlation between ultrasound and gross pathologic features of malignant ovarian tumors, highlighting histotype-specific patterns using IOTA terminology. All patients provided informed consent. Key tumor features (solid components, necrosis, septations, exophytic growth, and papillary projections) were evaluated using standardized IOTA terms. Ultrasound images were compared with matched gross pathology photographs. The integration of matched ultrasound and pathology images may represent an effective educational tool, improving diagnostic accuracy among sonographers. Knowledge of the ultrasound features more frequently reported for specific histotypes in the existing literature, interpreted using IOTA terminology and supported by gross-ultrasound image correlation, may aid the differential diagnosis of borderline and primary invasive ovarian tumors and support subsequent clinical management. This approach may inform surgical decision-making and guide pre-operative planning. A non-validated diagnostic flowchart is proposed to assist in the differential diagnosis of malignant ovarian tumors.

Accurate preoperative classification of ovarian tumors is essential for guiding treatment. There is an increasing body of data evaluating ultrasound-based models for this purpose in diverse clinical settings. The aim of this systematic review and meta-analysis was to generate up-to-date evidence on the diagnostic accuracy of the most relevant ultrasound-based models, including the Risk of Malignancy Index (RMI) versions 1, 2 and 3, Logistic Regression model 2 (LR2), Simple ultrasound-based Rules (SR), the Assessment of Different NEoplasias in the adneXa (ADNEX) model and subjective assessment (SA), for the differentiation between benign and malignant ovarian tumors. Ovid/MEDLINE, EMBASE and the Cochrane Library were searched systematically from database inception until 19 June 2025. Eligible studies investigated the diagnostic accuracy of at least one of the preselected models, collected model parameters prospectively and provided sufficient data to construct 2 × 2 tables. The risk of bias of all included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and QUADAS-C extension tools. Pooled summary estimates of sensitivity and specificity for all included models were calculated and bivariate models were fitted into hierarchical summary receiver-operating-characteristics curves. Bivariate random-effects meta-regression analysis was conducted to determine significant differences in sensitivity and specificity between models. Subgroup analyses were conducted according to menopausal status and prevalence of ovarian malignancy. A total of 99 studies were included, describing 42 496 ovarian tumors, of which 31 371 (74%) were benign and 11 125 (26%) were malignant. SA had both high sensitivity (90.2% (95% CI, 87.8-92.2%)) and high specificity (91.4% (95% CI, 89.3-93.2%)). SR followed by SA of inconclusive cases (SR + SA) showed similar performance to SA (sensitivity, 88.6% (95% CI, 85.7-91.0%); P = 0.397 and specificity, 91.0% (95% CI, 89.0-92.7%); P = 0.811), as did the ADNEX model with a cut-off of 20% (sensitivity, 86.7% (95% CI, 80.6-91.0%); P = 0.095; specificity, 87.9% (95% CI, 80.1-92.9%), P = 0.119). The ADNEX model with a cut-off of 10% had a similar sensitivity to SA (92.7% (95% CI, 90.8-94.2%); P = 0.130), but lower specificity (78.4% (95% CI, 71.7-83.8%); P < 0.001). Higher cut-offs of the ADNEX model led to a decrease in sensitivity, whereas lower cut-offs resulted in reduced specificity. The LR2 model with a 10% cut-off had a sensitivity of 89.5% (95% CI, 85.8-92.4%) and a specificity of 82.3% (95% CI, 75.0-87.8%). The RMI had the lowest diagnostic accuracy, with a sensitivity of 69.7% (95% CI, 67.0-72.2%) and a specificity of 90.5% (95% CI, 88.3-92.4%) for RMI version 1 with a cut-off of 200. Subgroup analyses showed that both menopausal status and prevalence of malignancy significantly affected sensitivity (P < 0.01) and specificity (P < 0.01). Postmenopausal status and higher disease prevalence were associated with lower specificity, while sensitivity was lower in premenopausal women. All approaches, except for the RMI, performed well and could be used to differentiate between benign and malignant ovarian tumors. Although SA with or without SR had the highest diagnostic performance, it is dependent on operator expertise. If a strategy independent of operator expertise is preferred, the ADNEX model is recommended. Because of the high sensitivity of the ADNEX model, the likelihood of missing malignancies is low. In postmenopausal women, however, the reduced specificity may warrant a higher cut-off, depending on how the impact of a false-positive test result is evaluated. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Oxidative phosphorylation (OXPHOS), a major metabolic pathway in normal/differentiated cells is also active in tumors and a target for cancer drug development. Atovaquone, an FDA-approved antiprotozoal and OXPHOS inhibitor, blocks electron transport at mitochondrial Complex III resulting in an oxygen radical surge that triggers cancer cell death. Here, we examine mechanisms that attenuate the efficacy of atovaquone as an anti-cancer agent. First, we demonstrate that exposure to atovaquone causes DNA damage and loss of nuclear integrity in cancer cells. DNA damage by atovaquone does not activate cGAS-STING signaling, likely due to repressed cGAS expression in the cell lines tested. Instead, ATM/ATR signaling is activated in response to atovaquone. Recently, we demonstrated that oxidative and endoplasmic reticulum stress in atovaquone-treated cancer cells was associated with elevation in danger associated molecular patterns (DAMPs) corresponding to increased lysis by natural killer cells. Contrary to this immune activating effect, we now report that cancer cells also employ an immunosuppressive mechanism upon exposure to atovaquone. Specifically, we observed ATM/ATR-dependent increase in expression of PD-L1 on the cancer cells. Increase in PD-L1 required STAT1 signaling but was not regulated by IRF1, HIF1α or p53. Increase in PD-L1 was confirmed on peritoneal p53-/- ID8-F3 tumors growing in mice receiving atovaquone therapy. Combining atovaquone with anti-PD-L1 resulted in significant delay in tumor growth. Data from this study provides a mechanistic basis for PD-L1 elevation in tumors treated with atovaquone. Our studies support further development of atovaquone-anti-PD-L1 combination for the treatment of ovarian and other malignancies.

Peritoneal metastasis is a common pattern of metastasis for gastrointestinal and ovarian malignancies and is associated with an extremely poor prognosis. Recently, Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), a novel locoregional drug delivery technology, has garnered significant attention. It delivers low-dose aerosolized chemotherapeutic drugs into the abdominal cavity, utilizing capnoperitoneum pressure and aerosol properties to achieve a more homogeneous spatial distribution and superior tissue penetration. Currently, numerous international studies have demonstrated the favorable safety, tolerability, and efficacy of PIPAC, leading to established expert consensus on its indications, technical procedures, and safety measures. However, a systematic and standardized PIPAC operational protocol remains lacking in China, owing to limited equipment accessibility and insufficient clinical evidence. Based on current research progress and international consensus, combined with characteristics of the domestic PIPAC system equipped with a high-pressure peristaltic pump and preliminary domestic clinical experiences, this paper formulates technical specifications and occupational protection recommendations for PIPAC in China. It systematically elaborates on patient selection, perioperative preparation, standardized operational procedures, and safety measures. This study aims to provide actionable and replicable technical guidance, ensuring treatment safety and operational reproducibility, thereby facilitating the standardized application and clinical promotion of PIPAC in China.

To explore the value of the ovarian-adnexal reporting and data system (O-RADS) combined with tumor markers, risk of ovarian malignancy algorithm (ROMA) in the differential diagnosis of benign and malignant ovarian-adnexal tumors. A total of 426 patients with 524 cases of ovarian-adnexal tumors confirmed by surgery from January 2021 to January 2024 were included. Ultrasound O-RADS classification, ROMA and their combination were used for differential diagnosis. Taking pathological results as the gold standard, the sensitivity, specificity and the area under the receiver operating characteristic curves were calculated. Among the 524 tumors, there were 104 cases in category 2, 113 cases in category 3, 81 cases in category 4, 226 cases in category 5. The proportions of malignancy in O-RADS categories 2-5 were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226). Thus, it can be observed that the higher the ultrasound O-RADS classification, the higher the risk of malignancy. This was statistically significant. Taking O-RADS category 4 as the research objective, the patients were divided into two groups, pre-menopausal and post-menopausal for statistical analysis. Analysis revealed that the malignancy rate of postmenopausal O-RADS category 4 tumors was similar to that of O-RADS category 5. The risk of malignant tumors in postmenopausal women with O-RADS category 4 is significantly higher compared with that in premenopausal patients and the difference is statistically significant. The diagnostic efficacy of ROMA for benign and malignant tumors in postmenopausal patients was significantly greater when compared with premenopausal patients. When combined diagnosis is adopted, regardless of whether it is in the premenopausal or postmenopausal stage, the sensitivity and specificity of the diagnosis are significantly higher compared with those of a single diagnosis. Taking O-RADS category 4 as the research objective, the incidence of malignant tumors of O-RADS category 4 in postmenopausal women is similar to that of category 5. The diagnostic efficacy of ROMA for postmenopausal patients is greater when compared with that for premenopausal patients. The use of O-RADS classification combined with ROMA can improve the sensitivity and specificity for the differential diagnosis of benign and malignant ovarian-adnexal tumors.

Endometriosis is a chronic estrogen-dependent disorder affecting approximately 10% of women of reproductive age. Increasing epidemiological and molecular evidence indicates that it may represent a precursor condition for a subset of ovarian malignancies collectively defined as endometriosis-associated ovarian cancer (EAOC), predominantly endometrioid and clear cell carcinomas. Malignant transformation is driven by the interplay between chronic inflammation, oxidative stress, and local hyperestrogenism within the endometriotic microenvironment. Recurrent hemorrhage and persistent immune activation further promote genomic instability and clonal expansion. Shared somatic mutations have been identified in both atypical endometriosis and adjacent carcinomas, supporting a model of stepwise tumorigenesis. Dysregulation of signaling pathways and epigenetic mechanisms, including microRNA alterations, further contribute to tumor development. Although the absolute risk of malignant transformation remains low, women with ovarian endometriosis and deep infiltrating disease show an increased risk of ovarian cancer. EAOC is frequently diagnosed at earlier stages and generally demonstrates a more favorable prognosis than high-grade serous carcinoma, although clear cell histotypes may exhibit chemoresistance and distinct molecular vulnerabilities. This review summarizes current evidence on the pathogenesis, molecular mechanisms, and clinical implications of EAOC, highlighting future strategies for risk stratification and personalized surveillance.

Objective: To determine the frequency and clinicopathological features of incidental premalignant and malignant gynecological lesions detected after hysterectomies performed for benign indications, and to identify associated risk factors. Methodology: This retrospective study reviewed 1,047 hysterectomies performed for benign conditions at a tertiary center in Ankara, Turkiye, over a ten years period (January 2006-December 2015). Demographic characteristics, preoperative assessments, surgical indications, and histopathological outcomes were analyzed. Incidental lesions were defined as pre-malignant or malignant pathologies identified postoperatively without prior clinical suspicion. Statistical analyses were performed using chi-square and t-tests. Results: Incidental pre-malignant or malignant lesions were identified in 6% (n=63) of cases, including cervical dysplasia/HSIL (0.9%), borderline ovarian tumors (1.1%), endometrial adenocarcinoma (0.5%), leiomyosarcoma (0.5%), and high-grade serous ovarian carcinoma (0.6%). Postmenopausal women had a significantly higher incidence than premenopausal women (9.2% vs. 3.8%, p&lt;0.001). Patients with incidental findings were older than those with benign pathology (55.4 ± 11.2 vs. 52.7 ± 9.6 years, p=0.034). Larger myomas were associated with uterine sarcoma (172 ± 92 mm vs. 71 ± 39 mm, p&lt;0.001). Ovarian malignancies were detected in 2.4% of cases without suspicious ultrasound features and in 14.8% of cases with ≥2 malignancy criteria (p=0.013). Serous tubal intraepithelial carcinoma (STIC) was identified in 0.28% (n=3). Conclusion: Incidental pre-malignant or malignant lesions were present in 6% of hysterectomies performed for benign indications. Age, menopausal status, myoma size, and suspicious imaging features were significant predictors. Preoperative evaluation may not completely exclude the possibility of occult pathology; therefore, this risk should be discussed during preoperative counseling.

Peritoneal inclusion cysts (PICs) are benign, multilocular fluid-filled lesions that predominantly affect women of reproductive age, often arising after abdominal surgery or chronic inflammation. We report a case of a 28-year-old female presenting with chronic left upper-quadrant abdominal pain for 1 year. Radiological evaluation revealed a large cystic lesion closely abutting the left adrenal gland and adjacent organs, creating a diagnostic dilemma regarding its tissue of origin. The patient was planned for diagnostic laparoscopy, which revealed a large, thin-walled cyst containing clear serous fluid. The lesion was not arising from the suprarenal gland or the pancreatic tail. Complete excision of the cyst was performed, and histopathological examination confirmed the diagnosis of a PIC. Notably, the patient had no prior history of abdominal surgery, making this presentation particularly unusual. The postoperative course was uneventful, and at 6-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights a rare suprarenal presentation of a PIC in a "virgin" abdomen, closely mimicking adrenal and pancreatic cystic pathology on imaging despite normal endocrine evaluation. It underscores the importance of imaging - particularly ultrasonography and contrast-enhanced computed tomography of the abdomen and pelvis - in evaluating cystic lesions and differentiating PICs from Paraovarian cysts, hydrosalpinx, or ovarian malignancy based on anatomical location. However, due to significant imaging overlap with adrenal and pancreatic cystic lesions, histopathological confirmation remains essential. Diagnostic laparoscopy with complete excision was crucial in establishing the diagnosis, avoiding unnecessary adrenal resection, and ensuring a favorable outcome without early recurrence.

As the second deadly cancer affecting women globally, precise and timely classification of ovarian tumors plays an instrumental role in improving the rate of curing and reducing the rate of mortality. This study was set out to comprehensively investigate the effectiveness of deep learning model for classifying benign and malignant ovarian tumors, utilizing multimodal ultrasound images and clinical data, in comparison to traditional methods such as manual assessment by radiologists and those based on O-RADS. This retrospective multicenter study recruited women diagnosed with ovarian tumors between January 2022 and June 2023, with histopathological examination results as the reference diagnoses. The dataset was divided into three subsets: training (70%), validation (10%), and test (20%). Employing the Dense Convolutional Network algorithm, we constructed and investigated two fusion models: DLM2F, integrating multimodal features extracted ultrasound (grayscale ultrasound, color Doppler flow imaging), and DLM3F, integrating DLM2F with clinical data (e.g. age, CA125, CA199, HE4, SCC, ROMA index, menopausal state, and mass volume). The outcome measure was the area under the receiver operating characteristic curve (AUC). We compared the models' performance in the test dataset against both radiologists, O-RADS and single-mode models. A total of 508 patients with ovarian tumors (mean age: 44.3 ± 15.9 years) were enrolled, including 327 benign and 181 malignant tumors. In the test set, the DLM2F model demonstrated an AUC of 0.919, sensitivity of 0.865 and specificity of 0.879, while the DLM3F model showed an AUC of 0.951, sensitivity of 0.865 and specificity of 0.939. Comparatively, radiologists scored AUC of 896 (Expert level III) and 0.827 (Expert level I), while O-RADS was able to achieve an AUC of 0.835. Evaluation of confusion matrices revealed that DLM3F model exhibited almost identical accuracy as a level III expert, demonstrating its promising potential as an clinical diagnostic tool to assist junior radiologists. The deep learning model integrating multimodal ultrasound images and clinical information is capable of discriminating between benign and malignant ovarian tumors, exceeding the diagnostic capabilities of both radiologists and O-RADS assessments.

Of all the gynecologic cancers, ovarian cancer has the greatest clinical challenge. It is often asymptomatic at an earlier stage and many of them present in an advanced stage for which the five-year survival rate remains low. However, the major hurdle faced by gynecologists is in diagnosing the disease early, owing to the fact that ovarian malignancies do not manifest clinically until a later stage. As the most important prognostic factor is the quality of primary cytoreductive surgery, a high degree of suspicion and multi-diagnostic approach is required in patients with nonspecific symptoms in the high-risk age group, to detect the malignancy at its earliest. There are only few studies on classification systems to categorize ovarian mass into benign and malignant pre-operatively and to decide upon proper management and counseling of the patient. In this study we assessed "the accuracy of International Ovarian Tumor Analysis (IOTA) simple rules with Risk Malignancy Index (RMI) to differentiate benign from malignant adnexal mass". By evaluating the performance of each classification system, we analyzed the nature of an adnexal mass pre-operatively based on its score and hence decide upon the treatment modality. A total of 49 patients were enrolled in the study and were followed up by menopausal status, ultrasonogram and serum tumour markers. When compared to HPE, RMI had sensitivity of 71.43% (95% CI 29.04-96.33%), Specificity was 97.62% (95% CI 87.43-99.94%), False positive rate was 2.38% (95% CI 0.06-12.57%), False negative rate was 28.57% (95% CI 3.67-70.96%), Positive predictive value was 83.33% (95% CI 35.88-99.58%), Negative predictive value was 95.35% (95% CI 84.19-99.43%) and Diagnostic accuracy was 93.88% (95% CI 83.13-98.72%) When compared to HPE, IOTA had a sensitivity of 100.00% (95% CI 2.50-100.00%), Specificity of 94.59% (95% CI 81.81-99.34%), False positive rate of 5.41% (95% CI 0.66-18.19%), False negative rate of 0.00% (95% CI - to 97.50%), Positive predictive value of 33.33% (95% CI 0.84-90.57%), Negative predictive value of 100.00% (95% CI 90.00-100.00%), and the Diagnostic accuracy was 94.74% (95% CI 82.25-99.36%). The diagnostic accuracy of the IOTA is better than RMI in our cohort study, which is synchronous. Though the diagnostic accuracy of RMI is found to be fairly good in our study population, it has misdiagnosed 4% of patients as benign when HPE was suggestive of Malignancy which majorly questions its role as a tool for pre-operative evaluation. Subjective assessment by an experienced sonographer combined with the use of serum tumour markers currently seems to be the most effective method to preoperatively characterize ovarian tumors.

The TP53 gene encodes the tumor suppressor protein 53, which is critical for maintaining genomic stability and preventing tumorigenesis. Mutations in TP53, particularly missense mutations, have a substantial impact on cancer progression because they give gain-of-function features that enhance proliferation, metastasis, and treatment resistance. This review examines the mechanisms underlying p53 mutations, including their interactions with critical regulatory circuits, and assesses novel medication and prodrug options targeting TP53 mutations in various malignancies. Small-molecule correctors, statins, Hsp90 inhibitors, and new drugs like Eprenetapopt and COTI-2 are among the therapeutic options proposed. The mechanisms of action and potential efficacy in treating leukemia, lung, breast, and ovarian malignancies are investigated. Emerging techniques for restoring wild-type p53 functionality or degrading mutant p53 demonstrate the therapeutic potential of these approaches. Challenges such as medication resistance, side effects, and the chemical complexity of p53 pathways are also addressed, emphasizing the importance of ongoing research. This review contributes to our understanding of TP53-targeted cancer medicines, offering hope for more innovative treatments with improved outcomes.