COMPARATIVE EFFECTIVENESS OF MODERN METHODS OF DIFFERENTIAL DIAGNOSIS OF OVARIAN NEOPLASMS
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Abstract
The aim of the research – to identify the most informative methods of differential diagnosis of ovarian neoplasms at the preoperative stage.
Materials and methods. The study involved 117 patients with ovarian neoplasms. The level of the tumor marker HE-4 was determined in all patients at the preoperative stage in addition to the standard examination. Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA) were calculated. Protocols of histological examination were studied after operations. The prognostic value of CA-125, HE-4, RMI and ROMA were calculated. Statistical analysis of the data is carried out.
Results. The most informative parameter for the differential diagnosis of benign and malignant ovarian neoplasms at the preoperative stage in the study was the RMI. Tumor marker HE-4 was characterized by the lowest sensitivity with the highest specificity in the differential diagnosis of ovarian neoplasms among the methods studied. The replacement of CA-125 by HE-4 in the RMI calculation formula (calculation of the «modified» malignancy index) led to an increase in the sensitivity and prognostic significance of the method in the differential diagnosis of ovarian neoplasms at the preoperative stage, which requires further study.
Conclusion. Taking into account the high prognostic value of RMI and the «modified» ovarian malignancy index, it is recommended to calculate the above indices at the preoperative stage to assess the nature of ovarian neoplasms (benign ormalignant).Keywords
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Management of Suspected Ovarian Masses in Premenopausal Women (Green-top Guideline N 62) [Electronic resource] : RCOG/BSGE Joint Guideline / British Society of Gynaecological Endoscopy (BSGE). – London : RCOG, 2011. – URL: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg62
Makarov OV, Borisenko SA. Prophylaxis, diagnosis, treatment of ovarian cancer. Medical journal of the Russian Federation. 1996; 3: 36–40. Russian (Макаров О.В., Борисенко С.А. Профилактика, диагностика, лечение рака яичников // Российский медицинский журнал. 1996. № 3. С. 36–40)
Gasparov AS, Zhordania KI, Payanidi YG, Dubinskaya ED. Oncogynecologycal aspects of adnexal masses. Annals of the Russian academy of medical sciences. 2013; 68(8): 9-13. Russian (Гаспаров А.С., Жорданиа К.И., Паяниди Ю.Г., Дубинская Е.Д. Онкогинекологические аспекты кистозных образований яичников // Вестник Российской академии медицинских наук. 2013. № 68. Т 8. С. 9 – 13)
Serov VN, Kudryavtseva LI. Benign tumors and tumor-like formations of the ovaries. Moscow: Triada-X, 2001. 149 р. Russian (Серов В.Н., Кудрявцева Л.И. Доброкачественные опухоли и опухолевидные образования яичников. Москва: Триада-Х, 2001. 149 с.)
Malignant neoplasms in Russia in 2016 (morbidity and mortality). Pod red. Kaprina AD, Starinskogo VV, Petrovoj GV. Moscow: MNIOI im. P.A. Gercena – filial FGBU «NMIRC» MZ RF, 2018. 250 p. Russian (Злокачественные новообразования в России в 2016 году (заболеваемость и смертность) [Под ред. Каприна А.Д., Старинского В.В., Петровой Г.В.]. Москва: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИРЦ» МЗ РФ, 2016. 250 с.)
Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007; 109: 221-227. DOI: 10.1002/cncr.22371
Kozachenko VP. Сlinical oncogynecology. Moscow: Meditsina; 2005. 372 p. Russian (Козаченко В.П. Клиническая онкогинекология. Москва: Медицина, 2005. 372 с.)
Paulsen T, Kjaerheim K, Kaern J, Tretli S, Trope C. Improved short-term survival for advanced ovarian, tubal, and peritoneal cancer patients operated at teaching hospitals. Int J Gynecol Cancer. 2006; 16(1): 11–17. DOI: 10.1111/j.1525-1438.2006.00319.x
Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011; 61(4): 212–236. DOI: 10.3322/caac.20121
Escudero JM, Auge JM, Filella X, Torne A, Pahisa G, Molino R. Comparison of serum human epididymis protein 4 with cancer antigen 125 as a tumor marker in patients with malignant and nonmalignant diseases. Clin Chem. 2011; 51(11): 1534–1544. DOI: 10.1373/clinchem.2010.157073
Barbati A, Lauro V, Orlacchio A, Cosmi EV. Immunoblotting characterization of CA125 in biological fluids: difference between pregnancy and cancer CA 125 origin. Anticancer Res. 1996; 16(6B): 3621-3624
Lennox GK, Eiriksson LR, Reade CJ, Leung F, Mojtahedi G, Atenafu EG, et al. Effectiveness of the risk of malignancy index and the risk of ovarian malignancy algorithm in a cohort of women with ovarian cancer: does histotype and stage matter? Int J Gynecol Cancer. 2015; 25(5): 809–814. DOI: 10.1097/IGC.0000000000000442
Jacobs I, Oram D, Fairbanks J, Turner G, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. British Journal of Obstetrics and Gynecology. 1990; 97(10): 922-929. DOI: org/10.1111/j.1471- 0528.1990.tb02448.x
Winarto H, Laihad BJ, Nuranna L. Modification of cutoff values for HE4, CA125, the Risk of Malignancy Index, and the Risk of Malignancy Algorithm for ovarian cancer detection in Jakarta, Indonesia . Asian Pac J Cancer Prev. 2014; 15(5): 1949–1953
Anton C, Carvalho FM, Oliveira EI, Maciel GA, Baracat EC, Carvalho JP. A comparison of CA125, HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification of ovarian masses. Clinics (Sao Paulo).2012; 67(5): 437-441
Delić R, Štefanović M, Krivec Š, Weber V, Koren G. Comparison of HE4 and CA125 levels in women with benign gynecologic disorders: Does age or menopausal status matter? Wien Klin Wochenschr. 2016; 128(7): 543–547. DOI: 10.1007/s00508-016-1099-1
Nikolova T, Zivadinovic R, Evtimovska N, Klisarovska V, Stanojevic M, Georgievska G, Nikolova N. Diagnostic performance of human epididymis protein 4 compared to a combination of biophysical and biochemical markers to differentiate ovarian endometriosis from epithelial ovarian cancer in premenopausal women. J Obstet Gynaecol Res. 2017; 43(12): 1870–1879. DOI: 10.1111/jog.13466
Ortiz-Muñoz B, Aznar-Oroval E, García García A, Covisa Peris A, Perez Ballestero P, Sanchez Yepes M, et al. HE4, Ca125 and ROMA algorithm for differential diagnosis between benign gynaecological diseases and ovarian cancer. Tumour Biol. 2014; 35(7): 7249–7258. DOI: 10.1007/s13277-014-1945-6
Huhtinen K, Suvitie P, Hiissa J, Junnila J, Huvila G, Kujari H, et al. Serum HE4 concentration differentiates malignant ovarian tumours from ovarian endometriotic cysts. Br J Cancer. 2009; 100(8): 1315-1319. DOI: 10.1038/sj.bjc.6605011
Sergeeva NS, Alentov II, Marshutina NV. Epididymis protein of human HE4 as a new tumor-associated marker. Onkoginekologiya. 2016; 4: 48-58. Russian (Сергеева Н.С., Алентов И.И., Маршутина Н.В. Белок эпидидимиса человека НЕ4 как новый опухолеассоциированный маркер // Онкогинекология. 2016. № 4. С. 48–58)
Gąsiorowska E, Michalak M, Warchoł W, Lemanska A, Jasinski P, Spazynski M, et al. Clinical application of HE4 and CA125 in ovarian cancer type I and type II detection and differential diagnosis. Ginekol Pol. 2015; 86(2): 88–93
Kristjansdottir B, Levan K, Partheen K, Sundfeldt K. Diagnostic performance of the biomarkers HE4 and CA125 in type I and type II epithelial ovarian cancer. Gynecol Oncol. 2013; 131(1); 52–58. DOI: 10.1016/j.ygyno.2013.07.094
Borisova EA, Bulanov MN, Pashov AI, Makarenko TA, Narkevich AN. Ultrasound and Tumor Markers (СА125, HE4, ROMA) in Ovarian Cancer Diagnosis. Ul'trazvukovaja i funkcional'naja diagnostika. 2015; 6: 36–52. Russian (Борисова Е.А., Буланов М.Н., Пашов А.И., Макаренко Т.А., Наркевич А.Н. Возможности комплексного использования эхографии и онкомаркеров (CA125, HE4, ROMA) для дифференциальной диагностики опухолей яичников // Ультразвуковая и функциональная диагностика. 2015. № 6. С. 36–52)