Background Previous results obtained from serum samples of late-stage, high-grade serous ovarian carcinoma patients showed large alterations in lipid metabolism. To validate and extend the results, we studied lipidomic changes in early-stage ovarian tumours. In addition to serous ovarian cancer, we investigated whether these changes occur in mucinous and endometrioid histological subtypes as well. Methods Altogether, 354 serum or plasma samples were collected from three centres, one from Germany and two from Finland. We performed lipidomic analysis of samples from patients with malignant ( N = 138) or borderline ( N = 25) ovarian tumours, and 191 controls with benign pathology. These results were compared to previously published data. Results We found 39 lipids that showed consistent alteration both in early- and late-stage ovarian cancer patients as well as in pre- and postmenopausal women. Most of these changes were already significant at an early stage and progressed with increasing stage. Furthermore, 23 lipids showed similar alterations in all investigated histological subtypes. Conclusions Changes in lipid metabolism due to ovarian cancer occur in early-stage disease but intensify with increasing stage. These changes occur also in other histological subtypes besides high-grade serous carcinoma. Understanding lipid metabolism in ovarian cancer may lead to new therapeutic and diagnostic alternatives.

ObjectivesElevated concentrations of polyamines have been found in urine of patients with malignant tumors, including ovarian cancer. Previous research has suffered from poorly standardized detection methods. Our liquid chromatography–tandem mass spectrometry (LC-MS/MS) method is capable of simultaneous standardized analysis of most known polyamines. Liquid chromatography–tandem mass spectrometry has not previously been used in the differential diagnostics of ovarian tumors in postmenopausal women.Materials and MethodsIn this prospective study, postmenopausal women (n = 71) presenting with an adnexal mass and, as controls, women with genital prolapse or urinary incontinence scheduled for surgery (n = 22) were recruited in the study. For analysis of the polyamines, a morning urine sample was obtained before surgery. Preoperative serum CA125 concentrations were determined in the study group.ResultsTwenty-three women with benign and 37 with malignant ovarian tumors were eligible. Of all analyzed polyamines, only urinary N1,N12-diacetylspermine showed statistically significant differences between all groups except controls versus benign tumors. N1,N12-diacetylspermine was elevated in malignant versus benign tumors (P < 0.001), in high-grade versus low malignant potential tumors (P < 0.001), in stage III to IV versus stage I to II cancers (P < 0.001), and even in early-stage cancer (stage I–II) versus benign tumors (P = 0.017). N1,N12-diacetylspermine had better sensitivity (86.5%) but lower specificity (65.2%) for distinguishing benign and malignant ovarian tumors than CA125 with a cut-off value of 35 kU/L (sensitivity, 75.7%; specificity, 69.6%).ConclusionsUrinary N1,N12-diacetylspermine seems to be able to distinguish benign and malignant ovarian tumors as well as early and advanced stage, and low malignant potential and high-grade ovarian cancers from each other, respectively.

Background/Aim: Most pancreatic cancer patients are diagnosed at an advanced stage, since the diagnosis is demanding. Field asymmetric waveform ion mobility spectrometry (FAIMS) is a sensitive technique used for the detection of volatile organic compounds (VOC). We evaluated the ability of FAIMS to discriminate between pancreatic cancer and healthy controls from a urine sample. Patients and Methods: For a proof-of-concept study in three Finnish hospitals, 68 patients with pancreatic cancer, 36 with acute pancreatitis, 18 with chronic pancreatitis, 8 with pancreatic pre-malign lesions and 52 healthy controls were prospectively recruited. Urine samples were collected at the time of diagnosis and stored at-70˚C. The samples were subsequently measured with FAIMS. The data were processed with linear discriminant analysis and crossvalidated with leave-one-out cross-validation. Results: FAIMS distinguished pancreatic cancer from controls with a sensitivity of 79% and specificity of 79%. Conclusion: As a non-invasive and rapid urine test, FAIMS can discriminate patients with pancreatic cancer from healthy controls. Pancreatic cancer is the eleventh most common cancer globally, but due to its poor prognosis it is the fourth leading cause of cancer death in Western countries (1-3). The mortality rates of all common cancers are predicted to decline, with the exception of pancreatic cancer (4, 5). The prognosis for pancreatic cancer patients has remained poor for the last four decades, but reports from recent years have shown modest improvements (1, 6). If pancreatic cancer is found at an early stage, it would be possible to achieve a much better prognosis (7-9). To date, a method to screen the entire population does not exist, but some studies have shown promising results in detecting pancreatic cancer in high-risk populations. Mayerle et al. achieved an excellent sensitivity and specificity in differentiating pancreatic cancer from chronic pancreatitis using metabolic biomarker testing combined with CA19-9 (10). The relatively low incidence of pancreatic cancer combined with its very high mortality rate makes it very difficult to find any applicable screening method (8). As has been demonstrated with colon cancer, the best hope for reducing cancer-specific mortality lies in early diagnosis and treatment, ideally at a precancerous stage (11). The major pancreatic pre-malign lesions are intraductal papillary 73 This article is freely accessible online.

BackgroundPreoperative evaluation of ovarian tumors is challenging. This study was undertaken to evaluate the performance of conventional two-dimensional (2D) ultrasound and CA125 in predicting malignant or benign nature of pelvic masses, and to investigate if three-dimensional power Doppler (3DPD) ultrasound provides any added value. Ninety-six postmenopausal and four perimenopausal women with supposed ovarian tumors were examined by standardized 2D and 3DPD ultrasounds preoperatively. The tumors were evaluated using the risk of malignancy index (RMI), International Ovarian Tumors Analysis (IOTA) group simple rules, expert opinion, IOTA logistic regression model 2 (LR2) and 3D vascular indices, and were postoperatively compared to histopathological results.ResultsNinety-eight tumors turned out to be ovarian in origin. Of these, 66 were benign and 32 malignant. RMI (cut-off value 200), simple rules, expert opinion and LR2 (cut-off value 25) were used to predict malignant nature of the tumors and had sensitivities of 71.9, 90.6, 87.5 and 90.6%, and specificities of 80.3, 84.6, 92.4 and 77.3%, respectively. When the 3D vascularization flow index (VFI) was added to RMI and LR2, the accuracy of the test improved from 77.6 to 81.4% and from 81.6 to 86.5%, respectively, at the expense of sensitivity, while VFI gave no added benefit for simple rules and expert opinion. Agreement between two examiners using expert opinion was good (Cohen’s kappa = 0.89).ConclusionsThe subjective opinion of an expert seems to be the most reliable method in assessing ovarian tumors, and the 3DPD indices seem to provide no significant added value.

Correspondent: Anu Aalto, anu.aalto@hotmail.com, tel.+358 40 55232953 Précis: Combination of treatments is the most effective option for vulvodynia patients in terms of pain reduction. 4 AbstractObjectives: 8 % of women suffer from vulvodynia (VD), a chronic pain disorder with unknown etiology. Aims of our study were to assess the efficacy of given VD treatments measured by numerical self-reported pain score (NRS) and patients' quality of life.Methods: Study material consisted of a retrospective VD patient cohort (n=70). Data was collected by postal questionnaires and review of the medical records.Results: We report here a statistically significant reduction in NRS only with combination of therapies (median NRS before treatments 8 vs. median NRS 4 after treatments, p<0.001) but not with any individual therapy alone i.e. physiotherapy, topical medications, oral pharmaceutical therapy, sexual counseling by a trained nurse, sacral neuromodulation, laser treatment or surgery. Older age (>30) and frequent (≥6) outpatient clinic visits associated with a significantly minor reduction in NRS (p=0.03 and p=0.04, respectively).Conclusions: The results of this retrospective study suggest, that an effective, multimodality-based treatment is most beneficial for VD patients, and VD at older age may represent a subtype more resistant to therapy.