Evaluation of Women’s Age and Ultrasonographic Features to Choose Surgical Treatment for Endometriosis Associated with Ovarian Cancer

Abstract

Adequate surgical management of malignant endometriosis remains a clinical challenge in gynecology. Age, sonography variables, and tumor biomarkers have been reported as candidates in the clinical decision. This study aims were to analyze the factors of women’s age, body mass index, ultrasound features, and tumor biomarkers to predict endometriosis-associated ovarian cancer in a large series of endometriomas and to study the surgical treatment performed in this cohort. In this retrospective study, we reviewed the medical records of patients with ultrasound diagnosis of ovarian cyst classified as endometrioma (benign as well as with risk of malignancy), surgically treated in the endometriosis unit of Hospital Universitario La Paz (Madrid, Spain) between January 2019 and July 2021. According to the final histology examination, the women were clustered as non-endometriosis-associated ovarian cancer (OE, benign endometriomas, n = 59) and endometriosis-associated ovarian cancer (EAOC) (n = 17). Demographic, clinical, and surgical data were collected from these women. International Ovarian Tumor Analysis (IOTA) criteria were assessed for the ultrasound examination. The age of the women in the EAOC group was 50.0 [43.0; 63.0] years, which was significantly higher than OE (39.0 [34.0; 46.0] years; p-value < 0.001). In addition, the body mass index for the OE group (24.9 ± 5.3 kg/m2) was significantly higher than for the EAOC group (23.3 ± 4.6 kg/m2; p-value < 0.001). However, the tumor biomarker levels (CA 125, CA 19.9 and He4) were not significantly different among the groups. We performed 51.4% cystectomies and 48.6% adnexectomies, with an association between the adnexectomy and EAOC group (p-value < 0.001). In addition, a significant association was found between ultrasound features suspicious for malignancy and the EAOC group. Conclusively, women’s age and ultrasound features, such as papillary projections, septa, and positive echo-Doppler, were the main factors to consider when evaluating the malignancy risk associated with endometriosis.

Clinical characteristics and serum CA19‐9 combined with HE4 are valuable in diagnosing endometriosis‐associated ovarian cancer

“…Udomsinkul et al 18 uncovered that CA125 of more than 117.6 U/mL was a sensitive index for the diagnosis of EAOC. However, in another study, there was no significant difference in CA125 level between EAOC and OEM 19 . In our study, we found that CA125 levels of patients with EAOC were higher than levels of patients with OEM, but the statistical difference was not significant.…”

“…Kuo et al 20 found that the sensitivity and specificity of HE4 in diagnosing EAOC were 81.6% and 98.7%, respectively. Moreover, another small sample sized study revealed that HE4 was not significantly elevated in patients with EAOC when compared with OEM patients 19 . However, in our study, it was shown that using 140 pmol/L as the cut‐off value, the sensitivity and specificity of HE4 in the diagnosis of EAOC were 13.6% and 99.4%, respectively.…”

“…However, in another study, there was no significant difference in CA125 level between EAOC and OEM. 19 In our study, we found that CA125 levels of patients with EAOC were higher than levels of patients with OEM, but the statistical difference was not significant. Moreover, multivariate analysis showed CA125 had weak relevance with EAOC.…”

“…Moreover, another small sample sized study revealed that HE4 was not significantly elevated in patients with EAOC when compared with OEM patients. 19 However, in our study, it was shown that using 140 pmol/L as the cut-off value, the sensitivity and specificity of HE4 in the diagnosis of EAOC were 13.6% and 99.4%, respectively. The explanation for low sensitivity could be an inadequate sample size.…”

Endometriosis-Associated Ovarian Cancer: What Are the Implications for Women with Intact Endometrioma Planning for a Future Pregnancy? A Reproductive Clinical Outlook

“…Human epididymis protein 4 (HE4) is a novel tumor biomarker approved for determining the likelihood that an ovarian mass is cancerous, with a sensitivity similar to that of CA-125 but with superior specificity [ 64 ]. In a recent small cohort of 76 women, 59 with endometrioma and 17 with EAOC, serum CA-125, and HE4 levels did not differ between the two groups [ 65 ].…”