Preoperative serum vascular endothelial growth factor correlated to three dimensional power Doppler indices in ovarian masses

Abstract

Objective: To assess the preoperative serum levels of vascular endothelial growth factor (VEGF) in ovarian masses compared to normal controls and to find a correlation between VEGF and Doppler indices in ovarian masses. Methods: The study was conducted from December 2009 to September 2012 in the oncology and ultrasound units in department of obstetrics and gynecology, Ain Shams University on 150 patients with ovarian masses. During preoperative workup, serum Ca-125 levels and serum VEGF levels were obtained. Ultrasonographic examination included two and three dimensional power Doppler ultrasound (3DPD). Laparotomic approaches were undertaken to obtain the final pathologic results. VEGF was measured in one hundred normal cases as controls. Results: Final ovarian pathology revealed seventy three malignant ovarian masses and seventy seven were benign. Serum Ca-125 levels in malignant cases were higher compared to those in benign cases (p < 0.001). Preoperative serum VEGF revealed higher levels in malignant ovarian masses than benign conditions and normal controls (p < 0.001). Three dimensional power Doppler indices, vascularization index (VI), flow index (FI) and vascularization flow index (VFI), correlated positively with serum VEGF levels. Conclusion: Preoperative serum VEGF revealed higher levels in malignant ovarian masses than benign conditions and normal controls. These levels positively correlated with the Doppler vascular indices of the masses.

A prospective study to evaluate the role of serum vascular endothelial growth factor levels and color Doppler indices in prediction of malignancy in adnexal masses

“…37 There is limited evidence with use of three dimensional and power Doppler indices for detection of malignancy. 21,38,39 Studies have demonstrated three dimensional power doppler indices to have a positive correlation with serum VEGF levels in ovarian masses. 21,38 Preoperative serum levels of vascular endothelial growth factor (VEGF) were correlated with three dimensional power Doppler indices in ovarian masses and the vascularization index (VI), flow index (FI) and vascularization flow index (VFI), correlated positively with serum VEGF levels, which were higher in malignant ovarian masses than in benign masses.…”

“…21,38,39 Studies have demonstrated three dimensional power doppler indices to have a positive correlation with serum VEGF levels in ovarian masses. 21,38 Preoperative serum levels of vascular endothelial growth factor (VEGF) were correlated with three dimensional power Doppler indices in ovarian masses and the vascularization index (VI), flow index (FI) and vascularization flow index (VFI), correlated positively with serum VEGF levels, which were higher in malignant ovarian masses than in benign masses. 38 However, another study which evaluated the 3-D power Doppler indices concluded that VI, FI and VFI had a high intra-observer variability and low accuracy for identifying false positive results of IOTA simple rules.…”

Preoperative Serum Vascular Endothelial Growth Factor as a predictor of malignant ovarian tumor

“…41.36±16.33 years which are consistent with the previous study where mean age of benign cases was 37.0 ± 2.4 years and malignant cases 58.9 ± 6.3 years. 9 As with most cancers, the risk of developing ovarian cancer increases with older age. Similarly, in this study more than half of women with ovarian cancer belong to age e" 40 years.…”

“…Among malignant ovarian masses there were 63 epithelial carcinoma of ovary, Germ cell tumors were 7, sex cord stromal tumors were 2 and secondary ovarian tumor was 1. 9 Tahmina S. found that among the 96 adnexal masses 10(10.4%) cases were malignant, 33 cases were benign neoplastic, 1 was borderline and 52 cases were benign like tubo-ovarian masses, ectopic pregnancy, endometriotic cyst. 10 That study was done on nonneoplastic and neoplastic ovarian (benign and malignant) masses.…”

“…15 Another study found that the ability of VEGF to differentiate malignancy from benign masses at a cut-off VEGF level of 280 pg/ml gave a sensitivity of 76%, a specificity of 70%, a positive predictive value of 89% and a negative predictive value of 52%. 9 According to the diagnostic specificity of serum VEGF, the study showed sensitivity of VEGF and CA-125 (48% vs. 67%), specificity of VEGF and CA-125 (94% vs. 92%), PPV of VEGF and CA-125 (94% vs. 94%) and their NPV was (47% vs. 51%) at a cut-off value of 187.45 pg/ml for serum VEGF and 28.89 u/ml for CA-125, respectively. 11 In opposition to present observations, the study of Cooper et al, to assess the clinical relevance of serum VEGF levels in distinguishing patients with ovarian cancer from those with benign adnexal masses, found that at a cut-off value of 246 pg/ml for VEGF and 35 u/ml for CA-125 sensitivity was (74% vs. 90%), specificity was (71% vs. 71%), PPV (88% vs. 93%) and NPV was (48% vs. 63%), respectively.…”