Symptoms, CA125 and HE4 for the preoperative prediction of ovarian malignancy in Brazilian women with ovarian masses

Abstract

BackgroundThis manuscript evaluates whether specific symptoms, a symptom index (SI), CA125 and HE4 can help identify women with malignant tumors in the group of women with adnexal masses previously diagnosed with ultrasound.MethodsThis was a cross-sectional study with data collection between January 2010 and January 2012. We invited 176 women with adnexal masses of suspected ovarian origin, attending the hospital of the Department of Obstetrics and Gynecology of the Unicamp School of Medicine. A control group of 150 healthy women was also enrolled. Symptoms were assessed with a questionnaire tested previously. Women with adnexal masses were interviewed before surgery to avoid recall bias. The Ward Agglomerative Method was used to define symptom clusters. Serum measurements of CA125 and HE4 were made. The Risk of Ovarian Malignancy Algorithm (ROMA) was calculated using standard formulae.ResultsSixty women had ovarian cancer and 116 benign ovarian tumors. Six symptom clusters were formed and three specific symptoms (back pain, leg swelling and able to feel abdominal mass) did not agglomerate. A symptom index (SI) using clusters abdomen, pain and eating was formed. The sensitivity of the SI in discriminating women with malignant from those with benign ovarian tumors was 78.3%, with a specificity of 60.3%. Positive SI was more frequent in women with malignant than in women with benign tumors (OR 5.5; 95% CI 2.7 to 11.3). Elevated CA125 (OR 11.8; 95% CI 5.6 to 24.6) or HE4 (OR 7.6; 95% CI 3.7 to 15.6) or positive ROMA (OR 9.5; 95% CI 4.4 to 20.3) were found in women with malignant tumors compared with women with benign tumors. The AUC-ROC for CA125 was not different from that for HE4 or ROMA. The best specificity and negative predictive values were obtained using CA125 in women with negative SI.ConclusionWomen diagnosed with an adnexal mass could benefit from a short enquiry about presence, frequency and onset of six symptoms, and CA125 measurements. Primary care physicians can be thereby assisted in deciding as to whether or not reference the woman to often busy, congested specialized oncology centers.

The diagnostic accuracy of human epididymis protein 4 (HE4) for discriminating between benign and malignant pelvic masses: a systematic review and meta‐analysis

“…For example, 55 studies selected participants based on disease status, 31 studies included patients below 18 years, and 19 others were excluded because it was not possible to assess eligibility due to incomplete reporting (Table S1). A final set of 17 studies was included in this review, [14][15][16][26][27][28][29][30][31][32][33][34][35][36][37][38][39] of which a total of 13 studies could be included in meta-analyses; seven studies in the main analysis of HE4, 26,30,34,[36][37][38][39] eight studies in the main analysis of CA125, 26,27,[29][30][31][32]34,37 four studies in the comparative analysis, 26,30,34,37 four in the HE4 subgroup analysis 28,29,32,33 and six in the CA125 subgroup analysis 26,28,29,32,33,35 (Figure…”

The diagnostic efficacy of Gynecology Imaging Reporting and Data System (GI-RADS): single-center prospective cross-sectional study

“…In Egypt, ovarian cancer represented 2.2% of all incident cancers and accounted for 4.4% of all newly diagnosed female cancers [2]. The assessment of an adnexal mass is difficult and meticulous preoperatively, which leads to a disproportionate number of women with benign ovarian tumors being referred to specialized centers, and conversely women with ovarian malignancy being inappropriately operated in non-specialized centers [3].…”

Fluxo De Atendimento Às Mulheres Com Câncer De Ovário Antes Do Encaminhamento Ao Nível Terciário

“…Referente aos sinais e sintomas, 75% teve alteração gastrointestinal como aumento do volume abdominal ou palpação de massa pélvica e 50% das pacientes cursaram com dor; observaram-se também alterações geniturinárias. Estes sintomas são inespecíficos, contribuindo para o diagnóstico tardio e são descritos na literatura (A. C. CAMARGO, 2014;2014;PITTA, 2013).…”