The Endometriotic Neoplasm Algorithm for Risk Assessment (e-NARA) Index Sheds Light on the Discrimination of Endometriosis-Associated Ovarian Cancer from Ovarian Endometrioma

Abstract

Background: Magnetic resonance (MR) relaxometry provides a noninvasive tool to discriminate endometriosis-associated ovarian cancer (EAOC) from ovarian endometrioma (OE) with high accuracy. However, this method has a limitation in discriminating malignancy in clinical use because the R2 value depends on the device manufacturer and repeated imaging is unrealistic. The current study aimed to reassess the diagnostic accuracy of MR relaxometry and investigate a more powerful tool to distinguish EAOC from OE. Methods: This retrospective study was conducted at our institution from December, 2012, to May, 2022. A total of 150 patients were included in this study. Patients with benign ovarian tumors (n = 108) mainly received laparoscopic surgery, and cases with suspected malignancy (n = 42) underwent laparotomy. Information from a chart review of the patients’ medical records was collected. Results: A multiple regression analysis revealed that the age, the tumor diameter, and the R2 value were independent malignant predicting factors. The endometriotic neoplasm algorithm for risk assessment (e-NARA) index provided high accuracy (sensitivity, 85.7%; specificity, 87.0%) to discriminate EAOC from OE. Conclusions: The e-NARA index is a reliable tool to assess the probability of malignant transformation of endometrioma.

Investigating the efficacy of tissue factor pathway inhibitor‑2 as a promising prognostic marker for ovarian cancer

“…Epithelial ovarian cancer is divided into two classes based on the criteria of Kurman and Shih ( 17 ). Type I includes low-grade serous, endometrial and mucinous carcinoma and OCCC, which are low-grade and relatively slow-growing ( 18 , 19 ). Type II includes high-grade serous, endometrial and undifferentiated carcinoma as well as carcinosarcoma, which are high-grade and relatively fast-growing ( 18 , 19 ).…”

“…Type I includes low-grade serous, endometrial and mucinous carcinoma and OCCC, which are low-grade and relatively slow-growing ( 18 , 19 ). Type II includes high-grade serous, endometrial and undifferentiated carcinoma as well as carcinosarcoma, which are high-grade and relatively fast-growing ( 18 , 19 ). Type I ovarian cancer is genetically stable and is often detected in the initial stages.…”

“…Jacobs and Oram suggested that CA125 is an important tumor marker for distinguishing benign from malignant tumors ( 30 ). Other than CA125, various tumor markers are used in gynecology, including CA19-9, CEA and human epididymis protein (HE) 4 ( 12 , 19 , 25 , 31 ). However, CA125 is affected by various factors, such as menopausal status, pregnancy, infection and endometriosis ( 10 , 11 , 32 ).…”

Derivation and validation of a nomogram based on clinical characteristics to diagnose endometriosis associated ovarian cancer preoperatively

“…Fourthly, morphological continuity was found between cancer and EM. However, more and more researchers found this diagnostic standard might be too strict to cause missed diagnosis (Younis and Izhaki 2023 ; Murakami et al 2020 ; Kawahara et al 2022 ; Zhu et al 2021 ; Kawahara et al 2021 ; Similä-Maarala et al 2022 ; Chao et al 2022 ; Hernández et al 2022 ). According to Gorp et al ( 2004 ), diagnostic standard of EAOC in this study was EOC with pelvic EM.…”

New insights about endometriosis-associated ovarian cancer: pathogenesis, risk factors, prediction and diagnosis and treatment

“…The Endometriotic Neoplasms Algorithm for risk Assessment (e-NARA) index provides a notable level of specificity in distinguishing between EAOC and benign endometriotic cysts ( 131 ). The assessment of intracytothelial iron concentration presents a valuable method for predicting and diagnosing EAOC.…”