Accuracy of Preoperative Prediction of Malignancy in Ovarian Mass by Ultrasound Examination and CA 125 Serum Level

Abstract

Background: Ovarian cancer is the second most common malignancy of the female reproductive system and one of the leading lethal gynecologic malignancies. Screening of ovarian cancer in certain high risk groups is very important due to unspecificity and late appearance of symptoms. Its risk factors include positive family history, older age of menopause and low parity as pregnancy protects against ovarian cancer. Objectives: to compare the accuracy of preoperative prediction of malignancy in ovarian mass by morphological ultrasound (US) examination, Doppler indices and CA 125 serum level with the result of histopathological examination mass after laparotomy. Methods: One hundred and four cases of ovarian masses predicted to be malignant by US examination and CA 125 serum level were subjected to laparotomy and histopathological examination. The main outcome measures in the ovarian masses were: a- the US signs of malignancy [ such as solid mass, multiple septation in cystic mass, mixed solid and cystic components, thick cyst wall (> 3 mm), nodule in a cyst wall ] , b- Doppler indices(resistance index and pulsatility index) , c- CA125 serum level, and d- histopathological examination findings after laparotomy. Results: The histopathology identified 20 benign (B) and 84 malignant (M) ovarian masses. The benign tumors were 9(45%) endometroitic cyst, 6(30%) pseudomucinous cyst adenoma and 5(25%) serous cyst adenoma. The malignant ones included 43(51.2%) papillary serous cyst adenocarcinoma 18(21.4%) endometrioid adenocarcinoma , 10(11.9%) pseudomucinous cyst adenocarcinoma, 5(5.9%) clear cell adenocarcinoma, 2(2.4%) papillary serous borderline cyst adenocarcinoma, 2(2.4%) borderline serous adenocarcinoma, 1(1.2%) serous adenocarcinoma, 1(1.2%) borderline endometroid adenocarcinoma, 1(1.2%) dysgerminoma and 1(1.2%) Pseudomucinous borderline cyst adenocarcinoma]. The US showed no morphological signs of malignancy in 10 [9.6% (9 M vs. 1 B)] masses, thick cyst wall and mixed solid & cystic components 1(1%) M; thick cyst wall1 and nodule in the cyst wall 1(1%) M, mixed solid and cystic components 15[14.4% (14 M vs. 1 B)], solid components 17(16.3%) M, thick cyst wall (> 3 mm) 27[26% (10 M vs. 17 B)] and nodules in the cyst wall in 33[31.7% (32 M vs. 1 B)] masses. Doppler studies of ovarian mass vasculature showed that < 0.4 resistance index and < 1 pulsatility index prevailed significantly in 83 and 82 malignant masses respectively (P< 0.001) while CA125 serum cutoff level 30 IU/ ml alone failed to differentiate between the benign and malignant masses Conclusion: using CA125 serum cutoff level 30 IU/ ml combined with US grey scale or color Doppler examination can discriminate between benign and malignant adnexal masses especially in positive Doppler indices.