Premenopozal Kadinlardaki Ovaryen Kitlelerin Preoperatif Tanisinda Transvaginal Ultrason Ve Komputerize Tomografinin Ca-125 İle Birlikte Değerlendirilmesi

Abstract

Amaç: Çalışmanın amaçları premenopozal kadınlardaki ovaryen kitlelerin preoperatif teşhisinde i transvaginal ultrason TVUS ve kompüterize tomografi CT ve ii bu görüntüleme yöntemleri ile kombine olarak CA-125 değerlerinin doğruluğunu karşılaştırmaktı. Gereç-yöntem: Adneksiyal kitleden şüphe edilen 91 premenopozal kadın çalışma kapsamına alındı. Hastaların TVUS, CT ölçümleri ile CA-125 değerleri saptandı. Daha sonra değerler histopatolojik sonuçlarla kıyaslandı. Test sonuçlarındaki genel kanı ve kesin sonuçlar kappa istatistiği ile hesaplandı. Bulgular: Histoloji sonuçlarına göre ovaryen tümorlerin 12si malign ve 79si benign idi. Aşağıdaki sonuçlar TVUS, CT ve TVUS ve CT nin CA-125 ile kombinasyonu olarak hesaplandı; sensitivite sırasıyla, 83%, 91%, 100%; spesifisite, 92%, 96%, 97% idi. Aynı zamanda, TVUS ve CT nin CA-125 ile kombinasyonu tek başına TVUS ve CT e göre daha yüksek doğruluk oranına sahipti sırasıyla 0.90, 0.76 ve 0.89 . Sonuç: TVUS ovaryen lezyonların teşhisinde kost –effektif olmasına rağmen, sonografide kanser şüphelenilen vakalarda CT ve CA-125 ölçümleri yayılımı göstermede ve preoperatif evrelemede yararlıdır

Transvagınal Ultrasound And Computed Tomography Combıned Wıth Ca125 Determınatıons In Preoperatıve Evaluatıon Of Ovarıan Masses In Premenopausal Women

Abstract

Background: The aims of the study were compare the accuracy of i transvaginal ultrasound TVUS and computed tomography CT and ii combined these imaging modalities together with CA-125 determinations in preoperative evaluation of ovarian masses in premenopausal women. Methods: Included in this study were 91 premenopausal women with suspicious adnexal mass. Patients underwent TVUS, CT and CA-125 determinations. The findings were then compared with histopathological diagnosis. The overall agreement between the test results and the actual outcome was calculated by means of kappa statistic. Results: Histology revealed 12 malignant and 79 benign ovarian tumors. The following data were calculated for TVUS, CT and TVUS and CT combined with CA-125 determinations, sensitivities, 83%, 91%, 100%; specificities, 92%, 96%, 97% respectively. TVUS and CT combined with CA-125 also had higher accuracy rate when compared with TVUS and CT alone 0.90, 0.76 and 0.89 respectively . Conclusion: Although TVUS is a cost-effective method in the diagnosis of ovarian lesions, CT and CA-125 determinations should be useful when ovarian carcinoma is suspected on sonography, to investigate the extent of neoplastic disease and preoperative staging

Keywords

• Transvaginal ultrasound,computed tomography,CA-125,ovarian masses,diagnosis

References

1. 1. Hubner KF, McDonald TW, Niethammer JG, et al. Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[18F]deoxyglucose (2-[18F]FDG). Gynecol Oncol, 1993; 51:197– 204.
2. 2. Maiman M. Laparoscopic removal of the adnexal mass: the case for caution. Clin Obstet Gynecol, 1995; 38:370–9.
3. 3. Osmers R. Sonographic evaluation of ovarian masses and its therapeutical implications. Ultrasound Obstet Gynecol, 1996; 8:217–22.
4. 4. Sengupta PS, Shanks JH, Buckley CH, et al. Requirement for expert histopathological assessment of ovarian cancer and borderline tumors. Br J Cancer, 2000;82:760–2.
5. 5. Rieber A, Nussle K, Stohr I, et al. Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings. AJR Am J Roentgenol, 2001;177(1):123-9.
6. 6. Alcazar JL, Errasti T, Zornoza A, Minguez JA, Galan MJ. Transvaginal color Doppler ultrasonography and CA-125 in suspicious adnexal masses. Int J Gynaecol Obstet, 1999; 66:255–61.
7. 7. Franchi M, Beretta P, Ghezzi F, et al. Diagnosis of pelvic masses with transabdominal color Doppler, CA 125 and ultrasonography. Acta Obstet Gynecol Scand, 1995; 74:734– 9.
8. 8. Komatsu T, Konishi I, Mandai M, et al. Adnexal masses: transvaginal US and gadolinium- enhanced MR imaging assessment of intratumoral structure. Radiology, 1996; 198:109–15.

9. 9. Jacobs I, Bast R. The CA125 tumor associated antigen: a review of the literature. Hum Reprod, 1989; 4:1–12.
10. 10. Van Vierzen PB, Massuger LF, Ruys SH, Barentsz JO. Borderline ovarian malignancy: ultrasound and fast dynamic MR findings. Eur J Radiol, 1998;28(2):136-42.
11. 11. Fenchel S, Grab D, Nuessle K, et al. Asymptomatic adnexal masses: correlation of FDG PET and histopathologic findings. Radiology, 2002;223(3):780-8.
12. 12. Minelli L. Ovarian cysts. Eur J Obstet Gynecol Reprod Biol, 1996; 65:81–9.
13. 13. Sassone AM, Timor-Tritsch IE, Artner A, Westhoff C, Warren WB. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol, 1991;78(1):70-6.
14. 14. Mogensen O. Prognostic value of CA 125 in advanced ovarian cancer. Gynecol Oncol, 1992; 44:207–12.
15. 15. Makar AP, Kristensen GB, Bormer OP, Trope CG. CA 125 measured before secondlook laparotomy is an independent prognostic factor for survival in patients with epithelial ovarian cancer. Gynecol Oncol, 1992; 45:323– 8.
16. 16. Niloff JM, Bast RC Jr, Schaetzl EM, Knapp RC. Predictive value of CA 125 antigen levels in second-look procedures for ovarian cancer. Am J Obstet Gynecol, 1985; 151: 981– 6.
17. 17. Huber S, Medl M, Baumann L, Czembirek H. Value of ultrasound and magnetic resonance imaging in the preoperative evaluation of suspected ovarian masses. Anticancer Res, 2002;22(4):2501-7.
18. 18. Jain KA, Freidman D, Pettinger TW, et al. Adnexal masses: comparison of specificity of endovaginal US and pelvic MR imaging. Radiology, 1993 ;186:697–704
19. 19. Yamashita Y, Torashima M, Hatanaka Y, et al. Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR Imaging. Radiology, 1995 ;194:557–65.
20. 20. Hata K, Hata T, Manabe A, Sugimura K, Kitao M. A critical evaluation of transvaginal Doppler studies, transvaginal sonography, magnetic resonance imaging, and CA 125 in detecting ovarian cancer. Obstet Gynecol, 1992; 80:922–6.
21. 21. Reles A, Wein U, Lichtenegger W. Transvaginal color Doppler sonography and conventional sonography in the preoperative assessment of adnexal masses. J Clin Ultrasound, 1997; 25:217–25.
22. 22. Ferrazzi E, Zanetta G, Dordoni D, et al. Transvaginal ultrasonographic characterization of ovarian masses: comparison of five scoring systems in a multicenter study. Ultrasound Obstet Gynecol, 1997;10(3):192-7.
23. 23. Kurjak A, Predanic M. New scoring system for prediction of ovarian malignancy based on transvaginal color Doppler sonography. J Ultrasound Med, 1992; 11:631– 8.
24. 24. Buist MR, Golding RP, Burger CW, et al. Comparative evaluation of diagnostic methods in ovarian carcinoma with emphasis on CT and MRI. Gynecol Oncol, 1994;52(2):191-8.
25. 25. Guerriero S, Mallarini G, Ajossa S, et al. Transvaginal ultrasound and computed tomography combined with clinical parameters and CA-125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol, 1997 ;9(5):339-43.