The efficacy of ultrasonographic morphological index using Depriest score in ovarian cancer prediction

Background: Ovarian cancer is the second most common cancer after cancer breast and the most lethal gynecologic malignancy in developed countries.The objective of this study was to evaluate the efficacy of ultrasonographic morphological index using Depriest score et al in identifying ovarian cancer and to calculate its specificity, sensitivity, positive predictive value and negative predictive value in ovarian cancer prediction.Methods: Preoperative estimation of morphological index by Depriest score using vaginal ultrasound examination for 130 cases with ovarian masses, followed by laparotomy, and histopathological examination of the masses. Correlation of the cases morphological index score was done for histopathological nature of masses whether it is benign or malignant. Calculation of the Depriest index score was done using 3 parameters which are tumor volume, cyst wall structure and thickness and Septal structure.Results: A significant difference were found between mean Depriest score (p=0.001) of malignant cases (mean score 8.27±1.77) and benign cases (mean score 4.38±1.61) while the mean volume showed no significant difference (p=0.101) between malignant (mean volume 3.24±0.69) and benign cases (mean volume 3.00±0.91). In relation to CA125 there was a significant difference (p=0.001) between malignant (mean CA125 86.34±73.87) and benign cases (mean CA125 31.48±12.83).Conclusions: Depriest et al morphological index is an effective and cost efficient method for malignant ovarian masses prediction and differentiation from benign masses

Comparison between Pap smear and visual inspection with acetic acid in screening of premalignant cervical intraepithelial lesion and subclinical early cancer cervix

Background: The objective of the study was to compare the sensitivity, specificity, positive predictive value and negative predictive value of VIA and Pap smear in screening of premalignant cervical intraepithelial lesion and subclinical early cancer cervix.Methods: An observational prospective study was done for 350 patients attending the gynecology outpatient clinic of the shatby maternity university hospital for any reasons, VIA and Pap test were done for all patients, then colposcopic guided biopsy from cases with positive colposcopic findings. Histopathological examination was done for collected biopsy. Collected data was statistically analyzed to compare between both tests (PAP and VIA).Results: Our results showed that the sensitivity of PAP test was 83.3%, specificity was 90.7%, positive predictive value was 50.8%, negative predictive value was 97.9% and accuracy was 90% while the VIA test had a sensitivity of 66.7%, specificity was 91%, positive predictive value was 46.1%, negative predictive value was 95.9% and accuracy was 88.5%.Conclusions: Via test has comparable results to Pap test regarding its sensitivity, specificity, positive predictive value, negative predictive value and accuracy and can be used as an alternative primary test to screen premalignant cervical intraepithelial lesion and subclinical early cancer cervix

Comparison of risk of malignancy indices in the preoperative evaluation of adnexal masses

Background: An adnexal mass patient is a common cause of hospital admission. The differentiation between malignant and benign cases is an important step in the management of such patients. The risk of malignancy index (RMI) is a simple scoring system depend on ultrasound data, menopausal status and serum concentrations of CA-125 tumor marker and has a great value in differentiation between benign and malignant adnexal masses. 4 different types of risk of malignancy index are created. The objective of the study was to compare the diagnostic performance of the four malignancy risk indices in differentiating benign and malignant ovarian tumors.Methods: This prospective study was performed on 60 patients with an adnexal mass confirmed on vaginal ultrasound.Results: There was statistical significance difference between the 4 types of RMI in benign and malignant groups. RMI 1, RMI 2, and RMI 3 had nearly the same area under the ROC curve; however, at the cut-off of>58.41, RMI 3 was more sensitive and less specific than RMI 1 or RMI 2. The RMI 2 was the most specific in predicting malignancy in terms of area under the curve; however, there was no statistically significant difference in performance of RMI 2 and 4 in malignant group.Conclusions: RMI 1, RMI 2, and RMI 3 had nearly the same area under the ROC curve; however, at the cut-off of >58.41, RMI 3 was more sensitive and less specific than RMI 1 or RMI 2, on the other hand the most specific was RMI 2 more than the other 3 RMIs

Study of leucine-rich alpha-2-glycoprotein-1 marker serum level in cases of malignant epithelial ovarian tumors

Background: The aim of this study was to compare the level of LRG1 in epithelial ovarian cancer (EOC) cases with benign ovarian masses and to evaluate results in relation to CA125.Methods: An observational prospective controlled study was done on 70 patients admitted to El Shatby Maternity University Hospital, Oncology department categorized as follows: study group (group I) included 35 patients, with epithelial ovarian malignancy confirmed by histopathological examination and control group (group Il) included 35 patients with benign ovarian tumors confirmed by histopathological examination. Determination of Serum LRGI level by using enzyme-linked immuno sorbent assay with CA125 tumor marker analysis were done for all cases of both groups.Results: As regard comparison between the two studied groups according to CA125 and LRGI. CA125 in group I ranged from 14.90 to 4600 with a mean value 856.73±1104.03, in group II ranged from 7.45 to 523 with a mean value of 51.97±86.14. LRGI in group I ranged from 62.46 to 653.98 with a mean value of 130.86±119.78, in group Il ranged from 47.73 to 261.78 with a mean value of 77.35±38.75. There was statistically significant difference between the two studied groups regarding CA125 and LRGI (p≤0.05).Conclusions: LRG1 can be used as promising tumor marker to diagnose epithelial malignant ovarian cancer with or without CA125 tumor marker as it was significantly higher in epithelial ovarian cancer patients

The relation between of insulin like growth factor II and endometrial carcinoma

Background: Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women. The need of a soft marker that can be used with CA-125 tumor marker for early detection of endometrial cancer and to predict late stages and advanced histopathological grades and to specify the cases who will be managed by complete surgical staging including para aortic and pelvic lymphadenectomy is of great importance. The aim of the study was to evaluate the role of insulin like growth factor 2 in endometrial carcinoma and to correlate it with different histopathological grades of the disease.Methods: This study was applied on sixty patients with abnormal uterine bleeding and were divided into two groups, Group A included 30 cases of endometrial carcinoma, while Group B included 30 cases complaining of abnormal vaginal bleeding due to other causes as a control group. Serum samples were taken from all patients and estimation of IGF-2 serum levels using ElISA technique was done. Comparison of IGF-2 serum level between both groups and correlation of its levels with different histopathological grades of endometrial cancer group were done.Results: As regard comparison between both groups and ILGF2 serum level, study results demonstrated that ILGF2 levels ranged between 600.0-1440.0 ng/ml and 40.0-560.0 ng/ml with the mean of 781.33 ng/ml±196.45 and 336.0 ng/ml±212.86 for cases Group A and control Group B respectively. There was a statistically significant difference between the two studied groups regarding ILGF2 serum level (p<0.001). As regards correlation between histopathological grades and ILGF-2 serum level in cases Group A, the study revealed a strong positive correlation.Conclusions: ILGF-2 can be used as a serum marker for endometroid adenocarcinoma of the body of the uterus and to predict its higher histopathological grades

Role of pelvic lymphadenectomy in stage 1A endometrial carcinoma diagnosed preoperatively by pelvic ultrasonography and CT scan

Introduction: Endometrial cancer is the commonest gynecological cancer mostly affecting women in the postmenopausal age group. There is a debate regarding the need of pelvic lymphadenectomy in managing stage 1A diagnosed preoperatively, we try to evaluate this need. Objective: To evaluate the role of pelvic lymphadenectomy in stage 1A endometrial carcinoma diagnosed preoperatively by pelvic ultrasonography and CT scan as microscopic invasion of pelvic lymph nodes will not be seen by this imaging technique. Methods: 60 Cases of endometrial carcinoma diagnosed by fractional curettage and proved to be stage 1A preoperatively by clinical examination, vaginal US and CT scan (negative myometrial invasion, ascites, LN spread and local spread) underwent total abdominal hysterectomy with salpingo-oopherectomy, peritoneal wash for cytology, omentectomy and pelvic lymphadenectomy (external iliac and obturator groups) after written informed consent. Histopathology of the uterus, tubes, ovaries, omentum and cytology of peritoneal wash were done for surgical staging, in addition histopathology of pelvic LN was done. Results: Histopathology of the cases revealed the following: 52 cases were endometrioid adenocarcinoma distributed as follows: 10 patients were grade 1, 35 patients were grade 2 and 7 patients were grade 3. Eight cases were serous papillary adenocarcinoma, 3 of them were grade 1 and 5 cases were grade 2. As regards myometrial invasion 9 cases of endometrioid carcinoma show invasion, 1 of grade 1, 3 of grade 2 and 5 of grade 3 in comparison to 4 cases of papillary serous adenocarcinoma 1 of grade 1 and 3 of grade 2, so 13 cases have been proved by histopathology to have myometrial invasion. Conclusion: There is no need for lymphadenectomy in stage 1A diagnosed preoperatively using CT scan and vaginal US, preventing high risk surgical intervention in this early stage