Analiza wyników fałszywie ujemnych subiektywnej oceny ultrasonograficznej guzów jajnika

Objectives: Currently transvaginal ultrasonography is the most effective method for ovarian tumor malignancy prediction. The aim of the study was to estimate the risk of false negative results in subjective interpretation of the ultrasound examination of ovarian tumors according to menopausal status. Material and methods: 318 women (210 pre and 108 post menopause) with adnexal masses were diagnosed preoperatively between 2004 and 2010. Subjective assessment of tumor characteristics was conducted by experienced ultrasound examiner. Tumors were divided into groups of: “certainly benign” (n=84), “probably benign” (n=116), “uncertain” (n=61), “probably malignant” (n=47), and “certainly malignant” (n=10). The percentage of false negative results was calculated among the first two groups according to menopausal status. Results: There were 91 malignant and 227 benign adnexal masses diagnosed in histopathological evaluation. There was one false negative result of subjective interpretation of ultrasound findings in postmenopausal women – 1.6% (1/64). She was a 63-year-old woman with bilateral solid ovaries sized: 4.2x3.1cm and 4.6x2.5 cm in ultrasound evaluation, where serous adenocarcinoma was diagnosed. There were three false negative results in premenopausal women – 2.2% (3/136). The first was a 34-year-old woman with a cyst with the appearance of ground glass of 19 x11cm in size where endometrioid ovarian adenocarcinoma was diagnosed. The second woman was a 32-year-old with a bilocular cyst 8x4.5cm diagnosed with borderline mucinous tumor. The third patient was a 21-year-old woman with unilocular-solid cyst 4.2x3.2cm where histopathological examination revealed borderline serous tumor. Conclusions: Subjective ultrasound evaluation of adnexal masses has high specificity but even in the group of tumors considered benign in premenopausal as well as postmenopausal women malignancy can be found. This occurs slightly more often before menopause.Cel pracy: Obecnie ultrasonografia przezpochwowa jest najbardziej efektywną metodą prognozowania złośliwości nowotworów jajnika. Celem pracy była ocena ryzyka wystąpienia wyników fałszywie ujemnych subiektywnej interpretacji badania ultrasonograficznego pacjentek z guzami jajnika w świetle ich statusu menopauzalnego. Materiał i metody: Analizie poddano 318 kobiet (210 przed i 108 po menopauzie) z rozpoznanymi i leczonymi operacyjnie guzami jajnika w latach 2004 - 2010. Subiektywna ocena cech guza została wykonana przez doświadczonego ultrasonografistę. Guzy podzielono na grupy: „na pewno niezłośliwe” (n=84), „prawdopodobnie niezłośliwe” (n=116), „niepewne” (n=61), „prawdopodobnie złośliwe” (n=47) i „na pewno złośliwe” (n=10). Odsetek wyników fałszywie ujemnych oszacowano na podstawie dwóch pierwszych powyższych grup w zależności od statusu menopauzalnego badanych pacjentek. Wyniki: W wyniku badania histopatologicznego rozpoznano 91 złośliwych i 227 niezłośliwych guzów jajnika. Wykazano jeden wynik fałszywie ujemny subiektywnej oceny ultrasonograficznej w grupie kobiet po menopauzie - 1,6% (1/64). Pacjentka miała 63 lata, w ocenie ultrasonograficznej obustronnie lite jajniki wielkości: 4,2x3,1cm i 4,6x2,5 cm, u której rozpoznano gruczolakoraka surowiczego. Wykazano trzy wyniki fałszywie ujemne u kobiet przed menopauzą - 2,2% (3/136). Pierwsza pacjentka miała 34 lata, w usg zmianę sugerującą torbiel endometrialną, wielkości 19 x11cm, u której rozpoznano gruczolakoraka endometrialnego. Druga kobiet miała 32 lata, dwukomorową torbiel o wymiarach 8x4,5cm, u której rozpoznano guz śluzowy o granicznej złośliwości. Trzecia pacjentka miała 21 lat, torbiel jednokomorową 4,2x3,2cm z wyroślami endofitycznymi oraz w badaniu histopatologicznym guz surowiczy o granicznej złośliwości. Wnioski: Subiektywna ocena ultrasonograficzna guzów jajnika ma wysoką wartość prognostyczną, ale nawet w grupie nowotworów uznanych za „niezłośliwe” zarówno u kobiet przed jak i po menopauzie może zostać rozpoznany ostatecznie nowotwór złośliwy jajnika. Nieznacznie częściej sytuacja taka występuje u kobiet przed menopauzą

The expression of Platelet-derived Growth factor receptors (PDGFRs) and their correlation with overall survival of patients with ovarian cancer

Objectives: The main aim of the study was to investigate the expression of Platelet-Derived Growth Factor Receptors alpha (PDGFR-alpha) and beta (PDGFR-beta) in malignant and benign ovarian tumors. We performed an analysis of the correlation of PDGFRs expression and stage of the disease, tumor grade and histopathological type of epithelial ovarian cancer (EOC). Additionally, we evaluated patient prognosis according to PDGFR expression.  Material and methods: Our study group was composed of 52 samples of EOCs, 35 samples of benign ovarian tumors (BOTs), and 21 samples of unchanged ovaries (UOs). The samples were collected from patients who had been operated on in the Division of Gynecological Surgery of the Poznan University of Medical Sciences.  Results: PDGFR-alpha was found to be expressed more frequently in cancer cells of EOCs, when compared with tumor cells of BOTs and epithelium of UOs. On the other hand, PDGFR-alpha receptors were present less frequently in the stroma of EOCs, when compared with the stroma of BOTs and UOs. Comparing the studied groups, there were no statistically significant differences in the expression of PDGFR-beta. The expression of both PDGFRs was not related to the FIGO stage, grade or histopathological type of EOCs. The expression of the PDGFR-beta receptor in cancer cells was associated with an improved overall survival among patients with EOCs. Patient prognosis was not affected by either PDGFR-alpha expres- sion or by PDGFR-beta tumor stroma expression.  Conclusions: The expression of PDGFR-alpha is significantly different when comparing EOCs, BOTs and UOs. However, the prognosis of EOC only seems to be affected by PDGFR-beta expression in cancer cells.

Usefulness of the HE4 biomarker as a second-line test in the assessment of suspicious ovarian tumors

PURPOSE: The aim of our study was the evaluation of HE4 usefulness as a test in assessment of ovarian tumors which are suspicious and difficult to classify correctly via subjective ultrasound examination. METHODS: In this retrospective cohort study 253 women diagnosed with adnexal masses were examined preoperatively. Suspicious tumors (n = 145) were divided into groups of: “probably benign” (n = 70), “uncertain” (n = 34), and “probably malignant” (n = 41). “Uncertain” tumors were also assessed as “benign” (n = 11) or “malignant” (n = 23). The logistic regression model was performed to analyze if the serum marker improves the prediction of a malignant finding and net reclassification improvement (NRI) was calculated to measure diagnostic improvement. RESULTS: Within the analyzed group 85 (58.6 %) benign and 60 (41.4 %) malignant tumors were confirmed histopathologically. The comparison of HE4 with subjective ultrasound assessment showed lowered NRI in the entire analyzed group as well as in the groups of tumors classified as “probably benign” or “probably malignant” (NRI = −0.16; P = 0.0139 and NRI = −0.133; P = 0.0489, respectively). The analysis of logistic regression model confirmed that biomarkers do not improve diagnostic accuracy. The difference between areas under ROC for HE4 (0.891) and CA125 (0.902) was not statistically significant (P = 0.760). CONCLUSIONS: After subjective ultrasound assessment, the addition of the second-line test—HE4 as well as CA125 serum level does not improve diagnostic performance. However, HE4 evaluation satisfies the clinical expectations of diagnostic tools for ovarian tumors and, thus, may be useful to less experienced sonographers

Using a Modified Polysaccharide as a Hemostatic Agent Results in Less Reduction of the Ovarian Reserve after Laparoscopic Surgery of Ovarian Tumors—Prospective Study

Background and Objectives: The study investigated whether the method of achieving hemostasis affects the ovarian reserve in patients undergoing laparoscopic surgery due to ovarian tumors or cysts. Materials and Methods: Patients with unilateral tumors or ovarian cysts, who qualified for laparoscopic tumor enucleation, were randomly selected to receive modified polysaccharides or bipolar coagulation. Ovarian reserve was analyzed by anti-Mullerian hormone (AMH) level. Results: The study included 38 patients: 19 patients in the modified polysaccharide group and 19 in the bipolar coagulation group. Patients after bipolar coagulation treatment had statistically significantly lower AMH 6 months after surgery compared to the group treated with modified starch. The levels of AMH in the study and control groups were 3.96 +/− 2.12 vs. 2.51 +/− 1.39 ng/mL, respectively; p = 0.018. A statistically significant decrease in AMH was also demonstrated in the bipolar coagulation group as compared to the preoperative assessment (p = 0.049). There was no statistically significant decrease in AMH in the group of patients treated with the modified starch. Conclusions: Using a modified polysaccharide during laparoscopic cystectomy is effective and has a positive effect on the ovarian reserve compared to the use of bipolar coagulation. Both the AMH level 6 months after surgery and the percentage decrease in AMH were more favorable in the group of patients treated with modified starch

Extracellular matrix metalloproteinase inducer (EMMPRIN) expression correlates positively with active angiogenesis and negatively with basic fibroblast growth factor expression in epithelial ovarian cancer

PURPOSE: The primary aim of this paper was to evaluate the expression of extracellular matrix metalloproteinase inducer (EMMPRIN) and its relationship with proangiogenic factors and microvessel density (MVD) in ovarian cancer. METHODS: The study group included 58 epithelial ovarian cancers (EOCs), 35 benign ovarian tumors, and 21 normal ovaries. The expression of EMMPRIN, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) was assessed by ELISA of tissue homogenates. Antibodies against CD105, CD31, and CD34 were used to immunohistochemically assess MVD. RESULTS: We have found significantly higher EMMPRIN expression in EOC than in benign ovarian tumors and normal ovaries. Similarly, the VEGF expression was higher in EOC than in benign ovarian tumors and normal ovaries. By contrast, bFGF expression was lower in EOC than in benign ovarian tumors and ovary samples. EMMPRIN expression in EOC was directly correlated with VEGF expression and CD105-MVD, but inversely correlated with bFGF expression. Grade 2/3 ovarian cancers had increased expression of EMMPRIN and VEGF, increased CD105-MVD, and lowered expression of bFGF compared to grade 1 ovarian cancers. Moreover, EMMPRIN expression was higher in advanced (FIGO III and IV) ovarian cancer. CONCLUSIONS: The upregulation of EMMPRIN and VEGF expression is correlated with increased CD105-MVD and silenced bFGF, which suggests early and/or reactivated angiogenesis in ovarian cancer. Aggressive EOC is characterized by the following: high expression of EMMPRIN and VEGF, high CD105-MVD, and low expression of bFGF

European Covid-19 Forecast Hub

European Covid-19 Forecast Hub

European Covid-19 Forecast Hub

European Covid-19 Forecast Hub