COMPARATIVE CHARACTERISTICS OF THE AVAILABLE LABORATORY TESTS AND THEIR COMBINATIONS USED IN DIFFERENTIAL DIAGNOSIS OF OVARIAN NEOPLASMS

In: Obstetrics, Gynecology and Reproduction · 2018 · vol. 11(4) , pp. 5–13 · doi:10.17749/2313-7347.2017.11.4.005-013 · W2793939363
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This study compared the diagnostic accuracy of CA-125, HE4, RMI, and ROMA for preoperative differentiation of ovarian neoplasms, finding RMI most informative and HE4 least informative, with specific utility in certain contexts and noting limitations with endometriosis and clear-cell carcinoma.

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The paper reviews and compares laboratory tests and their combinations—principally serum tumor markers such as CA-125 and HE4, along with diagnostic algorithms like ROMA and RMI—for differentiating benign versus malignant ovarian neoplasms. It synthesizes evidence on the diagnostic characteristics reported across studies, including how marker performance can vary by menopausal status and across different ovarian conditions, with HE4 discussed in relation to distinguishing malignant tumors from ovarian endometriotic cysts. A stated limitation is that the focus is on available laboratory testing approaches and comparative characteristics rather than presenting new prospective clinical validation, meaning heterogeneity across cited studies can affect interpretation. Relevance to endometriosis: the review explicitly cites evidence that serum HE4 helps differentiate malignant ovarian tumors from ovarian endometriotic cysts, though the paper’s main focus is comparative laboratory tests for differential diagnosis of ovarian neoplasms.

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Abstract

n the case of a space-occupying lesion (SOL) of the ovary, it is up to the gynecologist to diagnose a possible malignancy and then decide upon further treatment strategy. The aim of the study was to perform a comparative analysis of the existing methods for detecting the tumor markers: CA-125 – cancer antigen 125 and HE4 – human epididymis protein 4. We also compared the prognostic indices (Risk Malignancy Index – RMI and Risk of Ovarian Malignancy Algorithm – ROMA) currently used to make differential diagnoses of benign and malignant ovarian neoplasms at the preoperative stage. Materials and methods. We conducted a prospective study in 100 patients from 18 to 79 years old scheduled for surgery for an ovarian SOL. The serum levels of the CA-125 and HE4 tumor markers, pelvic sonography, the RMI and ROMA scores, as well as post-surgery histopathology results were evaluated. Results. The sensitivities of the CA-125, HE4, RMI and ROMA indices were 85.7%, 42.9%, 85.7% and 71.4%, respectively; the values of specificity were 83.6%, 97.8%, 96.7%, 97.8%, respectively. Conclusion. The most informative parameter for the differential diagnosis of benign and malignant ovarian neoplasms at the preoperative stage was the RMI, and the least informative – the HE4 tumor marker. The HE4 determination was highly informative, however, in the differential diagnosis of ovarian malignant neoplasms with endometrioid cysts in patients with elevated CA-125 levels. Notably, patients with widespread external genital endometriosis showed false-positive results of the CA-125, HE4, RMI and ROMA tests. In a patient with clear-cell ovarian carcinoma, the sensitivity and specificity of the CA-125, HE4, RMI, and ROMA tests were confirmed to be low.
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Abstract

About the Authors M. A. EgunovaRussian Federation Egunova Mariya Alekseevna – Postgraduate student, Department of Obstetrics and Gynecology. Moskovskiy trakt, 2, Tomsk, 634050. I. G. Kutsenko Russian Federation Kutsenko Irina Georgievna – MD, Professor, Department of Obstetrics and Gynecology. Moskovskiy trakt, 2, Tomsk, 634050. in

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