Added value of serum CA -125 level to CT in the differentiation of borderline ovarian tumors from stage I malignant epithelial ovarian tumors

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1 Added value of serum CA -125 level to CT in the differentiation of borderline ovarian tumors from stage I malignant epithelial ovarian tumors Poster No.: C-1279 Congress: ECR 2010 Type: Scientific Exhibit Topic: Genitourinary Authors: J.-E. Shin, H. J. Choi, J. K. Kim, K.-S. Cho; Seoul/KR Keywords: CT, CA-125, epithelial ovarian tumor DOI: /ecr2010/C-1279 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Purpose Additional diagnostic value of CA-125 level together with CT in order to differentiate borderline ovarian tumor from stage I malignant epithelial ovarian tumors. Methods and Materials Study Population From january 2001 to march patients BOTs (n = 43; mean age = 52 years old) stage I MEOTs (n = 44; mean age = 52 years old) 98 masses (52 BOTs & 46 stage I MEOTs) CT Technique Single-channel detector helical CT scanner (Somatom Plus-S, Siemens) Beam collimation of 5 or 7 mm, a pitch of 1.5 or 1.7, image reconstruction increment of 5 mm Orally administrated ml of contrast material (E-Z-CAT [barium sulfate suspension concentrate], EZ-EM). IV contrast material ( ml of Lopamiro 300 [iopamidol], Bracco Diagnostics of Ultravist 300 [Iopromide], Schering) - rate of 3.0 ml/sec IV From the diaphragm to the symphysis pubis Analysis and statistics Retrospectively & independently by two radiologists Imaging features - Presence of ascites, Pleural effusion, Peritoneal implant, Lymph node, Mass character, Size, Solidity, Surface Interpretation ( 5-point grading system ) : 0 = BOT, 1 = probably BOT, 2 = indeterminat, 3 = probably malignant, 4 = malignant Page 2 of 10

3 After 3months, interchange of the list and reevaluated it combining CA-125. Results Histologic diagnosis serous adenocarcionmas (n = 37) mucinous adenocarcionmas (n = 9) serous BOTs (n = 21) mucinous BOTs (n = 31) Page 3 of 10

4 Fig.: Box plots showing CA-125 serum levels by histologic diagnosis of ovarian masses. MEOT = stage I malignant epithelial ovarian tumor. BOT = borderline ovarian tumor. The mean serum CA-125s for MEOTs and BOTs were U/ml and 54.7 U/ml respectively (p = ). References: J.-E. Shin; Radiology, Asan medical center, Seoul, KOREA, Republic of Page 4 of 10

5 Addition both the serum CA-125 level and the CT images, we could achieve a more reproducible and accurate differentiation of BOTs and MEOTs Fig.: Graphs of the ROC analysis results show the additional value of the CA-125 for both readers attempting to differentiate borderline ovarian tumors and stage I malignant epithelial origin tumors. Solid line = diagnoses were done with only CT images. Dotted line = diagnoses were done with CT images and serum CA-125 levels. (a) The areas under the curve for reader 1 were 0.71 and 0.81 before and after addition of serum level CA-125 in the diagnoses with CT images (p = 0.009). (b) The areas under the curve for reader 1 were 0.67 and 0.78 before and after addition of serum level CA-125 in the diagnoses with CT images (p = 0.029). References: J.-E. Shin; Radiology, Asan medical center, Seoul, KOREA, Republic of Interobserver agreement Only the CT images : # = 0.74 Serum CA-125 level combined with the CT images : # = 0.91 Page 5 of 10

6 <Note> Fig. 1: Imaging features of stage I malignant epithelial ovarian tumors and borderline ovarian tumors Fig. 2: Case of stage I malignant epithelial ovarian tumors and borderline ovarian tumors Images for this section: Fig. 1: Imaging features of stage I malignant epithelial ovarian tumors compared with those of borderline ovarian tumors. The presence surface irregularity and enlargement of the lymph nodes were specific features which predominated in MEOTs. However, as the frequency of these findings were relatively low and there were significant overlaps, so they have little clinical significance. The presence of a peritoneal implants also there was a discrepancy between the two readers Page 6 of 10

7 Fig. 2 Page 7 of 10

8 Fig. 3 Page 8 of 10

9 Conclusion CT images combined with serum CA-125 # significantly increased diagnostic performance in differentiating BOTs from MEOTs References 1. Jones MB. Borderline ovarian tumors: current concepts for prognostic factors and clinical management. Clin Obstet Gynecol 2006;49: Bell DA, Longacre TA, Prat J, et al. Serous borderline (low malignant potential, atypical proliferative) ovarian tumors: workshop perspectives. Hum Pathol 2004;35: Tinelli R, Tinelli A, Tinelli FG, Cicinelli E, Malvasi A. Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol 2006;100: Cadron I, Leunen K, Van Gorp T, Amant F, Neven P, Vergote I. Management of borderline ovarian neoplasms. J Clin Oncol 2007;25: Berek JS. Berek & Novak's Gynecology. In: Berek JS, ed. Berek & Novak's Gynecology. 4th edition ed: Lippincott Williams & Wilkins, 2007; Berek JS. Berek & Novak's Gynecology. In: Berek JS, ed. Berek & Novak's Gynecology. 4th edition ed: Lippincott Williams & Wilkins, 2007; Buy JN, Ghossain MA, Sciot C, et al. Epithelial tumors of the ovary: CT findings and correlation with US. Radiology 1991;178: Dobson M, Carrington BM, Radford JA, Buckley CH, Crowther D. The role of computed tomography in the management of ovarian tumours of borderline malignancy. Clin Radiol 1997;52: Grab D, Flock F, Stohr I, et al. Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 2000;77: Page 9 of 10

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