超声特征及术前CA-125联合对51例卵巢交界性及Ⅰ期恶性肿瘤的鉴别诊断

doi:10.6040/j.issn.1671-7554.0.2021.0819

摘要/Abstract

摘要： 目的探讨超声特征联合术前血清糖类抗原-125(CA-125)水平对卵巢交界性肿瘤(BOTs)、Ⅰ期上皮性卵巢癌(EOC)的鉴别诊断价值。方法选取2019年6月至2020年6月术后病理证实为卵巢上皮性恶性肿瘤的患者51例(Ⅰ期EOC组27例,BOTs组24例)进行临床资料分析。采用逐步选择变量的多变量二分类Logistic回归分析确定与卵巢侵袭性有关联的独立因素:临床变量(月经状态)、超声特征和CA-125水平,并进行统计分析,以观察超声特征和CA-125在BOTs与Ⅰ期EOC术前鉴别诊断中的应用。结果 (1)超声表现:边缘不光滑、腹水及血流丰富的肿块(血流评分=4)多提示为Ⅰ期EOC,而存在乳头状突起及分隔多存在于BOTs组中;(2)术前CA-125水平>35 IU/mL或 >100 IU/mL的情况在Ⅰ期EOC组中的比率均远大于BOTs组(81.5% vs 41.7%, P=0.003;40.7% vs 8.3%, P=0.008);(3)血清CA-125水平用于区分BOTs和Ⅰ期EOC的灵敏度和特异度分别是81.5%和58.3%, CA-125对BOTs和Ⅰ期EOC具有一定的诊断参考价值;(4)多变量Logistic回归分析:CA-125水平>100 IU/mL是区别BOTs和Ⅰ期EOC的关键独立因素,CA-125水平>100 IU/mL较CA-125水平≤100 IU/mL的患者最终病理诊断为Ⅰ期EOC的风险将近提升14.67倍(OR=14.67,95%CI:1.32~162.94,P=0.029)。结论术前CA-125水平>100 IU/mL结合特殊的超声特征,对提高术前卵巢交界性肿瘤和Ⅰ期上皮性卵巢癌的鉴别诊断有一定的参考价值。

关键词: 卵巢交界性肿瘤, 上皮性卵巢癌, 糖类抗原-125, 超声, 附件

Abstract: Objective To investigate the value of ultrasound characteristics combined with preoperative serum carbohydrate antigen 125(CA-125)levels in the differential diagnosis of borderline ovarian tumors(BOTs)and stage Ⅰ epithelial ovarian cancer(EOC). Methods Clinical data of 27 EOC and 24 BOT pathologically confirmed cases treated during June 2019 and June 2020 were retrospectively analyzed. Independent factors related to ovarian invasion, including clinical variables(menstrual status), ultrasound characteristics and CA-125 level, were analyzed with multivariate binary Logistic regression with stepwise selection of variables. Results Ultrasound findings showed masses with rough edges, ascites, and rich blood flow(blood flow score=4)were indicative of stage Ⅰ EOC, while papillary protrusions and partitions were present in BOT. The ratio of preoperative CA-125 >35 IU/mL or >100 IU/mL in stage Ⅰ EOC was much higher than that in BOT(81.5 vs 41.7%, P=0.003; 40.7 vs 8.3%, P=0.008). The sensitivity and specificity of serum CA-125 level for distinguishing BOT and stage Ⅰ EOC were 81.5% and 58.3%, respectively, indicating that CA-125 level had a certain diagnostic reference value. Multivariate Logistic regression showed that CA-125>100 IU/mL was a key independent factor distinguishing BOT from stage Ⅰ EOC, indicating that patients with CA-125 >100 IU/mL had almost 14.67 times greater likelihood of stage Ⅰ EOC compared patients with CA-125 ≤100 IU/mL(OR=14.67; 95%CI: 1.32-162.94; P=0.029). Conclusion Preoperative CA-125 >100 IU mL combined with ultrasound characteristics helps in the differential diagnosis of borderline ovarian tumor and stage Ⅰ epithelial ovarian cancer before surgery.

Key words: Borderline ovarian tumors, Epithelial ovarian carcinoma, Carbohydrate antigen 125, Ultrasound, Adnexal

中图分类号:

R445.1

张艺馨,赵玉立,封丽. 超声特征及术前CA-125联合对51例卵巢交界性及Ⅰ期恶性肿瘤的鉴别诊断[J]. 山东大学学报 (医学版), 2022, 60(7): 104-109.

ZHANG Yixin, ZHAO Yuli, FENG Li. Ultrasound characteristics and preoperative CA-125 level in the differential diagnosis of 51 cases of borderline ovarian and stage I malignant tumors[J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 104-109.

参考文献

[1] Hauptmann S, Friedrich K, Redline R, et al. Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria [J]. Virchows Arch, 2017, 470(2): 125-142.
[2] Taylor HC. Malignant and semimalignant tumors of the ovary [J]. Surg Gynecol Obstet, 1929, 48: 204-230.
[3] Gershenson DM. Management of borderline ovarian tumours [J]. Best Pract Res Clin Obstet Gynaecol, 2017, 41: 49-59. doi: 10.1016/j.bpobgyn.2016.09.012.
[4] Manchul LA, Simm J, Levin W, et al. Borderline epithelial ovarian tumors: a review of 81 cases with an assessment of the impact of treatment [J]. Int J Radiat Oncol Biol Phys, 1992, 22(5): 867-874.
[5] Lee EJ, Kim SH, Kim YH, et al. Is CA-125 an additional help to radiologic findings for differentiation borderline ovarian tumor from stage I carcinoma? [J]. Acta Radiol, 2011, 52(4): 458-462.
[6] Rosen DG, Wang L, Atkinson JN, et al. Potential markers that complement expression of CA125 in epithelial ovarian cancer [J]. Gynecol Oncol, 2005, 99(2): 267-277.
[7] Xu Y, Zhong R, He J, et al. Modification of cut-off values for HE4, CA125 and the ROMA algorithm for early-stage epithelial ovarian cancer detection: results from 1 021 cases in South China [J]. Clin Biochem, 2016, 49(1-2): 32-40.
[8] Araujo KG, Jales RM, Pereira PN, et al. Performance of the IOTA ADNEX model in preoperative discrimination of adnexal masses in a gynecological oncology center [J]. Ultrasound Obstet Gynecol, 2017, 49(6): 778-783.
[9] Webb PM, Jordan SJ. Epidemiology of epithelial ovarian cancer [J]. Best Pract Res Clin Obstet Gynaecol, 2017, 41: 3-14. doi: 10.1016/j.bpobgyn.2016.08.006.
[10] Moufarrij S, Dandapani M, Arthofer E, et al. Epigenetic therapy for ovarian cancer: promise and progress [J]. Clin Epigenetics, 2019, 11(1): 7.
[11] Campbell S, Gentry-Maharaj A. The role of transvaginal ultrasound in screening for ovarian cancer [J]. Climacteric, 2018, 21(3): 221-226.
[12] 漆玖玲, 陆蓓蕾, 樊韵玲,等. 卵巢浆液性交界性肿瘤与卵巢浆液性囊腺瘤超声特征对比分析. [J]. 中国超声医学杂志, 2020, 36(10): 934-937.
[13] Bourdel N, Huchon C, Abdel Wahab C, et al. Borderline ovarian tumors: guidelines from the French national college of obstetricians and gynecologists(CNGOF)[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 256: 492-501. doi: 10.1016/j.ejogrb.2020.11.045.
[14] 王士琴, 袁伟, 赵进娥. 经阴道超声对卵巢肿瘤的诊断与鉴别诊断的应用价值[J]. 影像研究与医学应用, 2020, 4(15): 154-156.
[15] 杨孝明,李玉宏. 妇科恶性肿瘤保留生育功能的诊治 [J]. 中国优生与遗传杂志, 2021, 29(2): 139-142. YANG Xiaoming, LI Yuhong. Fertility preservation for patients with gynecologic malignancies [J]. Chinese Journal of Birth Health & Heredity, 2021, 29(2): 139-142.
[16] Darai E, Fauvet R, Uzan C, et al. Fertility and borderline ovarian tumor: a systematic review of conservative management, risk of recurrence and alternative options [J]. Hum Reprod Update, 2013, 19(2): 151-166.
[17] Timor-Tritsch IE, Foley CE, Brandon C. New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components [J]. Ultrasound Obstet Gynecol, 2019, 54(3): 395-402.
[18] Bent CL, Sahdev A, Rockall AG, et al. MRI appearances of borderline ovarian tumours [J]. Clin Radiol, 2009, 64(4): 430-438.
[19] Pascual MA, Tresserra F, Grases PJ, et al. Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings [J]. J Clin Ultrasound, 2002, 30(2): 76-82.
[20] Dochez V, Caillon H, Vaucel E, et al. Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review [J]. J Ovarian Res, 2019, 12(1): 28.
[21] Valentin L, Jurkovic D, Van Calster B, et al. Adding a single CA 125 measurement to ultrasound imaging performed by an experienced examiner does not improve preoperative discrimination between benign and malignant adnexal masses [J]. Ultrasound Obstet Gynecol, 2009, 34(3): 345-354.
[22] deSouza NM, ONeill R, McIndoe GA, et al. Borderline tumors of the ovary: CT and MRI features and tumor markers in differentiation from stage I disease [J]. AJR Am J Roentgenol, 2005, 184(3): 999-1003.
[23] Van Calster B, Timmerman D, Bourne T, et al. Discrimination between benign and malignant adnexal masses by specialist ultrasound examination versus serum CA-125 [J]. J Natl Cancer Inst, 2007, 99(22): 1706-1714.
[24] 段丽, 李菊香, 王亚敏,等. 经阴道超声、MSCT联合血清CA125、CA724诊断卵巢肿瘤的应用价值探讨[J]. 中国CT和MRI杂志, 2021, 19(6): 128-130. DUAN Li, LI Juxiang, WANG Yamin, et al. Application value of transvaginal ultrasound and MSCT conbined with serum CA125 and CA724 in diagnosis of ovarian tumors [J]. Chinese Journal of CT and MRI, 2021, 19(6): 128-130.
[25] 王建伟, 谢海花, 孙嘉峰,等. 血清癌胚抗原人附睾蛋白4 糖类抗原125糖类抗原199单独和联合检测在卵巢癌中的诊断价值[J]. 实用医技杂志, 2021, 28(6): 723-725. WANG Jianwei, XIE Haihua, SUN Jiafeng, et al. The diagnostic value of serum carcinoembryonic antigen,human epididymal protein 4,carbohydrate antigen 125,carbohydrate antigen 199 alone and four combined tests in ovarian cancer [J]. Journal of Practical Medical Techniques, 2021, 28(6): 723-725.

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