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Abstract

Background

There is overlap in imaging features between borderline and benign ovarian tumors.

Purpose

To analyze diagnostic performance of magnetic resonance imaging (MRI) combined with tumor markers for differentiating borderline from benign ovarian tumor.

Material and Methods

Ninety-nine patient with MRI and surgically confirmed ovarian tumors 5 cm or larger (borderline, n = 37; benign, n = 62) were included. On MRI, tumor size, septal number (0; 1–4; 5 or more), and presence of solid portion such as papillary projection or septal thickening 0.5 cm or larger were investigated. Serum tumor markers (carbohydrate antigen 125 [CA 125] and CA 19-9) were recorded. Multivariate analysis was conducted for assessing whether combined MRI with tumor markers could differentiate borderline from benign tumor. The diagnostic performance was also analyzed.

Results

Incidence of solid portion was 67.6% (25/37) in borderline and 3.2% (2/62) in benign tumors (P < 0.05). In all patients, without combined analysis of MRI with tumor markers, multivariate analysis revealed solid portion (P < 0.001) and CA 125 (P = 0.039) were significant for predicting borderline tumors. When combined analysis of MRI with CA 125 ((i) the presence of solid portion or (ii) CA 125 > 44.1 U/mL with septal number ≥5 for borderline tumor) is incorporated to multivariate analysis, it was only significant (P = 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of combined analysis of MRI with CA 125 were 89.1%, 91.9%, 86.8%, 93.4, and 90.9%, respectively.

Conclusion

Combined analysis of MRI with CA 125 may allow better differentiation between borderline and benign ovarian tumor compared with MRI alone.

Keywords

Borderline tumor ovary magnetic resonance imaging (MRI)tumor marker CA 125

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References

Harris

Whittemore

Itnyre

. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. III. Epithelial tumors of low malignant potential in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol 1992; 136: 1204–1211.

Acs

. Serous and mucinous borderline (low malignant potential) tumors of the ovary. Am J Clin Pathol 2005; 123 Suppl: S13–S57.

Cadron

Leunen

Van Gorp

. Management of borderline ovarian neoplasms. J Clin Oncol 2007; 25: 2928–2937.

Fauvet

Boccara

Dufournet

. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol 2005; 16: 403–410.

Reddy

Laufer

. Advantage of conservative surgical management of large ovarian neoplasms in adolescents. Fertil Steril 2009; 91: 1941–1944.

Koskas

Uzan

Gouy

. Prognostic factors of a large retrospective series of mucinous borderline tumors of the ovary (excluding peritoneal pseudomyxoma). Ann Surg Oncol 2011; 18: 40–48.

Suh-Burgmann

. Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study. Gynecol Oncol 2006; 103: 841–847.

Lee

. Prognostic factors predicting recurrence in borderline ovarian tumors. Gynecol Oncol 2009; 114: 237–241.

Winter

3rd Kucera

Rodgers

. Surgical staging in patients with ovarian tumors of low malignant potential. Obstet Gynecol 2002; 100: 671–676.

10.

Trimble

Kosary

Trimble

. Long-term survival and patterns of care in women with ovarian tumors of low malignant potential. Gynecol Oncol 2002; 86: 34–37.

11.

deSouza

O’Neill

McIndoe

. Borderline tumors of the ovary: CT and MRI features and tumor markers in differentiation from stage I disease. Am J Roentgenol 2005; 184: 999–1003.

12.

Lalwani

Shanbhogue

Vikram

. Current update on borderline ovarian neoplasms. Am J Roentgenol 2010; 194: 330–336.

13.

Zhao

Qiang

Zhang

. MRI in differentiating ovarian borderline from benign mucinous cystadenoma: pathological correlation. J Magn Reson Imaging 2014; 39: 162–166.

14.

Jung

Lee

Rha

. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics 2002; 22: 1305–1325.

15.

Exacoustos

Romanini

Rinaldo

. Preoperative sonographic features of borderline ovarian tumors. Ultrasound Obstet Gynecol 2005; 25: 50–59.

16.

Ilvan

Ramazanoglu

Ulker Akyildiz

. The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol 2005; 97: 395–399.

17.

Tamakoshi

Kikkawa

Shibata

. Clinical value of CA125, CA19-9, CEA, CA72-4, and TPA in borderline ovarian tumor. Gynecol Oncol 1996; 62: 67–72.

18.

Engelen

de Bruijn

Hollema

. Serum CA 125, carcinoembryonic antigen, and CA 19-9 as tumor markers in borderline ovarian tumors. Gynecol Oncol 2000; 78: 16–20.

19.

Kolwijck

Thomas

Bulten

. Preoperative CA-125 levels in 123 patients with borderline ovarian tumors: a retrospective analysis and review of the literature. Int J Gynecol Cancer 2009; 19: 1335–1338.

20.

McDonald

Modesitt

. The incidental postmenopausal adnexal mass. Clin Obstet Gynecol 2006; 49: 506–516.

21.

Bailey

Ueland

Land

. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol 1998; 69: 3–7.

22.

Mol

Bayram

Lijmer

. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril 1998; 70: 1101–1108.

23.

Somigliana

Vigano

Tirelli

. Use of the concomitant serum dosage of CA 125, CA 19-9 and interleukin-6 to detect the presence of endometriosis. Results from a series of reproductive age women undergoing laparoscopic surgery for benign gynaecological conditions. Hum Reprod 2004; 19: 1871–1876.

24.

Dotters

. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000; 182: 1328–1334.

25.

Siegelman

Oliver

. MR imaging of endometriosis: ten imaging pearls. Radiographics 2012; 32: 1675–1691.

26.

Bent

Sahdev

Rockall

. MRI appearances of borderline ovarian tumours. Clin Radiol 2009; 64: 430–438.

27.

Lenhard

Nehring

Nagel

. Predictive value of CA 125 and CA 72-4 in ovarian borderline tumors. Clin Chem Lab Med 2009; 47: 537–542.

28.

Markman

. Normal CA-125 and the risk of progression in ovarian cancer. J Clin Oncol 2006; 24: 3310–3310. . (author reply 3310–3311.

29.

Kelly

Archbold

Price

. Serum CA19.9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype. J Clin Pathol 2010; 63: 169–173.

30.

Yuen

Yip

. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 1997; 177: 109–114.

31.

Eltabbakh

Charboneau

Eltabbakh

. Laparoscopic surgery for large benign ovarian cysts. Gynecol Oncol 2008; 108: 72–76.

32.

Tempfer

Polterauer

Bentz

. Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynecol Oncol 2007; 107: 248–252.

33.

Zhang

. Combining multiple serum tumor markers improves detection of stage I epithelial ovarian cancer. Gynecol Oncol 2007; 107: 526–531.

34.

Husseinzadeh

. Status of tumor markers in epithelial ovarian cancer has there been any progress? A review. Gynecol Oncol 2011; 120: 152–157.

35.

Poncelet

Fauvet

Yazbeck

. Impact of serum tumor marker determination on the management of women with borderline ovarian tumors: multivariate analysis of a French multicentre study. Eur J Surg Oncol 2010; 36: 1066–1072.

36.

Morotti

Menada

Gillott

. The preoperative diagnosis of borderline ovarian tumors: a review of current literature. Arch Gynecol Obstet 2012; 285: 1103–1112.

37.

Thomassin-Naggara

Bazot

Darai

. Epithelial ovarian tumors: value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis. Radiology 2008; 248: 148–159.

38.