Shen-Gunther Jane, Mannel Robert S
Gynecologic Surgery and Oncology, 2911 N. Tenaya Way, Suite 105, Las Vegas, NV 89128, USA.
Gynecol Oncol. 2002 Oct;87(1):77-83. doi: 10.1006/gyno.2002.6800.
To determine the utility of ascites as a predictor of ovarian malignancy and define its relationship with the histologic type of ovarian tumor (benign, borderline, or malignant) and stage of disease.
This retrospective cohort study analyzed the clinical and pathological finding of 125 patients from two institutions treated for a pelvic mass. Preoperative data to include: physical examination, imaging studies (USD, CT, or MRI), and operative reports were reviewed for evidence of ascites. This was correlated with final pathologic findings and stage of disease. Collected data were summarized with descriptive statistics. Further statistical analysis was performed using Pearson's chi(2), cross tabulation, and the Median Test. Data were analyzed with SPSS 6.1 for Windows.
One-hundred twenty-five patients were evaluable for this study. The ovarian pathologic findings were as follows: 57 benign (45%), 12 borderline (10%), and 56 malignant (45%). Fifty-three patients (42%) had frank ascites at laparotomy. Seventy-two patients (58%) had no ascites. All patients with ascites diagnosed preoperatively (n = 41) on physical examination or imaging studies were confirmed intraoperatively. Absence of ascites was correctly diagnosed preoperatively in 72/84 patients (86%). Of the 57 benign tumors, only 5 patients (9%) had small amounts of peritoneal effusion. Of the 12 borderline tumors, 7 patients (58%) had ascites. Of the 56 malignant tumors, 41 (73%) had ascites. Using presence or absence of ascites on clinical assessment as the predictor variable and benign or malignant (borderline and invasive histopathology) tumors as the outcome variable, the positive predictive value (PPV) of ascites to detect ovarian malignancy was 95% and the negative predictive value (NPV) was 64%. When borderline tumors were excluded, the PPV and NPV of ascites to detect malignant invasive tumors were 95 and 73%, respectively. Furthermore, a progressive relationship between stage of ovarian malignancy and percentage of cases with ascites was identified. Ovarian malignancies in the early stages (I and II) produced ascites only in 17% of the cases. In advanced stages (III and IV), 89% produced ascites. In addition, for stage I and II disease, all patients possessed <0.5 liters of ascites at surgery, whereas the majority of patients (66%) with stage III and IV disease had >0.5 liters.
Our findings indicate the presence of ascites on preoperative physical examination or imaging study is highly predictive of ovarian malignancy in women with a pelvic mass. The absence of ascites may not always predict benign disease since nearly half of borderline tumors and 83% of early stage malignant ovarian tumors do not produce ascites. A progressive relationship between stage of malignancy and incidence as well as volume of ascites was also observed.
确定腹水作为卵巢恶性肿瘤预测指标的效用，并明确其与卵巢肿瘤组织学类型（良性、交界性或恶性）及疾病分期的关系。
这项回顾性队列研究分析了来自两家机构接受盆腔肿块治疗的125例患者的临床和病理结果。术前数据包括：体格检查、影像学检查（超声、CT或MRI）以及手术报告，以查找腹水证据。将其与最终病理结果和疾病分期相关联。收集的数据用描述性统计进行总结。使用Pearson卡方检验、交叉表和中位数检验进行进一步的统计分析。数据用SPSS 6.1 for Windows进行分析。
125例患者可纳入本研究。卵巢病理结果如下：57例良性（45%），12例交界性（10%），56例恶性（45%）。53例患者（42%）在剖腹手术时有明显腹水。72例患者（58%）无腹水。所有术前经体格检查或影像学检查诊断有腹水的患者（n = 41）术中均得到证实。72/84例患者（86%）术前无腹水的诊断正确。在57例良性肿瘤中，仅5例患者（9%）有少量腹腔积液。在12例交界性肿瘤中，7例患者（58%）有腹水。在56例恶性肿瘤中，41例（73%）有腹水。以临床评估中有无腹水作为预测变量，良性或恶性（交界性和浸润性组织病理学）肿瘤作为结果变量，腹水检测卵巢恶性肿瘤的阳性预测值（PPV）为95%，阴性预测值（NPV）为64%。当排除交界性肿瘤时，腹水检测恶性浸润性肿瘤的PPV和NPV分别为95%和73%。此外，还确定了卵巢恶性肿瘤分期与腹水病例百分比之间的递进关系。早期（I期和II期）卵巢恶性肿瘤仅17%的病例产生腹水。在晚期（III期和IV期），89%产生腹水。此外，对于I期和II期疾病，所有患者手术时腹水均<0.5升，而III期和IV期疾病的大多数患者（66%）腹水>0.5升。
我们的研究结果表明，术前体格检查或影像学检查中存在腹水对盆腔肿块女性的卵巢恶性肿瘤具有高度预测性。无腹水并不总是预示良性疾病，因为近一半的交界性肿瘤和83%的早期恶性卵巢肿瘤不产生腹水。还观察到恶性肿瘤分期与腹水发生率及腹水量之间的递进关系。
