Mori Yukiko, Nishii Hiroshi, Takabe Kazuaki, Shinozaki Hideo, Matsumoto Naoki, Suzuki Keitaro, Tanabe Hiroshi, Watanabe Akihiko, Ochiai Kazuhiko, Tanaka Tadao
Department of Obstetrics and Gynecology, Jikei University School of Medicine, Aoto Hospital, Tokyo, Japan.
Gynecol Oncol. 2003 Aug;90(2):338-41. doi: 10.1016/s0090-8258(03)00259-2.
Mature cystic teratoma of the ovary (MCT) is the most common ovarian cystic disease in young women. Although it is a rare occurrence, some cases develop malignant transformation (MT), which results in serious consequences. However, MT is currently diagnosed only by postoperative pathology in most cases. We have conducted a retrospective study in an attempt to seek the factor to diagnose MT from MCT prior to surgery.
Eighty-one patients with MCT and 39 patients with MT were entered in this study. Patient's age, tumor size, serum CEA levels, and serum SCC levels were tested by the Mann-Whiteney U test. Sensitivity and specificity were calculated, and the most suitable point was searched from the receiver operating characteristic (ROC) curve.
A significant difference was recognized in both patient's age and serum SCC level (P < 0.0001). For a patient less than 40 years old, the sensitivity to MT was 95%, and then the specificity to MT was 63%. When the standard value of the SCC level of the serum was established as 2.5 ng/ml, the sensitivity to MT was 80% and the specificity to MT was 94%. We apply two criteria at the same time (serum SCC levels less than 2.5 ng/ml and patient's age less than 40 years old). The sensitivity for MT was 77% and specificity was 96%.
The combination of the two criteria which are patient's age (under 40 years old) and serum SCC level (under 2.5 ng/ml) was considered a suitable marker for differential diagnosis between MCT and MT. Further the possibility for MT is quite low when the patient is 39 years old or younger and the serum SCC level is under 2.5 ng/ml. When any patient satisfies this condition, laparoscopic surgery will be able to be planned safely.
成熟性卵巢囊性畸胎瘤（MCT）是年轻女性中最常见的卵巢囊性疾病。虽然恶变情况罕见，但部分病例会发生恶性转化（MT），会导致严重后果。然而，目前大多数情况下MT仅在术后通过病理诊断。我们进行了一项回顾性研究，试图寻找术前从MCT中诊断MT的因素。
本研究纳入了81例MCT患者和39例MT患者。通过Mann-Whiteney U检验对患者年龄、肿瘤大小、血清癌胚抗原（CEA）水平和血清鳞状细胞癌抗原（SCC）水平进行检测。计算敏感性和特异性，并从受试者工作特征（ROC）曲线中寻找最合适的点。
患者年龄和血清SCC水平均存在显著差异（P < 0.0001）。对于年龄小于40岁的患者，对MT的敏感性为95%，对MT的特异性为63%。当血清SCC水平的标准值设定为2.5 ng/ml时，对MT的敏感性为80%，对MT的特异性为94%。我们同时应用两个标准（血清SCC水平低于2.5 ng/ml且患者年龄小于40岁）。对MT的敏感性为77%，特异性为96%。
患者年龄（40岁以下）和血清SCC水平（2.5 ng/ml以下）这两个标准的组合被认为是MCT和MT鉴别诊断的合适标志物。此外，当患者年龄在39岁或以下且血清SCC水平低于2.5 ng/ml时，MT的可能性相当低。当任何患者符合此条件时，可安全地计划进行腹腔镜手术。
