La Fianza A, Campani R, Dore R, Babilonti L, Torretta L
Istituto di Radiologia, Università di Pavia, IRCCS Policlinico S. Matteo.
Radiol Med. 1992 Apr;83(4):374-82.
Advanced malignant ovarian cancers are treated, after initial surgery, with first-choice mono/polychemotherapy, the response to which is evaluated by means of second-look laparotomy. The poor prognostic value of second-look results, the incidence of false negatives, the lack of valuable second-choice therapies, and the high incidence of complications after repeated interventions, lead to the testing of diagnostic imaging modalities--especially CT and tumor markers (Ca 125 and Ca 15-3). To define their actual clinical value, CT and serum assays of Ca 125 and Ca 15-3 have been performed on 32 treated patients affected with ovarian cancers (stages II-IV), who were clinically free of disease. The results have been compared with second-look pathology, but especially with patient follow-up (min. 24 months). Second-look laparotomy yielded a high number of false negatives (9/22 = 41%); moreover, many important/severe complications were observed. Thus, its value appears to be questionable. CT exhibited high positive predictive value (76.9% over the 24-month follow-up); high for both Ca 125 and Ca 15-3 (100% respectively, at 24-month follow-up) thus, few false positives were observed. Moreover CT, having higher sensitivity (55.5%) than Ca 125 (11.5%) and Ca 15-3 (27.7%), has greater diagnostic capabilities, especially when the lesion is in extraperitoneal location.
晚期恶性卵巢癌在初次手术后采用首选的单药/联合化疗进行治疗，通过二次剖腹探查术评估其疗效。二次探查结果的预后价值不佳、假阴性的发生率、缺乏有价值的二线治疗方法以及重复干预后并发症的高发生率，促使人们对诊断成像方法——尤其是CT和肿瘤标志物（Ca 125和Ca 15-3）进行测试。为了确定它们的实际临床价值，对32例患有卵巢癌（II-IV期）且临床无疾病的已治疗患者进行了CT以及Ca 125和Ca 15-3的血清检测。将结果与二次探查病理结果进行了比较，但尤其是与患者随访结果（最短24个月）进行了比较。二次剖腹探查术产生了大量假阴性结果（9/22 = 41%）；此外，还观察到许多重要/严重的并发症。因此，其价值似乎值得怀疑。CT表现出较高的阳性预测值（在24个月的随访中为76.9%）；Ca 125和Ca 15-3的阳性预测值也很高（在24个月的随访中分别为100%），因此观察到的假阳性很少。此外，CT的敏感性（55.5%）高于Ca 125（11.5%）和Ca 15-3（27.7%），具有更强的诊断能力，尤其是当病变位于腹膜外时。
