Hossain Fawzia, Karim Md Nazmul, Rahman Shah Md Mahfuzur, Khan Nasreen, Siddiqui Maruf, Hussain Raihan
Bangabandhu Sheikh Mujib Medical University, Dhaka.
Bangladesh Med Res Counc Bull. 2010 Aug;36(2):68-73. doi: 10.3329/bmrcb.v36i2.6991.
Early detection of ovarian malignancy is of great clinical importance. The high mortality rate is due to the difficulties with the early detection of ovarian cancer. Current research attempted to assess the accuracy of Color Doppler Sonography and serum CA-125 level as diagnostic tool of ovarian tumor.
In this cross-sectional study, 60 consecutive patients with ovarian tumor attending the Department of Obstetrics and Gynecology of BSMMU were recruited. Of the study participants 23.3% belong to 16-25 year age group, 20% belong to 26-35 years age group and 23.30% each were of 46-55 years and > 55 years age group. All the patients recruited were from in-patient department and had undergone surgery. Following excision, routine histopathology revealed 43.30% malignant (n=26) and 56.7% (n=34) benign ovarian lesion. Data were collected from the clinical history form and bimanual pelvic examination, serum CA 125 levels, estimation of Resistance index (RI), Pulsatility Index (PI), Novel Index by CDS and post-operative histo-pathological findings were then recorded. Sensitivity, specificity, accuracy, positive and negative predictive value of the diagnosis made by CDS, CA125, in the discrimination of the benign and malignant ovarian tumors was calculated. Using Receiver operative characteristics analysis the accuracy of RI, PI, CA 125 and Novel Index in the diagnosis of ovarian tumor (benign or malignant) were assessed.
With the Cut-off of < .5, Resistance Index is found to be capable of detecting 92% of malignant cases (sensitivity 91.7), and could detect 89% (specificity 88.9) of benign cases correctly which translates in to 90% accuracy in the diagnosis of ovarian tumor. Predictive values for positive (84.6) and negative (94.1) tests were also found to be quite high. Pulsatility index was found to be moderate accuracy (63.3%) with cutoff <1 for malignancy, however low predictive value for a positive test (38.5) questions its use. Both CA-125 and Novel Index showed similar level of sensitivity and specificity. Although Novel Index is derivative of CA125, Novel Index demonstrated better diagnostic accuracy and negative predictive value. The cutoff for CA 125 was mandated as 83.58. With the value the sensitivity is 76.9% and the specificity is 94.1%. RI is found to be more sensitive in detection of positive cases (Malignant) and CA125 is found to be more accurate in detection of negative cases (Benign). However a combination could be tried to make a better detection.
Color Doppler ultra-sonography and CA125 excels in different tasks, the study concludes in favor of concurrent use of the methods for improving efficacy and thus early detection of ovarian malignancy.
卵巢恶性肿瘤的早期检测具有重要的临床意义。高死亡率归因于卵巢癌早期检测的困难。当前研究试图评估彩色多普勒超声检查和血清CA - 125水平作为卵巢肿瘤诊断工具的准确性。
在这项横断面研究中，招募了60例连续就诊于孟加拉国谢赫穆吉布医学大学妇产科的卵巢肿瘤患者。研究参与者中，23.3%属于16 - 25岁年龄组，20%属于26 - 35岁年龄组，46 - 55岁和>55岁年龄组各占23.30%。所有招募的患者均来自住院部且已接受手术。切除术后，常规组织病理学显示43.30%为恶性（n = 26），56.7%（n = 34）为良性卵巢病变。从临床病史表、双合诊盆腔检查、血清CA 125水平、阻力指数（RI）、搏动指数（PI）、彩色多普勒超声的新指数以及术后组织病理学检查结果中收集数据。计算彩色多普勒超声、CA125在鉴别良性和恶性卵巢肿瘤诊断中的敏感性、特异性、准确性、阳性和阴性预测值。使用受试者操作特征分析评估RI、PI、CA 125和新指数在诊断卵巢肿瘤（良性或恶性）中的准确性。
当临界值<0.5时，阻力指数能够检测出92%的恶性病例（敏感性91.7），并能正确检测出89%（特异性88.9）的良性病例，这意味着在卵巢肿瘤诊断中准确率为90%。阳性（84.6）和阴性（94.1）检测的预测值也相当高。发现搏动指数对于恶性肿瘤临界值<1时准确性中等（63.3%），然而阳性检测的预测值较低（38.5），这对其应用提出了质疑。CA - 125和新指数显示出相似的敏感性和特异性水平。尽管新指数是CA125的衍生指标，但新指数显示出更好的诊断准确性和阴性预测值。CA 125的临界值设定为83.58。在此值时，敏感性为76.9%，特异性为94.1%。发现RI在检测阳性病例（恶性）时更敏感，而CA125在检测阴性病例（良性）时更准确。然而，可以尝试联合使用以进行更好的检测。
彩色多普勒超声和CA125在不同任务中表现出色，该研究得出结论支持同时使用这些方法以提高疗效，从而早期检测卵巢恶性肿瘤。
