From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.).
Radiographics. 2021 Oct;41(6):1839-1856. doi: 10.1148/rg.2021210005.
The ability to accurately detect early ovarian cancer and subsequently monitor treatment response is essential to improving survival for patients with ovarian malignancies. Several serum tumor markers (STMs)-including cancer antigen 125 (CA-125), human epididymis protein 4 (HE4), cancer antigen 19-9 (CA 19-9), and carcinoembryonic antigen (CEA)-have been used as a noninvasive method of identifying ovarian cancer in conjunction with imaging. Although current guidelines do not recommend use of STMs as screening tools for ovarian cancer, these markers have clinical utility in both diagnosis and surveillance for women with ovarian cancer. CA-125 is the most commonly used STM; its level may be elevated in several types of ovarian cancer, including epithelial cell tumors, carcinosarcoma, teratomas, and secondary ovarian malignancies. An elevated level of CA 19-9 is associated with clear cell tumors, teratomas, and secondary malignancies. CEA is most commonly associated with mucinous ovarian cancers. Finally, HE4 is being increasingly used to identify certain subtypes of epithelial ovarian cancers, particularly serous and endometrioid tumors. Diagnosis of ovarian cancers relies on a combination of CA-125 levels and US findings, which include a large adnexal mass or high-risk features, including septa and increased vascularity. CT is preferred for staging and is used along with PET and STM monitoring for surveillance. Increasingly, MRI is being used to characterize ovarian lesions that are indeterminate at US or CT. The future of STM testing involves development of "liquid biopsies," in which plasma samples are analyzed for evidence of tumors, including circulating tumor DNA or tumor cells and tumor micro-RNA. When combined with traditional imaging techniques, liquid biopsies may lead to earlier diagnosis and improved survival. RSNA, 2021.
准确检测早期卵巢癌并随后监测治疗反应对于提高卵巢恶性肿瘤患者的生存率至关重要。几种血清肿瘤标志物（STM）-包括癌抗原 125（CA-125）、人附睾蛋白 4（HE4）、癌抗原 19-9（CA 19-9）和癌胚抗原（CEA）-已被用作与影像学相结合的识别卵巢癌的非侵入性方法。尽管目前的指南不建议将 STM 作为卵巢癌的筛查工具，但这些标志物在诊断和监测卵巢癌患者方面具有临床应用价值。CA-125 是最常用的 STM；其水平可能在几种卵巢癌中升高，包括上皮细胞肿瘤、癌肉瘤、畸胎瘤和继发性卵巢恶性肿瘤。CA 19-9 水平升高与透明细胞肿瘤、畸胎瘤和继发性恶性肿瘤有关。CEA 最常与黏液性卵巢癌相关。最后，HE4 越来越多地用于识别某些上皮性卵巢癌亚型，特别是浆液性和子宫内膜样肿瘤。卵巢癌的诊断依赖于 CA-125 水平和 US 发现的结合，包括附件肿块较大或存在高危特征，包括间隔和血管增多。CT 是分期的首选方法，与 PET 和 STM 监测一起用于监测。越来越多的 MRI 用于特征不明的卵巢病变的定性，这些病变在 US 或 CT 上不确定。STM 检测的未来涉及“液体活检”的发展，即分析血浆样本以寻找肿瘤证据，包括循环肿瘤 DNA 或肿瘤细胞和肿瘤 micro-RNA。当与传统成像技术结合使用时，液体活检可能会导致更早的诊断和改善的生存。RSNA，2021 年。
