Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil.
Section of Imaging, Sumaré State Hospital, State University of Campinas, Sumaré, São Paulo, Brazil.
PLoS One. 2023 Mar 16;18(3):e0283212. doi: 10.1371/journal.pone.0283212. eCollection 2023.
To provide a straightforward approach to the sequential use of ultrasound (US), magnetic resonance (MR) and serum biomarkers in order to differentiate the origin of pelvic masses, making the most efficient use of these diagnostic resources.
This is a cross-sectional study with 159 patients (133 with ovarian and 26 with non-ovarian tumors) who underwent surgery/biopsy for an adnexal mass. Preoperative CA125 and CEA serum measurements were obtained and a pelvic/abdominal ultrasound was performed. Preoperative pelvic MR studies were performed for all patients. Morphological and advanced MR sequences were obtained. Using a recursive partitioning algorithm to predict tumor origin, we devised a roadmap to determine the probability of non-ovarian origin using only statistically significant US, laboratory and MR parameters.
Upfront US classification as ovarian versus non-ovarian and CA125/CEA ratio were significantly associated with non-ovarian tumors. Signal diffusion (absent/low versus high) was the only MR parameter significantly associated with non-ovarian tumors. When upfront US designated a tumor as being of ovarian origin, further MR signal diffusion and CA125/CEA ratio were corrected nearly all US errors: patients with MR signal diffusion low/absent and those with signal high but CA125/CEA ratio ≥25 had an extremely low chance (<1%) of being of non-ovarian origin. However, for women whose ovarian tumors were incorrectly rendered as non-ovarian by upfront US, neither MR nor CA125/CEA ratio were able to determine tumor origin precisely.
MR signal diffusion is an extremely useful MR parameter to help determine adnexal mass origin when US and laboratory findings are inconclusive.
提供一种连贯的方法，即序贯使用超声（US）、磁共振（MR）和血清生物标志物来区分盆腔肿块的来源，从而最有效地利用这些诊断资源。
这是一项横断面研究，共纳入 159 例（133 例卵巢来源，26 例非卵巢来源）接受手术/活检的附件肿块患者。术前获得 CA125 和 CEA 血清测量值，并进行盆腔/腹部超声检查。所有患者均行术前盆腔 MR 检查。获得形态学和高级 MR 序列。使用递归分区算法预测肿瘤来源，我们设计了一个路线图，仅使用具有统计学意义的 US、实验室和 MR 参数来确定非卵巢来源的概率。
初始 US 分类为卵巢或非卵巢以及 CA125/CEA 比值与非卵巢肿瘤显著相关。信号扩散（低/无与高）是唯一与非卵巢肿瘤显著相关的 MR 参数。当初始 US 将肿瘤指定为卵巢来源时，进一步的 MR 信号扩散和 CA125/CEA 比值几乎纠正了所有 US 错误：MR 信号扩散低/无且 CA125/CEA 比值≥25 的患者，非卵巢来源的可能性极低（<1%）。然而，对于那些被初始 US 错误地判断为非卵巢来源的卵巢肿瘤患者，MR 和 CA125/CEA 比值都无法准确确定肿瘤来源。
当 US 和实验室检查结果不确定时，MR 信号扩散是一种非常有用的 MR 参数，有助于确定附件肿块的来源。
