Schutter E M, Kenemans P, Sohn C, Kristen P, Crombach G, Westermann R, Môbus V, Kaufmann M, Caffier H, Schmidt-Rhode P
Department of Obstetrics and Gynaecology, Academic Hospital Free University, Amsterdam, The Netherlands.
Cancer. 1994 Aug 15;74(4):1398-406. doi: 10.1002/1097-0142(19940815)74:4<1398::aid-cncr2820740433>3.0.co;2-j.
In a prospective study, the differential diagnostic potential of pelvic examination, ultrasound, and serum CA 125 assay in postmenopausal patients presenting with a pelvic mass was assessed.
A total of 228 patients were evaluated preoperatively in an international, multicenter, prospective study using a standard protocol for pelvic examination, transvaginal (occasionally additional abdominal) ultrasound, and serum CA 125 determination with a cut-off level of 35 U/ml.
Ninety-five malignant (41.7%) and 127 benign (55.7%) pelvic tumors were found in addition to 6 borderline ovarian tumors (2.6%) in the 228 patients. Seventy-two patients had ovarian carcinoma, 49 of whom were International Federation of Gynecology and Obstetrics Stage III or IV. Borderline tumors were excluded from the statistical calculations. The individual accuracy of pelvic examination, ultrasound, and serum CA 125 in discriminating between benign and malignant pelvic masses was approximately the same (76, 74, and 77%, respectively). Using logistic regression analysis, the power of pelvic examination appeared to be the most relevant factor (adjusted odds ratio, 9.2), followed by serum CA 125 (odds ratio, 5.6), and ultrasound (odds ratio, 4.9). Age appeared to be nonpredictive. No cancer was found in any patient in whom all three methods scored negative (n = 53; positive predictive value for malignancy = 0 and 95%; confidence interval, 0-7).
The combined use of pelvic examination, ultrasound, and serum CA 125 leads to improved discrimination between malignant and benign pelvic masses, because malignancy can be excluded when all three examination methods are negative. A change to a more patient-tailored surgical approach could be considered in those cases.
在一项前瞻性研究中，评估了盆腔检查、超声检查和血清CA 125检测对绝经后盆腔肿块患者的鉴别诊断潜力。
在一项国际多中心前瞻性研究中，采用盆腔检查、经阴道（偶尔附加腹部）超声检查和血清CA 125测定（临界值为35 U/ml）的标准方案，对228例患者进行术前评估。
228例患者中，除6例交界性卵巢肿瘤（2.6%）外，发现95例恶性盆腔肿瘤（41.7%）和127例良性盆腔肿瘤（55.7%）。72例患者患有卵巢癌，其中49例为国际妇产科联盟III期或IV期。交界性肿瘤被排除在统计计算之外。盆腔检查、超声检查和血清CA 125鉴别良性和恶性盆腔肿块的个体准确性大致相同（分别为76%、74%和77%）。采用逻辑回归分析，盆腔检查的作用似乎是最相关的因素（调整比值比为9.2），其次是血清CA 125（比值比为5.6）和超声检查（比值比为4.9）。年龄似乎无预测价值。在所有三种方法均为阴性的任何患者中均未发现癌症（n = 53；恶性肿瘤的阳性预测值 = 0，95%置信区间为0 - 7）。
盆腔检查、超声检查和血清CA 125联合使用可提高对恶性和良性盆腔肿块的鉴别能力，因为当所有三种检查方法均为阴性时可排除恶性肿瘤。在这些病例中可考虑改为更适合患者的手术方法。
