García Enguídanos A, Crespo Azanza E, Díaz Recaséns J, Lobo Samper F, Jorge Herrero J A, Sáinz de la Cuesta Abbad R
Servicio de Obstetricia y Ginecología, Fundación Jiménez Díaz, Madrid.
Rev Clin Esp. 1998 Aug;198(8):502-5.
To determine the usefulness of diagnostic tests performed before a second look laparotomy in patients with epithelial ovarian cancer.
Thirty-three patients with epithelial ovarian cancer attended at Fundación Jiménez Díaz from 1984 to 1995 were studied. All patients initially underwent cyto-reducing surgery, followed by at least six platinum-based chemotherapy cycles. Prior to second look laparotomy all patients were evaluated by computerized tomography (CT) of the pelvis and abdomen, CA-125, pelvic-abdominal echography and gynecologic examination. To evaluate sensitivity, specificity, positive predictive value and negative predictive value for each test contingency tables were used.
Eleven out of the 33 second look patients (33%) had histologic or cytologic evidence of disease. Six out of the eleven positive second look had a positive CT prior to second look (sensitivity of 55%). CT showed lack of disease in 21 out of the 22 negative second look cases (specificity 95%). Positive and negative predictive values of the test were 86% and 81%, respectively. Nine cases out of the 28 who had a CA-125 obtained had a positive second look. Four out of these nine patients had an increased CA-125 value (sensitivity 44%, specificity 95%, positive predictive value 80% and negative predictive value 78%). Sensitivity, specificity, positive predictive value and negative predictive value of physical examination and echography were 36%, 100%, 100%, 76% and 27%, 95%, 75%, 72%, respectively. On the other hand, sensitivity, specificity, positive predictive value and negative predictive value of all tests taken together were 64%, 91%, 78% and 83%, with a rate of false-negative results of 17% and a rate of false-positive results of 22%.
Pelvic-abdominal computerized tomography, CA-125, pelvic-abdominal echography and gynecologic examination can be an alternative to second look laparotomy for the diagnosis of persistence or recurrence of the disease in patients with epithelial ovarian cancer.
确定上皮性卵巢癌患者二次剖腹探查术前诊断性检查的效用。
对1984年至1995年在希门尼斯·迪亚斯基金会就诊的33例上皮性卵巢癌患者进行研究。所有患者最初均接受了肿瘤细胞减灭术，随后进行至少六个周期的铂类化疗。在二次剖腹探查术前，所有患者均接受了盆腔和腹部计算机断层扫描（CT）、CA-125、盆腔-腹部超声检查和妇科检查。为评估每项检查的敏感性、特异性、阳性预测值和阴性预测值，使用了列联表。
33例二次探查患者中有11例（33%）有疾病的组织学或细胞学证据。11例二次探查阳性患者中有6例在二次探查前CT呈阳性（敏感性55%）。CT显示22例二次探查阴性病例中有21例无疾病（特异性95%）。该检查的阳性预测值和阴性预测值分别为86%和81%。28例进行CA-125检测的患者中有9例二次探查呈阳性。这9例患者中有4例CA-125值升高（敏感性44%，特异性95%，阳性预测值80%，阴性预测值78%）。体格检查和超声检查的敏感性、特异性、阳性预测值和阴性预测值分别为36%、100%、100%、76%和27%、95%、75%、72%。另一方面，所有检查综合起来的敏感性、特异性、阳性预测值和阴性预测值分别为64%、91%、78%和83%，假阴性率为17%，假阳性率为22%。
盆腔-腹部计算机断层扫描、CA-125、盆腔-腹部超声检查和妇科检查可作为上皮性卵巢癌患者疾病持续或复发诊断的二次剖腹探查替代方法。
