Risk for Malignant and Borderline Ovarian Neoplasms Following Basic Preoperative Evaluation by Ultrasonography, Ca125 Level and Age

Objective: To verify the basic preoperative evaluation in the discrimination between benign and malignantadnexal masses in our clinical practice. Materials and
Methods: Data were collected on the records of 636 womenwith adnexal masses who had undergone surgery either by open or endoscopic approaches. Those with obvioussigns of malignancy, any history of cancer, emergency surgeries without basic evaluation were excluded. Thepreoperative features by age, ultrasound and serum Ca125 level were compared with final histopathologicaldiagnosis at the four departments of the institution. These are the general gynecology (Group 1: exploratorylaparotomy), the gynecologic endoscopy (Group 2: laparoscopy and adnexectomy), the gynecological oncology(Group 3: staging laparotomy) and the gynecologic endocrinology and infertility (Group 4: laparoscopy andcystectomy).
Results: There were simple and complex cyst rates of 22.3% and 77.2%, respectively. There were86.3% benign, 4.1% (n:20) borderline ovarian tumor (BOT) and 6.4% (n:48) malignant lesions. There were 3BOT and 9 ovarian cancers in Group 1 and one BOT and two ovarian cancer in the Group 2. During the surgery,15 BOT (75%) and 37 ovarian cancer (77%) were detected in the Group 3, only one BOT was encountered in theGroup 4. The risk of rate of unsuspected borderline or focally invasive ovarian cancer significantly increased byage, size, complex morphology and Ca125 (95% CI, OR=2.72, OR=6.60, OR=6.66 and OR=4.69, respectively).
Conclusions: Basic preoperative evaluation by comprehensive ultrasound imaging combined with age andCa125 level has proved highly accurate for prediction of unexpected malignancies. Neither novel markers nornew imaging techniques provide better information that allow clinicians to assess the feasibility of the plannedsurgery; consequently, the risk of inadvertent cyst rupture during laparoscopy may be significantly decreasedin selected cases.