Ultrassonografia e CA-125 como preditores de malignidade em mulheres com tumores anexiais / Ultrasonography and CA-125 as predictors of malignancy in women with adnexal tumors

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

27/02/2012

RESUMO

Introduction: Ovarian cancer is the deadliest gynecologic neoplasm and it is the fifth leading cause of cancer-related deaths in women. The survival rate is low, not exceeding 40% after 5 years and is directly related to tumor stage at the time of diagnosis. To date there is still no screening method that is effective at reducing mortality from this neoplasm. However, ultrasonography and CA-125 are widely used in the differentiation of adnexal tumors. Despite all studies conducted with US, there is no consensus on the criteria to be used in the preoperative differentiation of these tumors. When an adnexal tumor is found, the gynecologist should assess the risk of tumor malignancy to institute a more appropriate preoperative preparation, predict the extension of the surgical procedure along with its potential complications. Objective: to evaluate ultrasound criteria of Timmerman et al. and CA-125 values as indicators of malignancy risk in women with adnexal tumors. Subjects and methods: a prospective study was conducted, including 105 women with 112 adnexal tumors. These women underwent peripheral blood collection for CA-125 measurement and ultrasound (US). US evaluation was performed by using standardized classification. Information on more than 40 morphologic and Doppler variables was obtained. Adnexal tumors were then classified according to 5 features of benign disorders: (B1) unilocular ovarian cyst, (B2) presence of solid components in which the largest solid component is <7mm, (B3) presence of acoustic shadows, (B4) multilocular tumor with smooth walls measuring less than 100mm and (B5) no detectable Doppler flow (color score 1). The 5 features of malignancy were: (M1) irregular solid tumor, (M2) presence of ascites, (M3) presence of at least 4 papillary projections, (M4) irregular solid multilocular tumor with largest measurement ? 100mm and (M5) high color content on Doppler exam (color score 4). Histopathological analysis of surgical specimens was considered the gold standard. Results: among the 112 tumors, 81 (72.3%) were benign and 31 (27.7%) were malignant. Ultrasound criteria were applicable to 91 (81.2%) of the tumors and resulted in a sensitivity of 90% and specificity of 87%. In tumors not classifiable according to criteria, we used subjective assessment to classify these tumors as benign or malignant, obtaining a sensitivity of 66.7% and specificity of 75%. CA-125 had a sensitivity of 69% and specificity of 87.8%. In tumors sonographically classified as benign, both age and CA-125 values did not contribute any further to the detection of histologically malignant tumors. In contrast, in the group of tumors classified as malignant on ultrasound, the age and the CA-125 values contributed significantly to the detection of histologically malignant tumors (p = 0.025). Conclusions: The majority of tumors may be correctly classified according to ultrasound criteria, with sensitivity and specificity similar to those of the original study by Timmerman. Measurement of CA-125 levels alone showed a worse performance than US evaluation in discriminating adnexal tumors. CA-125 measurement associated with age and ultrasound criteria in a logistic regression model, resulted in a better performance in discriminating the sonographically malignant tumors

ASSUNTO(S)

ultrasonography cancer ovários - tumores ultrassonografia cancer ovary

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