Lack of HPV in Benign and Malignant Epithelial Ovarian Tumors in Iran

Background: Ovarian epithelial tumors one of the most common gynecological neoplasms; we here evaluated the presence of HPV in benign and malignant examples. Methods: In this cross-sectional study the records of 105 patients with epithelial ovarian tumors (benign and malignant) referred to Imam Hossein University Hospital from 2012 to 2015 were evaluated along with assessment of the presence of the HPV infection using PCR. Results: Among 105 patients, comprising 26 (24.8%) with malignant and 79 (75.2%) with benign lesions, the factors found to impact on malignancy were age at diagnosis, age at first pregnancy, number of pregnancies and hormonal status. However, malignancies was not related to abortion, late menopause, and early menarche. In none of the ovarian tissues (benign and malignant) was HPV DNA found. Conclusion: In this study HPV DNA could not be found in any epithelial ovarian tumors (benign and malignant) removed from 105 women; more studies with larger sample size are needed for a definite conclusion.     

幼少女卵巢肿瘤的临床特点分析

目的：探讨幼少女卵巢肿瘤的临床特点。方法：回顾性分析我院1987年1月-2003年12月问收治的年龄未满18岁的卵巢肿瘤患者124例。其中，良性肿瘤88例，交界性肿瘤3例，恶性肿瘤33例。结果：患者年龄3岁-18岁，平均14．3岁；10岁以下、11岁-14岁、15岁-18岁三个年龄段，各组卵巢肿瘤所占的比例分别为11．29％、29．03％、59．68％；而在各组中生殖细胞肿瘤所占的比例分别为100%、63．89％、66．22％，上皮性肿瘤所占的比例分别为0％、33．33％、32．64％；恶性肿瘤所占比例分别为35．71％、41．67％、17．57％。临床表现以腹痛、腹胀、腹部包块为主要表现的占了82．26％；冰冻切片对肿瘤的良恶性诊断符合率高（98．2％）。结论：幼少女卵巢肿瘤发生率随年龄的增长而升高。组织类型以生殖细胞肿瘤为主，但随着年龄增长，上皮性肿瘤所占的比例升高。临床表现方面由患儿或家长发现腹部包块的占了很大比例，提示我们要重视对幼少女进行生殖系统检查。冰冻切片检查对决定手术范围有着重要的意义。     

Accuracy of Intra-operative Frozen Sections in the Diagnosis of Ovarian Masses

The accuracy of frozen section diagnosis in the intraoperative evaluation of ovarian masses is very importantwith regard to surgeon selection of appropriated operating procedures. For evaluation in our institute, therecords of 127 patients with ovarian masses submitted for intraoperative frozen sections between January 2001and December 2005 were reviewed. After exclusion of 4 completely infarcted masses and 11 cases with deferredfrozen section diagnoses, 112 were analyzed for diagnostic accuracy by comparing with the final histologicresults. We found sensitivity in the diagnosis of benign, borderline and malignant tumors to be 100%, 84%, and92 %, respectively, with specificities of 92.7%, 97.9%, and 100%, respectively. The overall accuracy with frozensections was 94 %. Among 18 patients with deferred or discordant diagnoses, mucinous tumors accounted for72 % of cases. No over-diagnosis of malignancy or misdiagnosis of metastatic lesions as primary ovarian cancerby frozen sections was observed. In conclusion, the accuracy of intraoperative frozen section for the diagnosisof ovarian masses is high. Frozen sections also help in the evaluation of metastatic tumors to the ovary. Mucinoustumors constitute an important group causing diagnostic discrepancies.     

Ultrasonography and Computed Tomography for Management of Adnexal Masses in Iranian Patients with Suspected Ovarian Cancer: Results of a Prospective Study

Background: To determine and compare the accuracy of sonographic and computerized tomography (CT)scan assessments in distinguishing between benign and malignant adnexal masses in an under-studied populationof Iranian patients. Methods: Transabdominal sonography (TAS) and CT reports of 75 women with adnexalmasses (34 malignant, and 41 benign) who were consecutive operated patients at a tertiary gynecology cancercenter (Tehran, Iran) were examined. The sonography examinations were operated by a radiologist experiencedin the gynecologic oncology field. Biomarkers were determined in blood samples. For CT and TAS, to classifymasses as malignant or benign, receiver operating curves (ROC) were assessed and the areas under the curveswere compared. Results: For TAS the sensitivity, specificity, positive predictive value and negative predictivevalue were 91%, 68%, 71% and 90%, respectively. For CT scans the results were 85%, 56 %, 62% and 83%,respectively. The AUC of sonography assessment to diagnose malignancy was significantly higher than that ofCT scan (0.8 vs.0.71; p<0.05). Conclusion: TAS is a sensitive method for preoperative detection and staging ofsuspected ovarian cancer. Biomarkers and CT scan imaging add no additional findings for pre-operativecharacterization of ovarian masses.     

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.     

Diagnostic Performance of Serum Human Epididymis Protein 4 (HE4) for Prediction of Malignancy in Ovarian Masses

Background: Early diagnosis of ovarian cancer is essential for long term disease control and mortality reduction.This has been achieved using tumor markers like cancer antigen 125 (CA-125) which is elevated in malignant as wellas non-malignant conditions. This dilemma led to efforts towards development of newer markers like serum humanepididymis secretory protein E4 (HE4). Present study aimed to evaluate role of HE4 in diagnosing ovarian cancersand comparing it with CA-125. Methods: Serum samples from 67 patients with ovarian cancer, 42 with benignovarian masses and 26 healthy controls were collected preoperatively and tested for serum HE4 levels and CA-125levels. Diagnostic performance of both tumor markers (HE4/CA-125) to diagnose malignancy in ovarian masses wascalculated and compared to each other. Results: Mean CA-125 and HE4 levels were significantly higher in patientswith ovarian cancer than in those with benign disease (p<0.001) or healthy controls (p< 0.001). Serum HE4 levelssignificantly increased in epithelial ovarian cancers when compared to non-epithelial ovarian cancers (p<0.01). Usingbenign control as comparison, receiver operating characteristic curve (ROC) was generated to predict a cut-off valuefor diagnosing malignancy for serum HE4 and CA-125. Compared to CA-125, HE4 had a similar sensitivity (83.6%vs. 85.10%) and higher specificity (100% vs. 90.48%); combination of serum HE4 and CA-125 improved the sensitivityto detect ovarian cancer to 92.54%. Sensitivity of HE4 to detect early stage ovarian cancer was superior to CA-125(92.61% vs. 63.41%). Conclusion: Serum HE4, a novel tumor marker, discriminated epithelial ovarian cancer frombenign ovarian masses. HE4 levels were related to the stage and histological types with the lowest levels in mucinousepithelial ovarian cancer and non-epithelial malignancy. Measuring serum HE4 levels alongwith CA-125 may providehigher accuracy for detecting epithelial ovarian cancer particularly in the early stages.     

Roles of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios in the Early Diagnosis of Malignant Ovarian Masses

Background: The present study aimed to investigate the utility and importance of the various parameters of complete blood count panel for benign-malignant differentiation of adnexal masses. Materials and Methods: This retrospective study involved 316 patients with documented benign and 253 patients with malignant adnexal masses who underwent primary surgical treatment at a tertiary referral center. Prior to the study, all benign and malignant cases were compared within their own groups and then the benign and malignant cases were compared to each other. For all cases, cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), neutrophil, lymphocyte, platelet and CA-125 parameters, and the results were compared in regards to the groups. Results: NLR, PLR, neutrophil, CA-125, and platelet values were higher in the malignant compared to the benign cases (p<0.01). The lymphocyte value was lower in the malignant cases (p<0.01). No significantdifferences were found for basophils and eosinophils (p > 0.05). For CA-125, the sensitivity, specificity, PPV and NPV for all cases were 78%, 62%, 62% and 78%, respectively. For NLR, they were 65.6%, 72.1%, 65.3%, and 72.3%, and for PLR, 48%, 81%, 67%, and 66%. Additionally, the sensitivity and specificity were 55% and 77% for CA-125, 66% and 58% for NLR, and 61% and 58% for PLR in early malignant cases. Conclusions: NLR and PLR appear to be useful methods that can be applied together with CA-125 due to the relatively high sensitivity values for the malign-benign differentiation of ovarian masses. Although the specificity of these parameters is lower than CA-125, especially in cases with early malignant ovarian pathology, their sensitivity being higher is promising for the early diagnosis of ovarian cancer. It can be used to detect ovarian malignancies in the early stages, and it will increase the treatment options and improve survival rates.     

HE4 and Mesothelin: Novel Biomarkers of Ovarian Carcinoma in Patients with Pelvic Masses

Objectives: To evaluate the utility of novel serum tumor markers, HE4 and mesothelin either alone or incombination with CA125 in diagnosis and early detection of ovarian carcinoma in patients with pelvic masses.Subjects and methods: Sera were obtained preoperatively from 65 women underwent surgery for a pelvic massand 25 age- and menopausal status-matched healthy women. All samples were analyzed for levels of CA125,HE4, and mesothelin by serum based immunoassays and patients results were compared to final pathologyfindings. Results: Of 65 patients with pelvic masses; 41 had histologically diagnosed ovarian cancer, and 24 hadbenign ovarian diseases. The studied tumor markers were significantly increased in malignant compared tobenign cases and healthy subjects, and in benign cases compared to healthy subjects (p<0.001). Based uponReceiver operator characteristic (ROC) curves analysis, HE4 had the highest sensitivity as a single marker indetecting ovarian malignancy (82.9%) and early stage malignancy (76.9%), followed by CA125, then mesothelin.The combination of HE4 and CA125 gave the highest sensitivity in detecting ovarian carcinoma and early stagedisease (90.2%, 84.6% respectively). Addition of mesothelin to this combination did not show any improvementin the sensitivity. Conclusions: As a single marker, HE4 had the highest sensitivity for detecting ovarian carcinomaspecially early stage disease. Combined CA125 and HE4 was a more accurate predictor of ovarian malignancythan either alone.     

The Ovarian Tumor Index predicts risk for malignancy

BACKGROUND: Prediction of ovarian malignancy by ultrasonographic findings and patient age in the scenario of clinically suspected adnexal masses is a desirable goal. METHODS: Prospective evaluation of clinically suspected adnexal masses was performed with transvaginal ultrasound using real-time, Doppler velocimetry, and color-flow mapping. Continuous ultrasound variables included ovarian volume, the Sassone morphology scale, and Doppler determination of angle-corrected systole, diastole, and time-averaged velocity, in addition to patient age. The Doppler pulsatility index (PI), vessel location, presence of a diastolic notch, and echogenic predominance of the lesion, suggestive of dermoid, also were assessed. RESULTS: Of 244 women with follow-up, 214 had nonmalignant findings (85 of which were benign neoplasms), and 30 had malignant neoplasms. Age and all ultrasound continuous variables except systole were found to be statistically significant (P < 0.05) between patients with both malignant (N = 30) and nonmalignant masses (N = 214), as well as those with benign (N = 85) and malignant (N = 30) neoplasms. By adding the continuous measures (age [in years], ovarian volume [mL], and Sassone morphology scale [1-15]) and weighting other variables ([-10] x PI, central or septal location [+10], peripheral location [-10], and echogenic [-10]), a receiver operating characteristic curve was generated (area under the curve = 0.91), which was found to be discriminating, predictive, and able to replicate the more complex logistic regression model. Prediction of malignancy was generated from the population-based data of the current study. CONCLUSIONS: The Ovarian Tumor Index, which combines patient age with specific ultrasonographic markers, is an accurate method for predicting ovarian malignancy in the clinical scenario of suspected adnexal masses.     

Pre-Operative Evaluation of Ovarian Tumors by Risk of Malignancy Index,CA125 and Ultrasound

Purpose: To evaluate the diagnostic performances of risk of malignancy index (RMI), CA-125 and ultrasoundscore in differentiating between benign and borderline or malignant ovarian tumors and find the best diagnostictest for referral of suspected malignant ovarian cases to gynaecologic oncologists. Materials and Methods: Thisprospective study covered 467 women with pelvic tumors scheduled for surgery at our hospital between July2011 and July 2013. The RMI was obtained from ultrasound score, CA125 and menopausal status. The diagnosticvalues of each parameter and the RMI were determined and compared using Statistical Packages for SocialSciences Version 14.0.1. Results: In our study, 61% of ovarian tumors were malignant in the post-menopausalage group. RMI with a cut-off 150 had sensitivity of 84% and specificity of 97% in detecting ovarian cancer.CA-125>30 had a sensitivity of 84% and a specificity of 83%. An ultrasound score more than 2 had a sensitivityof 96% and specificity of 81%. RMI had the least false malignant cases thus avoiding unnecessary laparotomies.Ultrasound when used individually had the best sensitivity but poor specificity. Conclusions: Our study hasdemonstrated the RMI to be an easy, simple and applicable method in the primary evaluation of patients withpelvic masses. It can be used to refer suspected malignant patients to be operated by a gynaecologic oncologist.Other models of preoperative evaluation should be developed to improve the detection of early stage invasive,borderline and non-epithelial ovarian cancers.     

Role of Ultrasound in Characterization of Ovarian Masses

Background: Ovarian cancer is the second most common malignancy in Pakistani women, accounting for 4%of all cancers in the female population. The aim of this study was to determine sensitivity, specificity, positive andnegative predictive values and 95% confidence intervals for ultrasound in characterization of ovarian masses inpatients presenting at public and private tertiary care hospitals in Karachi, Pakistan. Materials and Methods:We adopted a cross-sectional analytical study design to retrospectively collect data from January 2009-11 frommedical records of two tertiary care hospitals. Using a non-probability purposive sampling technique, werecruited a sample of 86 women aged between 15 and 85 years fulfilling inclusion criteria with histopathologicallyproven ovarian masses presenting for an ultrasound examination in our radiology departments. Results: Ourretrospective data depicted sensitivity and specificity of ultrasound to be 90.7%, 95%CI (0.77, 0.97) and 91.4%,95%CI (0.76, 0.98) respectively. Positive predictive value was 93%, 95%CI (0.79, 0.98) and negative predictivevalue was 89%, 95%CI (0.73, 0.96). A total of 78 ovarian masses were detected, out of which 42 were malignantand 36 were benign. Conclusions: Results of our study further reinforce the conclusion that ultrasound shouldbe used as an initial modality of choice in the workup of every woman suspected of having an ovarian mass. Itnot only results in decreasing the mortality but also avoids unnecessary surgical interventions.     

Measuring Ovarian Escape in Premenopausal Estrogen Receptor-Positive Breast Cancer Patients on Ovarian Suppression Therapy

PurposeThis study evaluated the proportion of premenopausal women who experience persistent ovarian escape (OE) while receiving ovarian suppression (OS) therapy for estrogen receptor‐positive (ER+) breast cancer treatment. The study also examined clinical factors that may predispose to higher risk of persistent OE.Materials and MethodsThis was a retrospective, “real‐world” study to evaluate premenopausal women receiving adjuvant endocrine OS therapy. The primary objective was to measure the percentage of persistent OE within the first 3 months of OS injections (using either leuprolide or goserelin). The secondary objective was to associate baseline clinical data (age, body mass index [BMI], and previous chemotherapy) with the probability of OE.ResultsOf the 46 patients included in this analysis, 11 (23.9%) women did not achieve OS within 3 months. Three women (6.5%) remained in OE at 12 months. Older age (odds ratio, 0.86; confidence interval, 0.76–0.98, p = .024) was associated with lower chance of developing OE. BMI, previous chemotherapy, and drug used (tamoxifen versus aromatase inhibitor) did not correlate with the likelihood of OE in this patient cohort.ConclusionAmong the premenopausal women who did not attain complete ovarian suppression, young age was a significant risk factor for likelihood of OE. Although the clinical relevance of this finding is not yet known, it should prompt further studies to determine whether inadequate OS is associated with higher recurrence risk for patients with ER+ breast cancer.Implications for PracticeBecause up to a quarter of premenopausal women do not attain adequate ovarian suppression within the first 3 months of gonadotropin‐releasing hormone (GnRH) agonist therapy, bloodwork should be checked to ascertain hormone levels prior to starting aromatase inhibitor therapy, and at regular intervals, for these women.     

Comparison of Two Ovarian Malignancy Prediction Models Based on Age Sonographic Findings and Serum Ca125 Measurement

Objective: The aim of our study is to compare an ovarian malignancy prediction model based on age andfour sonographic findings (OMPS1) with a new model called OMPS2 which differs just by adding serum CA125measurement to (OMPS1). Methods: In a cross sectional comparative study OMPS1 was validated in 830 operatedovarian masses within a 3 years period (2006-2009). Logistic regression analysis was used to construct OMPS2based on OMPS1 adding serum CA125 findings. The area under the curve for two models was compared in411 patients. Results: OMPS2 was calculated as follows: OMPS1 + 1.444 (if serum CA125= 36-200) or 3.842 (ifserum CA125 is more than 200). AUC of OMPS2 was increased to 84.3% (CI 95% 78.1- 89.8) in comparison toOMPS1 with AUC of 78.1% (CI 95% 71.8-84.5). Conclusion: Our second model is more accurate in predictionof ovarian malignancy, compared with our first model.     

多层螺旋CT对原发性卵巢癌的诊断价值

目的 探讨多层螺旋CT(MSCT)对原发性卵巢癌的诊断价值.方法 选取卵巢肿块患者110例,均行MSCT检查,并与病理结果 进行比较.结果110例患者中,良性肿块患者42例,恶性肿块患者68例;CT诊断与病理结果一致性Kappa值为0.584,P<0.05,CT诊断卵巢恶性肿块的灵敏度、特异度、阳性预测值、阴性预测值和...     

Adnexal masses in pregnancy

With the widespread use of routine abdominal ultrasound examination during pregnancy, adnexal masses are observed with increasing frequency. Most patients are clinically asymptomatic at the time of presentation, and most of the adnexal masses detected during early pregnancy disappear during the first 16 weeks of pregnancy. Ovarian tumors are estimated to occur in about 1 in 1,000 pregnancies and of these 3% are malignant. Here we present an overview about frequency, diagnostic procedures and pathological characteristics of these ovarian tumors. Moreover, current modalities for treatment during pregnancy are summarized. Surgical treatment of the adnexal masses has to be performed with adequate staging and debulking equal to the treatment of non-pregnant women. However, whereas during organogenesis abortion has to be considered prior to chemotherapy, later in pregnancy surgical debulking as complete as possible, followed by taxol-platinum chemotherapy is indicated. If the fetus is not viable at the time of primary surgery, neoadjuvant chemotherapy and complementation of surgery after delivery of the baby should be performed. It should be stressed that chemotherapy for ovarian cancer applied during pregnancy appears to be safe. However, no studies have evaluated the long-term consequences for children exposed to intra-uterine chemotherapy. Aspiration of cysts should be avoided, as the correlation between the histological evaluation of an ovarian malignancy and the cytological evaluation of aspirates is poor. Moreover, spillage of malignant cysts is hazardous for the patient.     

Epithelial Ovarian Cancer at a Cancer Hospital in a Developing Country

Objectives: To analyze records of patients seen with malignant epithelial ovarian cancer at a tertiary care cancerhospital in Pakistan and obtain information on factors as laterality, histology, CA-125 levels, and stage of the disease,determine age at presentation and, assess menopausal status of the patients. Also, to review results obtained in lightof data published in indexed journals. Patients and Methods: We analyzed 544 cases of malignant ovarian epithelialtumors registered at the Shaukat Khanum Memorial Cancer Hospital and Research Center from December 1994-December 2003. Results: Mean age at presentation: 48.1 years (SD 13, range 4-82 years); commonest histologicalsub-type: serous cystadenocarcinoma (28.6%); most frequently seen stage: 3 (43.5%), followed by stage 4 (22.4%);post-menopausal: 56.8% of the women; bilateral disease: 41.2% of the women; and Cancer Antigen-125 (CA-125)level: elevated in 70% of the females. Conclusions: Stage at presentation in majority of the cases was advanced ascompared to that seen in the west. With only minor variations, our findings seem consistent with those reported inother local studies. However, it is imperative to conduct an extensive population-based study to understand theimpact of, and develop strategies for the management of ovarian cancer in Pakistan.     

Role of a Risk of Malignancy Index in Clinical Approaches to Adnexal Masses

Objective: The aim of this study was to evaluate predictive role of risk of malignancy index in discriminatingbetween benign and malignant adnexal masses preoperatively. Methods: This retrospective study was conductedwith a total of 569 patients with adnexal masses/ovarian cysts managed surgically at our clinic between January2006 and January 2012. Obtained data from patient files were age, gravidity, parity, menopause status,ultrasound findings and CA125 levels. For all patients ultrasound scans were performed. For the assessment ofrisk of malignancy index (RMI) Jacobs’ model was used. Histopathologic results of all patients were recordedpostoperatively. Malignancy status of the surgically removed adnexal mass was the gold standard. Results: Of thetotal masses, 245 (43.1%) were malignant, 316 (55.5%) were benign and 8 (1.4%) were borderline. The mean ageof benign cases was lower than malign cases (35.2±10.9 versus 50.8±13.4, p<0.001). Four hundred and five of them(71.2%) were in premenopausal period. Malignant tumors were more frequent in postmenopausal women (81%versus 29%, p<0.001). All ultrasound parameters of RMI were statistically significantly favorable for malignantmasses. In our study ROC curve analysis for RMI provided maximum Youden index at level of 163.85. Whenwe based on cutoff level for RMI as 163.85 sensitivity, specificity , PPV, NPV was calculated 74.7%, 96.2%, 94%and 82.6%, respectively. Conclusions: RMI was found to be a significant marker in preoperative evaluation andmanagement of patients with an adnexal mass, and was useful for referring patients to tertiary care centers.Although utilization of RMI provides increased diagnostic accuracy in preoperative evaluation of patient withan adnexal mass, new diagnostic tools with higher sensitivity and specificity are needed to discriminate ovariancancer from benign masses.     

Survival of Ovarian Cancer in Iran: 2000-2004

Objective: The aim of this study was to estimate the 5-year survival of ovarian cancer in Iran between 2000and 2004, according to age and histology. Methods: Cancer registry of Iran, 2000-2004, was used coveringnearly 80% of all ovarian cancers and 100% of all pathologically diagnosed ovarian cancers. Results: Of 1,246new ovarian cancer cases, 451 were available for further follow-up which revealed 169 deaths and 282 live cases.The 5-year survival was 61%; 85% for germ cell tumors and 59% for epithelial tumors. Survival of serous,mucinous, endometrioid and clear cell histologic subtypes of epithelial tumors was 41%, 62%, 76% and 78%,respectively. Young patients with epithelial tumors (below 45) displayed significantly better 5-year survivalrates (63% versus 53%). Conclusion: we found that ovarian cancer had a better survival rate in Iran in comparisonto other regions. We also reviewed all probable confounding factors or real causes. In this study, age and histologyaffected survival.     

Comparison of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios for Predicting Malignant Potential of Suspicious Ovarian Masses in Gynecology Practice

Purpose: To compare the diagnostic accuracy of the neutrophil/lymphocyte ratio (NLR) with the platelet/lymphocyte ratio (PLR) in predicting malignancy of pelvic masses which are pre-operatively malignant suspicious. Materials and Methods: In this retrospective study we evaluated the clinical features of patients with ovarian masses which had pre-operatively been considered suspicious for malignancy. The patients whose intraoperative frozen sections were malign were classified as the study group, while those who had benign masses were the control group. Data recorded were age of the patient, diameter of the mass, pre-operative serum Ca 125 levels, platelet count, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. Results: There was statistically significantly difference between the groups in terms of age, diameter of the mass, serum Ca 125 levels, platelet number and platelet/lymphocyte ratio. Mean neutrophil/lymphocyte ratios showed no difference between the groups. ROC curve analysis showed that age, serum Ca 125 levels, platelet number and PLR were discriminative markersin predicting malignancy in adnexal masses. Conclusions: According to the current study, serum Ca 125 levels, pre-operative platelet number and PLR may be good prognostic factors, while NLR is an ineffective marker in predicting the malignant characteristics of a pelvic mass.