Pelvic Examination, Tumor marker Level, and Ultrasonography and Doppler Sonography in the Prediction of Cancer Ovary

Background: The presence of a pelvic mass is one of the most common indications for gynecologic operative intervention. Approximately 4-24% of adnexal masses in premenopausal women and 39-63% in postmenopausal women are malignant. Accurate preoperative prediction of malignancy is important for patient counseling, as well as for selecting the optimal operative approach (laparoscopy versus laparotomy), incision type, and operative procedure (cystectomy versus ovarotomy).Objectives: The current study was undertaken to determine the efficacy of pelvic examination, TVS, transvaginal colour Doppler and CA125 in prediction of ovarian cancver.Patients and methods: Of the three modalities, we evaluated transvaginal ultrasonography yielded the best diagnostic indices. Pelvic examination is essential but the usefulness of pelvic examination was hampered by the fact that approximately half of women with cancer had a non-suspiciousd examination specially in early stages of cancer. Transvaginal color Doppler ultrasonography has been used in detection of ovarian carcinoma on the basis of neovascularization of the malignant neoplasms and the detection of the new blood flow and determination of velocity and certain flow indices were very helpful in this current study.CA125 level has been reported to be more useful in postmenopausal women than in premenopausal women. In the present study, 50 patients were included from those attending the Obstetrics and Gynecology Outpatient Clinic at Zagazig University Hospitals during the period from April 2010 till March 2011.Results: All patients were admitted in the Zagazig University Hospitals for further investigation. They were not divided into subgroups, all patients were subjected to the following: full history taking, general examination, bimanual examination, transvaginal ultrasonography, TVSCD, determination of CA125, then histopathology. In this study, the sensitivity of TVS was 82.8% which was also better than pelvic examination or color Doppler which had sensitivity of 58.6% while the color Doppler had highest specificity (90.5%). On the other hand, tumour markers have been also used to differentiate benign from malignant adnexal tumour. Here, we used CA125 which had sensitivity like the TVS CD but of lower specificity.Conclusion: ultrasonographic tumor appearance and size are the best predictors of malignancy in premenopausal women, whereas CA-125 level and ultrasonographic appearance are the best predictors in postmenopausal women. The additionof Doppler sonography for cases in which the grayscale findings are suspicious is not recommended; this results in a small improvement in positive predictive value at the cost of a large decrease in sensitivity.