title: Blood clotting activation analysis for preoperative differentiation of benign versus malignant ovarian masses.
abstract: Preoperative evaluation of patients presenting with ovarian masses is challenging, partly due to shortcomings with the commonly used marker, CA-125. Ovarian cancer is associated with systemic coagulation activation. Measurement of D-dimer, serum tissue factor (TF), and the coagulation process as a whole are considered candidates for improving discrimination between benign and malignant ovarian masses. We therefore sought to identify possible benefits by analyzing preoperative coagulation status in conjunction with CA-125 in patients with ovarian masses. Preoperative blood from 95 patients with ovarian masses (75 benign, 20 malignant) and 30 controls was analyzed, prospectively. Thromboelastography served for global hemostatic assessment. Plasma TF antigen and D-dimer were measured by ELISA and microparticle-associated TF activity by thrombin generation assay. TF microparticles were enumerated by flow cytometry. Time to clot formation by thromboelastography was similar between patients having either benign or malignant ovarian tumors. Clot formation rate, clot strength, and coagulation index were significantly increased in patients having malignant versus benign tumors, indicating that thromboelastography differentiated malignant from benign tumors. D-dimer alone differentiated malignant from benign ovarian tumors and also improved differentiation when combined with CA-125. Circulating TF antigen, activity, and TF microparticle numbers, however, failed to differentiate benign from malignant tumors. Significant coagulation activation occurs in women with ovarian malignancies. Plasma D-dimer may help discriminate between patients with benign and malignant tumors. Thromboelastography may also contribute meaningfully when combined with CA-125 in the preoperative evaluation of ovarian masses. Larger studies are needed to assess these possibilities.
authors: Center for Thrombosis Research, Florida Hospital, 2501 N. Orange Ave, Orlando, FL 32804, USA. ali.amirkhosravi@flhosp.org
authors: Ali
authors: A
authors: Amirkhosravi
authors: Glenn
authors: G
authors: Bigsby
authors: Hina
authors: H
authors: Desai
authors: Mildred
authors: M
authors: Rivera-Amaya
authors: Enriqueta
authors: E
authors: Coll
authors: Liza
authors: L
authors: Robles-Carrillo
authors: Patricia
authors: P
authors: Faust
authors: Alane
authors: A
authors: Waters
authors: Todd
authors: T
authors: Meyer
authors: Enriquo
authors: E
authors: Reyes
authors: Florian
authors: F
authors: Langer
authors: John L
authors: JL
authors: Francis
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology*; D018394:CA-125 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D057234:Preoperative Period; D012680:Sensitivity and Specificity; D013916:Thrombelastography; D013925:Thromboplastin / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen; D013925:Thromboplastin