title: Risk for malignant and borderline ovarian neoplasms following basic preoperative evaluation by ultrasonography, ca125 level and age.
abstract: OBJECTIVE
  To verify the basic preoperative evaluation in the discrimination between benign and malignant adnexal masses in our clinical practice.
  
  
  METHODS
  Data were collected on the records of 636 women with adnexal masses who had undergone surgery either by open or endoscopic approaches. Those with obvious signs of malignancy, any history of cancer, emergency surgeries without basic evaluation were excluded. The preoperative features by age, ultrasound and serum Ca125 level were compared with final histopathological diagnosis at the four departments of the institution. These are the general gynecology (Group 1: exploratory laparotomy), the gynecologic endoscopy (Group 2: laparoscopy and adnexectomy), the gynecological oncology (Group 3: staging laparotomy) and the gynecologic endocrinology and infertility (Group 4: laparoscopy and cystectomy).
  
  
  RESULTS
  There were simple and complex cyst rates of 22.3% and 77.2%, respectively. There were 86.3% benign, 4.1% (n:20) borderline ovarian tumor (BOT) and 6.4% (n:48) malignant lesions. There were 3 BOT 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 the Group 4. The risk of rate of unsuspected borderline or focally invasive ovarian cancer significantly increased by age, 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 and Ca125 level has proved highly accurate for prediction of unexpected malignancies. Neither novel markers nor new imaging techniques provide better information that allow clinicians to assess the feasibility of the planned surgery; consequently, the risk of inadvertent cyst rupture during laparoscopy may be significantly decreased in selected cases.
authors.affiliation: Department of Obstetrics and Gynecology, Ankara Teaching and Research Hospital, Ankara, Turkey E-mail : drburakkaradag@gmail.com.
authors.forename: Burak
authors.initials: B
authors.lastname: Karadag
authors.forename: M
authors.initials: M
authors.lastname: Kocak
authors.forename: F
authors.initials: F
authors.lastname: Kayikcioglu
authors.forename: F
authors.initials: F
authors.lastname: Ercan
authors.forename: B
authors.initials: B
authors.lastname: Dilbaz
authors.forename: Mf
authors.initials: M
authors.lastname: Kose
authors.forename: A
authors.initials: A
authors.lastname: Haberal
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D000328:Adult; D000367:Age Factors; D018394:CA-125 Antigen / Q000097:blood*; D018293:Cystadenoma, Serous / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D011230:Precancerous Conditions / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D014463:Ultrasonography
chemical_list: D018394:CA-125 Antigen