Clinical Analysis Of 546 Cases Of Postmenopausal Ovarian Masses

Objective:To analyse the clinical characteristics of postmenopausal women with ovarian masses and to find the relationship between ultrasound index and benign or malignant disease in order to provide the reference for the following diagnostic tests; To analyse the relationship between the maximal diameter of the masses and the torsion in order to provide the reference for the treatment of acute abdomen for the elderly; To evaluate the risk of malignancy index (RMI) in differentiating benign from malignancy of postmenopausal ovarian masses before operation, as well as the role of guiding treatment options.Methods:This was a retrospective study of 546 cases of postmenopausal ovarian masses for surgical treatment admitted in the Second Affiliated Hospital of Jilin University between January 2006 and December 2010. To analyse the clinical features of postmenopausal ovarian masses; To compare the relationship between age, yesrs since menopause, years of ovulation, times of pregnancy, times of delivery, unilateral or bilateral, several separates, maximal diameter of the masses and the incidence of malignant lesions; To analyse the relationship between the maximal diameter of the masses and the torsion, and to analyse the surgical treatment for people occurred torsion; To compare the detection rates of serum CA125 in different groups; To compare sensitivity and specificity of RMI, ultrasound score and serum CA125 in the diagnosis of ovarian malignant tumor, and to asses RMI as the role of guiding treatment options. To validate the feasibility of the low risk by RMI2 <25 as the criterion to screen people could take conservative treatment who did not have any ill symptom, who′s ultrasound examination was showed completely echo-free zone, unilateral and single room cyst with smooth wall.Results:1. There were 546 cases of postmenopausal women with ovarian masses. The number of cases in 2006, 2007, 2008, 2009, and 2010 were 76, 110, 109, 119, and 132 respectively; There were 30 cases of<50 years old, 236 cases of 50-59 years old, 193 cases of 60-69 years old, 87 cases of≥70 years old. The number of postmenopausal women with ovarian masses took suygical treatment rase with age, and reached the peak age of 55. But the number declined after the age of 55. There were 240 cases of postmenopausal women with ovarian malignant tumors, including 14 cases of<50 years old, 114 cases of 50-59 years old, 75 cases of 60-69 years old, and 37 cases of≥70 years old.2. There were 350 cases of epithelial tumors, including 50 cases of germ cell tumors, 77 cases of sex cord stromal tumors, 63 cases of tumor-like lesions, and 6 cases of others (4 cases of ovarian Krukenberg′s tumors, 1 case of ovarian leiomyosarcoma, 1 case of steroid cell tumor). There was no significant difference in histological distribution of ovarian tumors among all age groups. There were 220 cases of epithelial tumors, 3 cases of germ cell tumors, 12 cases of sex cord stromal tumors, and 5 cases of others (4 cases of ovarian Krukenberg′s tumors, 1 case of ovarian leiomyosarcoma) among people with ovarian malignant tumors.3. There was no significant difference in the incidence of malignant lesions of postmenopausal women with ovarian masses among all age groups or years since menopause groups. There was no significant difference in age or years since menopause between benign lesions and malignant lesions.4. (1) There was no significant difference in the incidence of malignant lesions of postmenopausal women with ovarian masses among all years of ovulation groups, all times of pregnancy groups, or all times of delivery groups. There was no significant difference in years of ovulation, times of pregnancy, or times of delivery between benign lesions and malignant lesions of postmenopausal women with ovarian masses.(2) There was no significant difference in the incidence of malignant lesions of postmenopausal women with ovarian epithelial masses among all years of ovulation groups (≤25 years, 26-35 years,≥36 years), all times of pregnancy groups (≤2 times,≥3 times), or all times of delivery groups (≤2 times,≥3 times). There were significant difference in years of ovulation, times of pregnancy and times of delivery between benign lesions and malignant lesions of postmenopausal women with ovarian epithelial masses.The years of ovulation of postmenopausal women with ovarian benign epithelial masses were less than the malignant lesions′. The times of pregnancy of postmenopausal women with ovarian benign epithelial masses were more than the malignant lesions′. The times of delivery of postmenopausal women with ovarian benign epithelial masses were more than the malignant lesions′. To compare the incidence of malignant lesions among all years of ovulation groups, all times of pregnancy groups, and all times of delivery groups with the separations of≤0 times,≤1 times,≤3 times,≤4 times, and≤5 times. There were significant difference in the incidence of malignant lesions among all times of pregnancy groups and all times of delivery groups with the separations of≤4 times and≤5 times. The incidence of malignant lesions in the groups of times of pregnancy or times of delivery≤4 was more than the group of times of pregnancy or times of delivery>4. The incidence of malignant lesions in the groups of times of pregnancy or times of delivery≤5 was more than the groups of times of pregnancy or times of delivery>5. There was no significant difference in the incidence of malignant lesions among all times of pregnancy groups or all times of delivery groups with the separations of≤0 times,≤1 times, and≤3 times.5. (1) The incidences of malignant lesions of postmenopausal women with ovarian masses were 38.1% with the unilateral and 74.2% with the bilateral. There were significant difference in the incidence of malignant lesions of postmenopausal women with ovarian masses between the unilateral lesions and the bilateral lesions.(2) The incidences of malignant lesions in postmenopausal women with unilateral ovarian masses were 23.1% with the maximum diameter of <5cm, 32.5% with the maximum diameter of 5-10cm, and 47.7% with the maximum diameter of >10cm respectively. There were significant difference in the incidence of malignant lesions of postmenopausal women with ovarian masses between the maximal diameter of <5cm and >10cm, and between the maximal diameter of 5-10cm and>10cm.(3) There was no significant difference in the incidence of malignant lesions of postmenopausal women with ovarian cystic masses, or mixed cystic and solid masses between the group with several separates and the group without several separates. There was no significant difference in the incidence of malignant lesions in postmenopausal women with ovarian cystic masses between the group with several separates and the group without several separates. There was no significant difference in the incidence of malignant lesions in postmenopausal women with ovarian mixed cystic and solid masses between the group with several separates and the group without several separates.6. In this study, 28 cases (5.13%) occurred torsion and they all occurred in the unilateral lesions′. There were 4 cases of tumor-like lesions, 21 cases of benign tumors, 2 cases of borderline tumors and 1 case of malignant tumor. There were 10 patients underwent emergency surgery. There was no significant difference in the maximum diameter between groups with torsion and groups without torsion of postmenopausal women with ovarian unilateral masses.7. The detection rates of serum CA125 in 2006, 2007, 2008, 2009, and 2010 were 57.9%, 59.1%, 74.3%, 83.2%, and 84.1% respectively; There were significant difference in the detection rate of serum CA125 between 2006 and 2009, between 2006 and 2010, between 2007 and 2009, between 2007 and 2010. There was no significant difference among other groups. The detection rates of serum CA125 of cases in 2009 and 2010 were more than the detection rates in 2006 and 2007 respectively. There were significant difference in serum CA125 between benign lesions and malignant lesions. Serum CA125 of the malignant lesions was more than the benign lesions′.8. The sensitivity, specificity and the overall compliance rate of ultrasound score in the diagnosis of ovarian malignant masses were 74.4%, 78.6%, and 76.5% respectively; The sensitivity, specificity and the overall compliance rate of serum CA125 in the diagnosis of ovarian malignant masses were 67.8%, 92.5%, and 80.1% respectively; The sensitivity, specificity and the overall compliance rate of RMI1 in the diagnosis of ovarian malignant masses were 70.4%, 93.0%, and 81.8% respectively; The sensitivity, specificity and the overall compliance rate of RMI2 in the diagnosis of ovarian malignant masses were 75.4%, 90.0%, and 82.8% respectively; The sensitivity, specificity and the overall compliance rate of RMI3 in the diagnosis of ovarian malignant masses were 70.4%, 92.5%, and 81.5% respectively. By means of McNemar test, the sensitivity of RMI2 in the diagnosis of ovarian malignant masses was more than RMI1, RMI3 and serum CA125; And there was no significant difference among other groups. The specificity of serum CA125, RMI1 and RMI2 in the diagnosis of ovarian malignant masses were more than ultrasound score; The specificity of RMI1 in the diagnosis of ovarian malignant masses was more than RMI2; And there was no significant difference among other groups. The diagnostic tests including ultrasound score, serum CA125, RMI1, RMI2, and RMI3 highly agreed well with pathology.9. In this study, there were 27 cases who did not have any ill symptoms, who′s ultrasound examination was showed completely echo-free zone, unilateral and single room cyst with smooth wall. There were 9 cases who′s serum CA125 were not detected and 22 cases who′s serum CA125 were detected. The serum CA125 were <35U/ML, the maximum diameters were <10cm. Risk patterns were classified according to RMI2. There were 2 cases of low-risk pattern and their maximum diameter were <5cm, including 1 case of ovarian cyst and 1 case of parovarian cyst. There were 12 cases of low-risk pattern and their maximum diameter were 5-10cm, including 3 cases of ovarian cysts, 5 cases of parovarian cysts (1 case was duraing for 2 years and its diameter was not increased), 3 cases of serous cystadenoma (2 cases were duraing for 1 year and 8 years respectively and their diameter were both increased), 1 case of mucinous cystadenoma. There were 8 cases of medium-risk pattern, including 3 cases of parovarian cysts (1 case was combined with tuberculosis), 3 cases of serous cystadenoma, 1 case of mucinous cystadenoma, and 1 case of serous cystadenoma with local area of borderline lesion.Conclusion:1. The number of postmenopausal women with ovarian masses who took suygical treatment showed increasing trend year by year. The cases rase with age, and reached the peak age of 55. But the cases declined after the age of 55. The number of postmenopausal women of 50-59 years old with ovarian masses was the most, and the number of postmenopausal women of 50-59 years old with ovarian malignant masses was also the most. So ovarian tumors′screening of postmenopausal women should be strengthened in 50-59 years old group for early detection of disease and to improve prognosis. Epithelial tumors accounted for the majority of postmenopausal ovarian tumors. Epithelial cancers also accounted for the majority of malignant tumors.2. The age and years since menopause failed to help differentiate benign from malignancy of postmenopausal ovarian masses. The hypothesis of continuous ovulation was fit for the epithelial ovarian tumors. Multiple times of pregnancy or times of delivery provided protection against cancer. But there were significant difference when times of pregnancy or times of delivery were over 4 times.3. The incidence of malignant lesions in bilateral lesions was higher than unilateral lesions′. The incidence of malignant lesions of the maximum diameter >10cm in unilateral ovarian tumor was more than the maximum diameter≤10cm. Several separates failed to help differentiate benign from malignancy of postmenopausal ovarian masses.4. The incidence of torsion of ovarian tumor in postmenopausal women was lower. Malignant tumors were rare in those of torsion. The maximum diameter failed to help judge the incidence of torsion. 5. The detection of serum CA125 of ovarian tumors in postmenopausal women had aroused sufficient attention in recent years. RMI2 was more worth in differentiating benign from malignancy of postmenopausal ovarian masses before operation in order to guide treatment and surgical option. But it needed to be improved and it had widely improved space.6. It was feasible of the low risk by RMI2<25 as the criterion to screen postmenopausal people could take conservative treatment who did not have any ill symptoms, who′s ultrasound examination was showed completely echo-free zone, unilateral and single room cyst with smooth wall.