| Background Recently, the diagnosis of borderline ovarian tumors(BOT) draws more and more attention.The definition of BOT in the World Health Organization(WHO) is between clearly benign and malignant tumors, with no damage to interstitial infiltration in the growth pattern and cytological features, and compared with the same clinical stage of ovarian cancer, most ovarian cancer patients have a much better prognosis. About 1/3 of the BOT patients less than 40 years old, they desire to retain ovary to maintain fertility and normal female endocrine function, requiring a conservative surgery. National Comprehensive Cancer Network(NCCN) guidelines in 2011 recommend: they can make the full surgical staging who want to retain fertility for the BOT patients of stage Ⅰ-Ⅳ. The 5-year survival rate of stage Ⅰ BOT is up to 96% and other are about 92%. A large number of clinical studies prompted that there is no distinction between the BOT’s conservative surgery patients and those made satisfactory surgical staging in disease-free survival and overall survival, nearly to 100%. The fertility and pregnancy outcome of conservative surgery is also very good, but patients need close follow up. The early-stage epithelial ovarian cancer(EOC) patients need comprehensive laparotomy and staging radical surgery.The difference of surgery range between BOT and early ovarian cancer is significant and the survival and security of patients are as important as fertility,so an accurate preoperative diagnosis is very meaningful. The preoperative diagnosis of BOT is same as ovarian cancer, including serum tumor markers, ultrasound by abdominal and transvaginal ultrasound, Computed Tomography(CT), Magnetic Resonance Imaging(MRI), Positron Emission Tomography and Computed Tomography(PET-CT). Serum tumor marker carbohydrate antigen 125(CA125), carbohydrate antigen 199(CA199) are commonly used for preliminary identification between benign and malignant ovarian tumors in clinical. Ultrasound is the common means for cancer screening examination with low prices, high diagnostic value and no radiation. When ultrasound couldn’t provide enough mass features used for diagnosis, other means of inspection tests to should be used, such as CT, MRI. Because CT soft tissue contrast is poor, for the differential diagnosis of ovarian cancer as good as MRI, but is often used for pelvic metastasis and International Federation of Gynecology and Obstetrics(FIGO) stage. MRI can be multi-faceted, multi-parameter, multi-sequence imaging, with good soft tissue contrast resolution. the MRI’s differential diagnostic value of ovarian cancer is better than ultrasound’s, multi-slice spiral CT’s. Although PET-CT in the diagnosis of malignant tumor is higher value than MRI, but the false positive rate, and expensive and radiation, not often in clinical application. In recent years, with the rapid development of MRI technology, magnetic resonance diffusion weighted imaging, enhanced or dynamic contrast-enhanced magnetic resonance imaging have been widely applied, which increasingly shows superiority in the differential diagnosis of ovarian tumors and efficacy assessments. The MRI morphological features and degree of enhancement of ovarian tumors can identify benign and malignant. Serum CA125, CA199 is one of the biological behaviors of BOT, which is combined with the morphological features to improve the accuracy of pre-operative diagnosis of BOT.Objective The objective of the study is to explore the value of MRI findings and CA125, CA199 to the differential diagnosis of BOT and stage I EOCMethods Enrolled patients are divided into two groups, 30 cases of patients with BOTs as the BOTs group and 27 cases of patients with stage Ⅰ EOCs as the stage Ⅰ EOCs group in the 57 cases of patients with epithelial ovarian tumors,and we retrospectively analyzed MRI findings and the serum CA125, CA199 levels of the two groups of patients and its clinicopathological features. The contents observed and recorded:(1) The clinical featuers: pathological types, age, menopausal status, symptom.(2) The levels of CA125 and CA199.(3) MRI findings:(a). location and tumor size;(b). the size of solid components and the degree of their enhancement, numbers and thickness of septations;(c) ascites, peritoneal implants and lymph node metastasis. The results of the datas obtained are analyzed statistically.Results 1. The age in the BOT group(43±13 years old) was 9 years younger than one in the Stage ⅠEOC group(54±10 years old), the difference statistically significant(P<0.05). The percentage of patients with symptomatic in Stage Ⅰ EOC group(92.6%) was more than ones in the BOT group(56.7%), the difference statistically significant(P<0.05). 2. The maximum diameter of solid component and the thickness of septation of Stage I EOC(respectively 31.6±12.3mm、5.3±2.5mm) were bigger than the BOT’s(22.1±11.4mm、3.3±1.5mm), the difference statistically significant(P<0.05). There is no significant difference among the tumor size, distribution, the partition number, ascites and increasing signal in the solid component(P>0.05). 3. The areas under the Receiver Operating Characteristic Curve(ROC) curve mapped out based on the maximum diameter of solid component and the thickness of septation for the identification of BOT and stage Ⅰ EOC were respectively 0.730(95%CI:0.565-0.894,P=0.016)、0.826(95%CI:0.665-0.987,P=0.002). When the cut-off value of the maximum diameter of solid component was 25.5 mm, the sensitivity and specificity for the identification of BOT and stage Ⅰ EOC with solid component were respectively 66.7%、76.5%, and the accuracy was 71.1%. The cut-off value of the thickness of septation was 4.0 mm, the sensitivity, specificity for the identification of BOT and stage Ⅰ EOC with septation were respectively 78.6%, 87.5%, and the accuracy was 83.3%. 4. In the stage Ⅰ EOC group and the stage Ⅰ EOC group with solid components(respectively 145.67 u/m L、156.87 u/m L), the levels of the serum CA125 were both significantly higher than ones in the BOTs group(respectively 44.07 u/m L、45.76 u/m L), the difference statistically significant(P<0.05). However the stage Ⅰ EOC group with septation(140.24 u/m L), the levels of the serum CA125 were slightly higher than ones in the BOT group(50.90 u/m L), the difference no statistically significant(P>0.05). The levels of the serum CA199 were no significant differences between the two groups and its corresponding groups(respectively 19.95 u/m L、13.00 u/m L,19.95 u/m L、13.95 u/m L,27.83 u/m L、11.76 u/m L)(P> 0.05). 5. The areas under the ROC curve mapped out based on the levels 0f the serum CA125 for the identification of BOT and stage Ⅰ EOC, them with solid component were 0.696(95%CI:0.548-0.843,P=0.011)、0.728(95%CI:0.560-0.897,P=0.017). When the cut-off value of the levels of the serum CA125 was 103.22U/ml, the sensitivity and specificity for the identification of BOT and stage Ⅰ EOC were respectively 62.9%, 90.0%, and the accuracy was 77.2%. However, the cut-off value of the levels of the serum CA125 was also 103.22U/ml, the sensitivity, specificity BOT and stage Ⅰ EOC with solid component were respectively 71.4%, 82.4%, and the accuracy was 76.3%. 6. The CA125, CA199 positive rates of BOT and stage Ⅰ EOC, them with solid component and them with septation(respectively 53.3%、63.0%,58.8%、71.4%,62.5%、64,3%) were none significant differences(P> 0.05).The positive rate of CA125(61.0%) in the serous tumors was significantly higher than ones of CA199(14.6%) and there was statistically significant(P< 0.05), while the positive rates of CA199 and CA125 in the mucinous tumors(respectively 54.5%、36.4%) were no statistically significant(P> 0.05). The positive rate of CA199(34.6%) in the mucinous tumors(including BOTs, EOCs) was significantly higher than ones(17.7%) in the serous tumors and there was statistically significant(P< 0.05). However, the positive rates of CA125 in the serous and mucinous tumors(respectively 14.6%、54.5%) were no statistically significant(P> 0.05). 7. The area under the ROC curve mapped out based on the maximum diameter of solid component and the level of CA125 for the identification of BOT and stage Ⅰ EOC with solid component was 0.804(95% CI: 0.565-0.894)(P <0.05), which was higher than only MRI or CA125. The sensitivity, specificity were respectively 66.7%, 76.5%, and the accuracy was 84.2%.Conclusion 1. Borderline ovarian tumors are masses with MRI features similar to stage I epithelial ovarian cancers. 2. The maximum diameter of solid component and the thickness of septations contribute to the differentiation of borderline tumors from stage I disease. 3. The CA125 level of ovarian tumors with solid component have tendency to increase with the degree of malignancy. The level of CA125 contribute to the differentiation of borderline tumors from stage I disease. 4. The value of MRI findings combined with CA125 is better than ones of alone MRI, CA125 for the differentiation of borderline tumors from stage I disease. |
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