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Simple laboratory score improves the preoperative diagnosis of adnexal mass

  • Original Article
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Tumor Biology

Abstract

We assessed the diagnostic accuracy of a newly developed laboratory score—based on CA125, platelet count (PLT), C-reactive protein (CRP), and fibrinogen levels—in the preoperative diagnosis of adnexal mass. In this retrospective single-center study, we analyzed records of 142 patients with 54 malignant (38 %) and 88 benign (62 %) ovarian tumors. Preoperative levels of CA125, PLT, CRP, and fibrinogen were dichotomized according to the common cutoff values (CA125, 35 U/ml; PLT, 350/nl; CRP, 5.0 mg/l; fibrinogen, 400 mg/dl), resulting in “1” for results above the cutoff and “0” for results within the normal ranges. The values (1 or 0) were summarized to a “low” (0–2) or “high” (3–4) score. Its diagnostic accuracy was compared to the “gold standard,” CA125. All parameters differed significantly between malignant and benign cases. The score was false positive in 5/88 (5.7 %) and false negative in 13/54 (24 %) of cases. Conversely, CA125 was false positive in 18/88 (20.4 %) and false negative in 4/54 (7.4 %). The diagnostic accuracy of CA125 (>35 U/ml) was sensitivity 0.93, specificity 0.80, positive predictive value (PPV) 0.74, negative predictive value (NPV) 0.95, and positive likelihood ratio (weighted by prevalence) (+LH/p) 2.78. The diagnostic accuracy of the score was sensitivity 0.76, specificity 0.94, PPV 0.89, NPV 0.86, and +LH/p 8.2. In conclusion, the score is easy to use and generates no additional costs. It provides a better specificity, PPV, and +LH/p than CA125. The sensitivity and NPV are lower, but acceptable. A validation of the score in a large patient cohort is needed.

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Acknowledgments

We thank Prof. Johannes Forster (University of Freiburg) for his assistance in preparing the study project. We thank Ms. Barbara Steffan and Christine Rauch (Central Laboratory of the St. Josefskrankenhaus, Freiburg) for providing the technical specifications of the laboratory methods.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Sautierstr. 1, Freiburg, Germany

    Rafał Watrowski

  2. Department of Obstetrics and Gynecology, Molecular Oncology Group, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria

    Robert Zeillinger

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  1. Rafał Watrowski
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Correspondence to Rafał Watrowski.

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Approval for this study has been obtained from the Institutional Review Board of the University of Freiburg, Germany (Reference No. 192/12).

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Watrowski, R., Zeillinger, R. Simple laboratory score improves the preoperative diagnosis of adnexal mass. Tumor Biol. 37, 4343–4349 (2016). https://doi.org/10.1007/s13277-015-4280-7

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  • DOI: https://doi.org/10.1007/s13277-015-4280-7

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