October 18th, 2018

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Risk Factors for Malignancy in Women Undergoing Adnexal Mass Surgery at an Inner City Public Hospital
Authors:  Anna Strohl, M.D., Ashley Battarbee, M.D., Lindsay Zimmerman, M.P.H., Ashlesha Patel, M.D., M.P.H., and Radha Burtch, M.D., M.S.
  OBJECTIVE: To identify preoperative risk factors, especially the local empiric use of CA-125 levels, with operative discovery of benign conditions versus malignancy in women undergoing surgery for adnexal masses at an inner city, public hospital.

STUDY DESIGN: A retrospective cohort study of all women who underwent surgery for adnexal masses between July 2006 and July 2011 was performed, under an IRB approved protocol. Those patients diagnosed with cancer at the time of surgery were identified and compared to those with benign disease. Log-binomial data analysis was performed to identify preoperative factors associated with cancer.

RESULTS: Of the 593 women who underwent surgery for an adnexal mass, 30.9% (183/593) were found to have malignant disease. In this study, very elevated CA-125 (>200 U/mL) was the only factor significantly associated with malignancy (RR=3.35, 95% CI 1.32–8.49), while race/ethnicity, menopausal status, parity, family history of cancer, tumor volume, presence of ascites, omental caking, and lymphadenopathy were not significantly associated with malignancy at the time of surgery. In premenopausal women, malignant tumors were more likely identified at CA-125 levels 400–999 U/mL. In contrast, malignant tumors were more likely identified in postmenopausal women when CA-125 levels were much lower, 100–199 U/mL.

CONCLUSION: These results suggest that different risk stratification thresholds for referral to Gynecologic Oncology should be used for premenopausal and postmenopausal women. Such use better directs resource allocation for suspected ovarian cancer.
Keywords:  adnexal diseases, adnexal masses, antigen CA-125, CA 125 antigen, gynecology, malignancy, oncology, ovarian cancer, referral
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