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SM ISO690:2012 CODREANU, Nadejda, PUNGĂ, Iurie, CODREANU, Igor, MURŞIEV, Cristina, IPATII, Vl.. Managementul contemporan al formaţiunilor de volum ovariene. In: Buletin de Perinatologie, 2015, nr. 4(68), pp. 16-21. ISSN 1810-5289. |
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Buletin de Perinatologie | ||||||
Numărul 4(68) / 2015 / ISSN 1810-5289 | ||||||
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CZU: 618.11-006-071 | ||||||
Pag. 16-21 | ||||||
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Background: Nowadays, the number of onco-gynecological diseases is increasing, affecting more and more the quality of women’s life. According to the National Cancer Institute, USA, 13-21% of women are diagnosed with ovarian cancer at different stages. In spite of this, screening and early diagnosis remains a challenge for the national and global medicine. Recently, an association has been established between the molecular expression of the biological marker HE4 (Human Epididymal Protein 4) and the presence of malign ovarian tumours. HE4 has a high sensitivity and specificity when is interpreted on its own, but even better results are reached when interpreted along with the values of CA125 marker in the context of the pre-/postmenopausal status: 74-94% specificity and 75-95% sensitivity in the differentiation of benign and malign ovarian masses. This parameters were included in the ROMA (Risk of Ovarian Malignancy Algorithm) score, which became a revolutionary instrument for early ovarian cancer diagnosis with benign/ malign differentiation, offering the possibility of an early management initiation and reducing the number of surgical diagnostically interventions, and consequently patients’ discomfort and medical expenses. Even better results can be achieved when combined with morphological index evaluation (fig. 1). Based on these results, we began a study in which we aimed to evaluate the importance of the ROMA score utilisation in the management of women with pelvic ovarian masses. Materials and methods: The retrospective case control study is based on the data of 208 women, 98 admitted in the Department of Gynaecology of the Nr.1 Municipal Hospital in Chişinău and 120 from other medical institutions with the diagnosis of ovarian mass in the period of 2010-2013. They were evaluated from the perspective of their age, clinical and laboratory findings and the final established diagnosis, all of these correlated with their ROMA score results. Results and conclusions: 1.The study confirmed the clinical importance of the age criteria in making the prognosis over the ovarian mass malignancy, as the malign tumours were encountered 80 times more frequently in the postmenopausal period (p< 0,001). 2. The usage of the ROMA score together with the morphological index in the primary patient evaluation helped us to differentiate the functional masses in 48,33 % of cases with their further efficient conservatory treatment, thus helping avoid surgical manipulations. 3. In 100% cases when ROMA had a high value in postmenopausal woman, malign tumours were confi rmed. Also, elevated CA125 levels associated with normal HE4 values confirmed endometriosis (and endometrial cysts) in 100%. 4. The informativity of the ROMA score allowed reducing twice the number of the surgical manipulations in women with ovarian masses. 5. Laparoscopy as first step management in these patients is appropriate only in benign and endometriosical masses and is inappropriate in functional masses and even elevating the risk of dissemination in malign tumours |
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Cuvinte-cheie ovarian masses, ROMA score, ovarian benign/malign tumours |
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