Screening for Ovarian Malignancy

Evaluating the risk of malignancy in adnexal masses: validation of O-RADS and comparison with ADNEX model, SA, and RMI

To evaluate the diagnostic value of Ovarian-adnexal Reporting and Data System (O-RADS), and to compare it with Assessment of Different NEoplasias in the adnexa (ADNEX) model, Subjective Assessment (SA), and Risk of Malignancy Index (RMI) in differentiating benign and malignant adnexal masses (AMs). Ultrasound characteristics of 445 patients included in the study were retrospectively analyzed and evaluated using diagnostic models. The diagnostic performances of ultrasound diagnostic models were measured by assessing, receiver-operating characteristic curves, sensitivities, positive predictive values, positive likelihood ratios, specificities, negative predictive values, and negative likelihood ratios. Kappa values were used to evaluate inter-reviewer agreement (IRA). Of the 445 AMs, 265 were benign and 180 were malignant. The area under the curve (AUC) of O-RADS (0.941), ADNEX model (0.925), and SA (0.931) were higher than RMI (0.815) (all p 0.05), and there was no statistical significance among them (p > 0.05). The specificity of O-RADS, ADNEX model, SA, and RMI was 90.2%, 90.6%, 90.2%, and 92.5%, respectively, with no statistical significance (p > 0.05). All four ultrasound diagnostic methods showed better IRA. O-RADS, ADNEX model and SA have better diagnostic value in differentiating benign and malignant AMs than RMI.

Ovulation induction drug and ovarian cancer: an updated systematic review and meta-analysis

Abstract Objective To explore the association between ovulation induction drugs and ovarian cancer. Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) Women without ovarian cancer who ever or never underwent ovarian induction. Intervention(s) An extensive electronic search of the following databases was performed: PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library and CNKI, from inception until January 2022. A total of 34 studies fulfilled our inclusion criteria and were included in the final meta-analysis. The odds ratio (OR) and random-effects model were used to estimate the pooled effects. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Funnel plots and Egger tests were used to assess publication bias. Main outcomes New diagnosed borderline ovarian tumor (BOT) and invasive ovarian cancer (IOC) between ovulation induction (OI) group and control (CT) group considering fertility outcome, OI cycles and specific OI drugs. Results Primarily, there was no significant difference in the incidence of IOC and BOT between the OI and CT groups. Secondly, OI treatment did not increase the risk of IOC and BOT in the multiparous women, nor did it increase the risk of IOC in the nulliparous women. However, the risk of BOT appeared to be higher in nulliparous women treated with OI treatment. Thirdly, among women exposed to OI, the risk of IOC and BOT was higher in nulliparous women than in multiparous women. Fourthly, the risk of IOC did not increase with increasing OI cycles. Lastly, exposure to specific OI drugs also did not contribute to the risk of IOC and BOT. Conclusion Overall, OI treatment did not increase the risk of IOC and BOT in most women, regardless of OI drug type and OI cycle. However, nulliparous women treated with OI showed a higher risk of ovarian cancer, necessitating their rigorous monitoring and ongoing follow-up.

The Optimal Cut-Off Point of the Andex Model for the Prediction of the Ovarian Cancer Risk

Objective: This study aimed to assess the effectiveness and determine the optimal cut-off point of the ADNEX model in women presenting with a pelvic or adnexal tumor. Method: All women presented with adnexal mass and were scheduled for operation at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital, Vietnam during June 2019 – May 2021 were included and categorized according to their histopathologic reports into ovarian cancer groups and benign ovarian tumor groups. Multivariable logistic regression was used to explore for potential predictors. The ADNEX model with and without CA125 was used to assess the risk of ovarian cancer preoperative. The goldden standard to evaluate the accuracy of ultrasonography using the ADNEX model was the pathological report. In addition, the accuracy as well as optimum cut-off point of the ADNEX model was estimated with and without CA125. Results: A total of 461 participants were included in analysis and predictive model development, 65 patients in ovarian cancer group and 361 in benign tumor group. The ADNEX model combined with CA125 proved to be a useful predictor with an area under ROC of 0.961 (0.940 – 0.977) with Youden’s index of 0.8395, p < 0.001. The ADNEX model without CA125 also had high predictive value between benign and malignant tumors, with an area under ROC of 0.956 (0.933 – 0.973) with Youden’s index of 0.8551, p < 0.001. Cut-off of the ADNEX with CA125 was 13.5 and without CA125 was 13.1 for sensitivities were 90.8 (81.0 – 96.5) and 93.9 (85.0 – 97.5), specificities 93.2 (90.2 – 95.5) and 91.67 (88.5 – 94.2). The difference in the predictive value of malignancy-risk between the ADNEX model with CA125, without CA125 was not statistically significant, p=0.4883. Conclusion: The ADNEX model, with or without the combining marker CA 125, provides a valuable predictive value for ovarian tumor malignancy preoperative.

RETRACTED: Comparison of the four malignancy risk indices in the discrimination of malignant ovarian masses: A cross-sectional study

To evaluate the accuracy of the four malignancy risk indices to distinguish benign from malignant ovarian masses MATERIALS AND METHODS: This was an observational cross-sectional study conducted on 155 patients between January 2016 and January 2019. Women with ovarian masses planned for surgical management were recruited from the outpatient Gynecology clinic of the hospital. The risk of malignancy index (RMI 1-4) was calculated for all women with ovarian masses. Biopsies obtained from the ovarian masses after the surgical intervention was sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses was considered the gold standard for diagnosis. The participants' mean age in the group of patients with benign masses was 33.50 ± 14.53 years versus 45.09 ± 13.67 years in the malignant group. The two most prominent features in the malignant group were solid areas in 85.3 % of malignant masses and about 91.2 % of malignant masses showing size <7 cm in their largest diameter. The RMI's most sensitive individual parameter was the CA-125 level, while the lowest sensitivity was for the menopausal status. RMI 2 had the highest sensitivity of 76.47 %, while RMI 1 and 3 had the highest specificity, 92.56 %. RMI 2 had the highest AUC, 0.83. RMI 2 is a simple and reliable tool and had the best performance among all RMIs in benign discrimination from malignant ovarian masses with high sensitivity and accuracy.

Ovarian cancer screening: Current status and future directions

Ovarian cancer is the third most common gynaecological malignancy and the most lethal worldwide. Most patients are diagnosed with advanced disease which carries significant mortality. Improvements in treatment have only resulted in modest increases in survival. This has driven efforts to reduce mortality through screening. Multimodal ovarian cancer screening using a longitudinal CA125 algorithm has resulted in diagnosis at an earlier stage, both in average and high risk women in two large UK trials. However, no randomised controlled trial has demonstrated a definitive mortality benefit. Extended follow up is underway in the largest trial to date, UKCTOCS, to explore the delayed reduction in mortality that was noted. Meanwhile, screening is not currently recommended in the general population Some countries offer surveillance of high risk women. Novel screening modalities and longitudinal biomarker algorithms offer potential improvements to future screening strategies as does the development of better risk stratification tools.

Hoang Lam Vo

Dr. Vo Hoang Lam earned his medical degree from Hue University of Medicine and Pharmacy, Vietnam. Since 2021, he has been a key contributor to the Obstetrics and Gynecology Department at the same institution. In 2023, he completed his master's degree specializing in Obstetrics and Gynecology at Hue University of Medicine and Pharmacy, further advancing his expertise in women's health.

Lam Huong Le

Minh Tam Le

Dr. Le Minh Tam earned his medical degree from Hue University of Medicine and Pharmacy (Hue UMP), Vietnam, and has been a faculty member of the Department of Obstetrics and Gynecology since 2001. In 2004, he completed his master’s degree in obstetrics and gynecology at the same institution. From 2006 to 2009, he was awarded a long-term DAAD fellowship (German Academic Exchange Service) to pursue a Ph.D. in Obstetrics and Gynecology at the University of Freiburg, Germany. Currently, Dr. Tam serves as a senior lecturer in the Department of Obstetrics and Gynecology at Hue UMP, vice chairman of the department, and director of the Center for Reproductive Endocrinology and Infertility (HueCREI). He is also an executive committee member of the Vietnam Society of Gynecology and Obstetrics (VAGO), general secretary of the Vietnamese Journal of Obstetrics and Gynecology (VJOG), and vice president of the Vietnam Society for Sexual Medicine (VSSM). Dr. Tam has received extensive training in reproductive medicine at internationally recognized institutions, including Shady Grove Fertility, Maryland, USA (2014); University Hospital Tartu, Estonia (2013); PREG Centers, Greenville, South Carolina, and Memphis, Tennessee, USA (2012); University of Tsukuba, Japan (2011); Freiburg Women’s Hospital, Germany (2006–2009); University Hospital of Guangzhou, China (2006); and a one-year IVF training program (2003) He has authored approximately 120 scientific articles in Vietnamese medical journals (with over 75% as first or corresponding authors), 68 international publications indexed in ISI/Scopus, and has presented at more than 20 professional conferences. His current H-index is 19. Key Research Interests: 1. Male infertility and sperm quality, which includes sperm DNA fragmentation, the effects of reactive oxygen species (ROS), metabolic syndrome in men, and cryopreservation techniques. 2. Disorders of gynecologic endocrinology, especially PCOS; controlled ovarian hyperstimulation in female infertility. 3. Assisted reproductive technologies and embryo culture. 4. Gynecologic infections, particularly human papillomavirus (HPV) and cervical intraepithelial lesions.

Nguyen Thi Phuong Dung

Tran Thao Nguyen Nguyen

Dr. NGUYEN Tran Thao Nguyen is a Lecturer and Attending Physician in the Department of Obstetrics and Gynecology at Hue University of Medicine and Pharmacy Hospital, Vietnam. She completed postgraduate medical training and subsequently undertook residency (internat) training in France, where she gained extensive clinical experience within a modern, evidence-based healthcare system. She is actively involved in both clinical practice and academic activities, with primary clinical expertise in the management of high-risk pregnancies and prenatal screening. Her clinical work focuses on early risk assessment, antenatal surveillance, and multidisciplinary management of complex obstetric conditions to optimize maternal and perinatal outcomes. In the academic field, she has authored and co-authored more than 20 peer-reviewed scientific publications in national and international medical journals. Her research interests include prenatal screening strategies, risk stratification in pregnancy, obstetric outcomes, and evidence-based interventions in maternal–fetal medicine. In addition to her clinical and research responsibilities, she serves as a lecturer involved in undergraduate and postgraduate medical education, as well as clinical supervision and mentoring of medical students, residents, and postgraduate trainees in obstetrics and gynecology.

Vu Quoc Huy Nguyen

Nguyen Vu Quoc Huy, MD, PhD is an academic OBGYN specialist from Hue University of Medicine and Pharmacy, Vietnam. He has published 24 books or chapters nationally and internationally, and is the reviewer for 14 international journals and several national journals. He is the first author and co-author of over 190 original and review articles on national and international peer-reviewed journals. His professional fields of interest include evidence-based medicine, quality assurance in obstetrics and gynecology, high-risk pregnancy, and especially prevention and treatment of gynecological cancers. He has served as Consultant for Vietnam Ministry of Health, Asian Development Bank, WHO and WHO Vietnam Country Office, United Nations Population Fund, Pathfinder International, PATH, Marie Stopes International, and Save the Children International. He is Editorial Board Member of BMC Women's Health.