The role of biochemical parameters and preoperative ultrasonographic markers in detecting malignancy in adnexal masses

Background: Accurate preoperative differentiation of adnexal masses is crucial for appropriate patient management. This study aimed to evaluate the diagnostic performance of preoperative ultrasonographic (USG) markers and biochemical parameters in distinguishing between malignant and benign adnexal masses and to compare the utility of the Risk of Malignancy Indexes. Methods: This retrospective cohort study analyzed data from 141 patients who underwent surgery for adnexal masses at the Department of Oncology, Azerbaijan Medical University. Data collected included demographics, clinical features, preoperative serum levels of biochemical markers (Cancer Antigen 125 (CA125), CA15-3, CA19-9, Alpha-Fetoprotein (AFP), and Carcinoembryonic Antigen (CEA)), and specific ultrasound (USG) findings. Postoperative histopathology served as the gold standard, identifying 91 benign and 50 malignant cases. Statistical analyses employed included the Independent Samples t-test, the Mann-Whitney U test, the Chi-square test, and multivariate backward stepwise logistic regression. Results: Malignancy was significantly associated with older patient age (mean age difference, p = 0.04), bilateral tumor presentation (44% in malignant vs. 9.9% in benign, p < 0.05), and elevated preoperative serum levels of CA125 and CA15-3 (p < 0.05 for both). Specific USG features significantly associated with malignancy included the presence of septations, irregular tumor surface, and the presence of ascites (p < 0.05 for all). Ascites demonstrated the highest predictive value, being present in 94% of malignant cases compared to 2.2% of benign cases (p < 0.05). RMI-4 exhibited slightly higher sensitivity (74%) and specificity (84.6%) for malignancy detection compared to RMI-3 (sensitivity 72%, specificity 83.5%). Conclusions: The integration of patient age, tumor laterality, specific USG characteristics, and selected serum biomarkers significantly enhances the preoperative prediction of malignancy in women presenting with adnexal masses. While advanced diagnostic modalities offer superior performance, RMI remains clinically valuable in resource-limited settings where implementation barriers may limit access to sophisticated diagnostic tools.

Adnexal masses; Ovarian cancer; Risk of malignancy index; Ultrasonography; Biomarkers; Preoperative diagnosis

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