Biomarcatori nella diagnosi del carcinoma dell’ovaio: dialogo fra un patologo clinico e un ginecologo oncologo

AUTORI

ABSTRACT

Biomarkers in the diagnosis of ovarian cancer: a dialogue between a clinical pathologist and a gynecologic oncologist

A general consensus exists on the effectiveness of CA125 in ovarian cancer management, where it is currently used as an aid in clinical decisions for the initial work-up, post-operative follow-up and for monitoring chemotherapy in advanced disease. It is, however, apparent that no effective marker is presently available for costeffective screening of asymptomatic population. The debate is still open on the role of markers in the differential diagnosis of adnexal masses and some agreement exists on the following issues: 1) the referral to a gynecologic oncologist improves outcome for ovarian cancer patients, including overall survival; 2) markers should not be intended as a cancer diagnostic test, but as one of the criteria for the selection of patients with adnexal mass at a higher cancer risk; 3) CA125 appears to have several shortcomings: low sensitivity for early stage disease and low specificity, especially in premenopausal women; 4) algorithms combining CA125, age and imaging to assess the risk of a mass being malignant improve diagnostic accuracy of CA125 used alone; 5) among novel markers, HE4 has emerged as the most effective, overperforming CA125 mainly in premenopausal women; 6) mixed data have been reported on the advantages of ROMA, a diagnostic algorithm integrating HE4, CA125 and menopausal status, vs. HE4 alone; 7) conflicting data suggest that properly designed and well performed studies are still needed to identify the most effective diagnostic approach to assess cancer risk in patients with adnexal mass.

BIBLIOGRAFIA