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Benign and Malignant Disease of the Ovary
3
II
. .., ..
9216 3-3220-000-9301/130601
1. 2. 3. 4. 5. BRCA 6.
16%
( 1 2) 3 4 ( 3 4)
?
40 56-60
?
1 - 15 2556 1
?
? 5 50%
(incessant ovulation) stroma inclusion cyst
? 3.1 4.6 (lifetime risk) 5% 7% 5-10%
BRCA 1 17 BRCA 2 13 BRCA 1 80-90% BRCA 2 14% BRCA 1 28-44% BRCA 2 27%
2 1 - 15 2556
(functional cyst) (Pelvic inflammatory disease), (Endometriosis) (Pedunculated subserous myoma uteri)
(Ovarian cancer screening) 80-90%
(Common epithelial ovarian cancer) 50-79 3 4 (advanced disease) 5 50% (Early stage) (Pre-invasive) (Sensitivity) 80% (Positive predictive value) 10% 10 1
(Exploratory laparotomy) (laparoscopic surgery)
? CA-125 CA-125 High molecular weight glycoprotein
OC-125 monoclonal antibody 80% (Common epithelial ovarian cancer) 2, 3 4 CA-125 1 50% CA-125 CA-125 CA-125 (specificity) CA-125 25 U/mL CA-125 (serial serum CA-125) tumor markers (complementary markers) OVX 1 M-CSF
? (Transvaginal sonography)
CA-125 100% 98% 10% Color Doppler Morphology index
1 - 15 2556 3
(First-line screening) 99.6%
?
(Systematic review) CA-125
50 25 14,469 BRCA 1 BRCA 2 Hereditary breast ovarian cancer Hereditary breast cancer CA-125 40%
CA-125 CA-125
CA-125
(Preoperative prediction of adnexal mass)
(Gynecologic oncologist)
A. Menopausal status 39-63%
B. Tumor marker CA-125 80% CA-125 ( 35 U/mL) 50% CA-125 CA-125 CA-125 CA-125
4 1 - 15 2556
CA-125 CA-125 35 U/mL (False positive) (False negative)
C. (Conventional grayscale ultrasonography)
(transabdominal ultrasonography) .. 2532 (Transvaginal ultrasonography) (frequency) (Morphological pattern) Unilocular cyst, thin wall, regular outline or capsule, no papillary projection multiloculated cyst, irregular septa, papillary projection, irregular outline or capsule ascites
(Morphological criteria)
International Ovarian Tumor Analysis (IOTA) (Overlap) ( CA-125 )
D. Color Doppler (Color Doppler Ultrasonography)
Color Doppler - (neovascularization) (tumor angiogenic factors) cellular composition, basement membrane structure permeability (muscularis) Vascular tone (Impedance) (arteriovenous shunting anastomosis) pressure gradient (low impedance) (high blood velocity) Color Doppler Color Doppler
1 - 15 2556 5
Color Doppler morphology Color Doppler 10-20% Color Doppler morphology (adnexal tumor vascularity) Color Doppler Pulsatility index (PI)
E. Ovarian tumor index Risk of malignancy index (RMI) , menopausal status, ( CA-125 ), Color Doppler receiver-operator characteristic curve RMI 1, RMI 2, Ovarian tumor index, Mainz score
Color Doppler
5 25-30%
ACOG
1. BRCA 20-25% (genetic testing)
2. BRCA 5-10%
35 CA-125
3
a. tumor marker CA-125 CA-125 tumor markers lysophosphatidic acid, osteopontin, kallikreins, serum inhibin proteomics-based biomarker b. c. CA-125
6 1 - 15 2556
of Ovarian Cancer Screening
CA-125 50-74
CA-125
CA-125
CA-125
CA-125
CA-125 CA-125
United Kingdom Collaborative Trial CA-125
? Incessant ovulation
?
?
(,
)
? Gonadotropin stimulation
? FSH
?
LH PCOS
progestin-only
OCs FSH oncogenes
? Hormonal stimulation
? androgens tumor microenvironment carcinogenesis progestin
? circulating androgens inclusion cysts PCOS progestin apoptosis
? Inflammation
? inflammation
? NSAID talc asbestos PID
? Ovarian-stromal
? theca cells
?
granulosa cells
apoptosis steroids
FSH = Follicle-stimulating hormone; LH = Luteinizing hormone; PCOS = Polycystic ovarian syndrome; PID = Pelvic inflammatory disease; NSAID = Non-steroidal anti-inflammatory drug
1 - 15 2556 7
BRCA 1 BRCA 2 CA-125 30-35 5-10
BRCA A. BRCA 20-25%
1. ( )
2. *
3. Ashkenazi Jew 4. 50 * 5. Ashkenazi Jew 40 6. * BRCA B. BRCA 5-10% 1. 40 2. Serous high grade 3. ( 40 ) 4. 50 * 50
5. Ashkenazi Jew 50
6. * 2 ( 50 )
7. *
* 1 ( - ) 2 (- - )
6 5.1
1. 1.9-2.7 1.6-2.3 90% BRCA 1 ( 17) BRCA 2 ( 13)
8 1 - 15 2556
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