Differentiating stage I epithelial ovarian cancer from benign disease in women with adnexal tumors using biomarkers or the ROMA algorithm.

We have read with interest the recent report of Kondalsamy-Chennakesavan et al. [ [1] Kondalsamy-Chennakesavan S. Hackethal A. Bowtell D. Obermair A. on behalf of the Australian Ovarian Cancer Study GroupDifferentiating stage 1 epithelial ovarian cancer from benign ovarian tumours using a combination of tumour markers HE4, CA125, and CEA and patient's age. Gynecol Oncol. Mar 13 2013; ([pii: S0090-8258(13)00149-2. Epub ahead of print])https://doi.org/10.1016/j.ygyno.2013.03.001 Abstract Full Text Full Text PDF Scopus (39) Google Scholar ] in which they advocate the use of tumor markers to differentiate stage I invasive ovarian cancer from benign adnexal pathology. We entirely agree that clinicians do not need sophisticated algorithms or biomarkers to characterize adnexal masses that are accompanied by evident signs of malignant disease. However, it is not just with late stage cancer where the diagnosis is relatively straightforward. A large proportion of benign ovarian tumors can also be reliably diagnosed using easy to use descriptors without the need for further testing [ [2] Kaijser J. Bourne T. Valentin L. Sayasneh A. Van Holsbeke C. Vergote I. et al. Improving strategies for diagnosing ovarian cancer: a summary of the International Ovarian Tumor Analysis (IOTA) studies. Ultrasound Obstet Gynecol. Jan 2013; 41: 9-20 Crossref PubMed Scopus (115) Google Scholar ]. Furthermore, we know that using simple ultrasound based rules over 75% of ovarian masses can be classified with a high level of test performance, leaving a proportion of more difficult masses where there is a need for better second stage tests [ [2] Kaijser J. Bourne T. Valentin L. Sayasneh A. Van Holsbeke C. Vergote I. et al. Improving strategies for diagnosing ovarian cancer: a summary of the International Ovarian Tumor Analysis (IOTA) studies. Ultrasound Obstet Gynecol. Jan 2013; 41: 9-20 Crossref PubMed Scopus (115) Google Scholar ]. The accurate characterization of these more difficult to characterize isolated adnexal masses is the current diagnostic challenge, and this is of paramount importance to ensure triage of patients to appropriate treatment pathways [ [2] Kaijser J. Bourne T. Valentin L. Sayasneh A. Van Holsbeke C. Vergote I. et al. Improving strategies for diagnosing ovarian cancer: a summary of the International Ovarian Tumor Analysis (IOTA) studies. Ultrasound Obstet Gynecol. Jan 2013; 41: 9-20 Crossref PubMed Scopus (115) Google Scholar ]. However, we disagree with the authors and question whether biomarkers alone or diagnostic algorithms, which are highly dependent upon tumor markers, are most helpful to clinicians as a primary test to differentiate between the benign or the malignant nature of these more difficult masses.