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Ascites as a predictor of ovarian malignancy
Jane Shen-Gunther1, Robert S Mannel
1Gynecologic Surgery and Oncology, 2911 N. Tenaya Way, Suite 105, Las Vegas, NV 89128, USA. jshengunth@aol.com
Gynecologic Oncology
|December 7, 2002
Summary
Ascites (fluid in the abdomen) is a strong indicator of ovarian cancer, especially in advanced stages. However, its absence does not rule out malignancy, particularly in early-stage or borderline ovarian tumors.
Area of Science:
- Gynecologic Oncology
- Diagnostic Imaging
- Pathology
Background:
- Ascites, or fluid accumulation in the abdominal cavity, is a clinical finding that can be associated with various pelvic pathologies.
- Its utility as a specific predictor of ovarian malignancy requires further elucidation, particularly in relation to tumor histology and disease stage.
Purpose of the Study:
- To evaluate the diagnostic value of ascites in predicting ovarian malignancy.
- To examine the correlation between ascites, ovarian tumor histology (benign, borderline, malignant), and disease stage.
Main Methods:
- Retrospective cohort study of 125 patients with pelvic masses.
- Review of preoperative clinical data, imaging (ultrasound, CT, MRI), and operative reports for evidence of ascites.
- Correlation of ascites presence with final histopathological findings and International Federation of Gynecology and Obstetrics (FIGO) staging.
Main Results:
- Ascites was present in 42% of patients; 73% of malignant ovarian tumors had ascites, compared to 58% of borderline and 9% of benign tumors.
- The positive predictive value (PPV) of ascites for malignancy was 95%, with a negative predictive value (NPV) of 64%.
- Ascites incidence and volume increased progressively with advanced stages of ovarian malignancy (89% in stages III-IV vs. 17% in stages I-II).
Conclusions:
- Preoperative detection of ascites is highly predictive of ovarian malignancy.
- Absence of ascites does not exclude ovarian cancer, as many early-stage and borderline tumors lack ascites.
- A clear relationship exists between the stage of ovarian cancer and the presence/volume of ascites.