Preoperative serum vascular endothelial growth factor (VEGF) in ovarian masses

To determine the diagnostic value of serum vascular endothelial growth factor (VEGF) in the preoperative assessment of the nature of ovarian masses.

A prospective cohort study was conducted from August 2001 to September 2002 on 40 premenopausal and 23 postmenopausal patients with ovarian masses. During preoperative workup, patient age, serum Ca-125 levels, serum VEGF levels, and tumor volume based on ultrasonographic examination were determined. Laparoscopic (n=23) or laparotomic (n=39) approaches were undertaken to obtain the final pathologic result. According to the final ovarian pathology, follicular cysts, corpus luteum cysts and endometriomas were grouped as non-neoplastic ovarian masses (n=40, group I). Serous or mucinous cyctadenomas, dermoid tumors and fibromas were allocated into the neoplastic benign ovarian mass group (n=10, group II). Primary malignant ovarian neoplasms were categorized into the neoplastic-malign group (n=12, group III).

Mean ages of cases among groups I, II and III were 39.0 +/- 2.0, 42.2 +/- 5.2 and 56.9 +/- 4.2, respectively. As age of the cases enrolled in this sudy increased, the more likely was the occurrence of neoplastic malign ovarian pathologies (p < 0.001). Among postmenopausal cases diagnosed with an ovarian mass, serum Ca-125 levels were 113.5 +/- 20 IU/ml compared to those in premenopausal cases (85.8 +/- 16.0, p = 0.05). The values for serum VEGF values among pre- and postmenopausal ovarian masses were 46.2 +/- 6.7 pg/ml and 68.2 +/- 7.9, respectively (p = 0.04). In group I, serum VEGF levels of endometriomas (56.5 +/- 1.5 pg/ml) were higher compared to those of follicular or corpus luteum cysts (30.6 +/- 2.8, p = 0.05). In contrast, tumor size appeared to be larger in non-endometriotic. non-neoplastic cysts (10.1 +/- 2.0 cm), compared to endometriomas (6.4 +/- 0.6 cm, p < 0.01). Serum VEGF levels of group III were higher than other groups (p < 0.001). With respect to the discriminating benign or malign nature of the mass, with a specific cut-off value of serum VEGF level of 68.7 pg/ml, the sensitivity, specificity, positive and negative likelihood ratios were 92.3%, 88.0%, 3.3 and 0.1, respectively. For serum Ca-125 levels, the sensitivity, specificity, positive and negative likelihood ratio with a statistically relevant cut-off value of 102 IU/ml were, 76.9%, 76.0%, 3.21 and 0.3, respectively. Area under curve (AUC) for serum VEGF and Ca-125 values were 0.938 (95% CI: 0.81-0.96) and 0.769 (95% CI: 0.64-0.86), respectively (p = 0.02). Among the postmenopausal group, AUC for serum VEGF and Ca-125 was detected as 0.902 (95% CI: 0.70-0.98) and 0.873 (95% CI: 0.66-0.91) (p = 0.14).

Serum VEGF has the potential to be considered as a tumor marker with a good diagnostic relevance in differentiating the nature of ovarian masses.