The value of Ca125, HE4, BCL2 i̇n the evaluation of adnexial masses

Adnexial mass is a common problem that can be encountered in clinical practices. It is very important to verify whether the mass is benign or malign in preoperative period in order to be defining the cure period. Most of the malign adnexial mass are belong to epithelial ovarian cancers. For the early stages surgery might be curing but for late stages survival is very low. Epithelial ovarian cancer is asymptomatic for early stages and only 30% of the cases can be diagnosed. Today in the evaluation part of the adnexial masses, pelvic examination, transvaginal ultrasonography and a tumor marker Ca-125 are basic methods. But those are inadequate for early stage diagnoses and to differentiate the benign adnexial masses. Most commonly using tumor marker in order to diagnose and evaluate the adnexial masses is Ca-125. It is leveled up for 80-90% of late staged ovarian cancers and 50% of early stages. Moreover Ca-125 might be leveled up for some benign gynecologic diseases and also for some nongynecologic diseases. Because of the insufficiency of Ca-125 itself for evaluation, some other tumor markers with high sensitivity and specifity are needed. According to that fact in our study, the importance of Ca-125, HE4 and bcl2 for malignity of adnexial masses are researched. Study is planned, dissipated and applied on 50 patients with proved adnexial masses and 30 patients as a control group like a prospective study in Başkent University Gynecology Department and Gynecologic Oncology section between November 2010 and March 2011. Ca-125, HE4 in blood serum, HE4, bcl2 in urine and bcl2 in saliva are measured. Blood samples were taken from antcubital ven, urine samples were taken from urine catheter centrifuged well and kept at -80 °C. Saliva samples were taken into biochemical tubes without heparin with the help of pipettes centrifuged and frozen at -20 °C. As a conclusion, levels of Ca-125, HE4 in blood serum and HE4 in urine are relatively high for malign cases. (p<0, 05) Ca-125 is increased for some benign cases but HE4 is stable for same patients. After Ca-125 and HE4 are combined and ROMA algorithm is established, it is shown that sensitivity of those two markers is 91.7% for postmenopausal malign patients. Results for bcl2, both in saliva and urine are meaningless. (p>0, 05) It is strictly recommended that if the number of subjects is increased we could result in more meaningful prospective study. iv Key Words: Adnexial mass, ovarian cancer, tumor marker,Ca125,HE4,Bcl2