Ovarian cancer biomarkers as diagnostic triage tests

Ovarian cancer survival improves with accurate surgical staging, maximal tumor removal, and appropriate adjuvant chemotherapy. Therefore, survival is higher among patients managed by a gynecologic oncologist trained in these surgical techniques. Unfortunately, identifying patients preoperatively for referral to a gynecologic oncologist is often challenging, given that there are no definitive noninvasive diagnostic tests to triage patients with an adnexal mass to a surgical subspecialist. Inaccurate preoperative diagnosis of an adnexal mass frequently results in either unnecessary surgery for a benign mass or inadequate surgical staging for a malignant mass, with a subsequent negative effect on overall survival. Several recent tests have been investigated to improve the preoperative diagnosis of women presenting with adnexal masses. Cancer antigen 125 is the most commonly used serum marker for screening and monitoring of ovarian cancer, but is elevated in many benign conditions and falsely normal in 50% of early-stage epithelial ovarian cancers. The relatively low sensitivity and specificity of CA125 has driven researchers to identify new biomarkers and algorithms to assist with triaging adnexal masses. A promising new biomarker, human epididymis protein 4, has been developed to monitor for recurrence of ovarian cancer. Three algorithms have also been developed, ie, risk of malignancy index, risk of ovarian malignancy algorithm, and OVA-1, which is the first diagnostic algorithm that combines multiple biomarkers for the purpose of triaging adnexal masses to be approved by the US Food and Drug Administration.