The Discrepancy between Preoperative Tumor Markers and Imaging Outcomes in Predicting Ovarian Malignancy

SIMPLE SUMMARY: Preoperative tumor markers and imaging often differ in predicting whether an ovarian tumor is malignant. We evaluated the correlation between the predictive values of imaging and tumor markers for diagnosing ovarian tumors, especially when there were discrepancies between the two. We found that, to prevent misidentification, it is necessary to understand the underlying disease that can increase tumor marker levels or benign tumors, which are difficult to distinguish from malignant tumors in imaging tests and several rare histopathologies with low risk of ovarian malignancy algorithm values. The malignant prediction of tumor markers and imaging was different in many patients with ovarian tumors, and this study will help to reduce the misidentification of tumors. ABSTRACT: Preoperative tumor markers and imaging often differ in predicting whether an ovarian tumor is malignant. Therefore, we evaluated the correlation between the predictive values of imaging and tumor markers for diagnosing ovarian tumors, especially when there were discrepancies between the two. We enrolled 1047 patients with ovarian tumors. The predictive values and concordance rates between the preoperative risk of ovarian malignancy algorithm (ROMA) and imaging, including CT and MRI, were evaluated. Diagnoses of 561 CT (77.9%) and 322 MRI group (69.2%) participants were consistent with the ROMA. Among them, 96.4% of the CT (541/561) and 92.5% of the MRI (298/322) group predicted an accurate diagnosis. In contrast, 67.3% (101/150) of CT and 75.2% (100/133) of MRI cases accurately predicted the diagnosis in cases with discrepancies between ROMA and CT or MRI; a total of 32% (48/150) of the CT and 25.5% (34/133) of the MRI group showed an accurate ROMA diagnosis in cases with discrepancies between ROMA and imaging. In the event of a discrepancy between ROMA and imaging when ovarian tumor malignancy prediction, the question is which method should take precedence. This study demonstrates that MRI has the greatest diagnostic accuracy, followed by CT and ROMA. It is also important to understand underlying diseases and benign conditions and rare histopathologies of malignant tumors.