Circulating tumor cells in the differential diagnosis of adnexal masses

// Dong Hoon Suh 1 , Miseon Kim 1 , Jin Young Choi 1 , Jiyoon Bu 2 , Yoon-Tae Kang 2 , Byung Su Kwon 3 , Banghyun Lee 4 , Kidong Kim 1 , Jae Hong No 1 , Yong-Beom Kim 1 and Young-Ho Cho 2 1 Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea 3 Department of Obstetrics and Gynecology, Pusan National University Hospital, Busan, Korea 4 Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea Correspondence to: Yong-Beom Kim, email: ybkimlh@snubh.org Keywords: ovarian neoplasm, circulating tumor cell, preoperative period, differential diagnosis, early stage cancer Received: January 02, 2017      Accepted: June 27, 2017      Published: August 24, 2017 ABSTRACT The aim of this study was to evaluate circulating tumor cell (CTC) detection in the differential diagnosis of adnexal masses. A total of 87 preoperative women with an indeterminate adnexal mass were prospectively enrolled. Preoperative diagnostic modalities including CTC detection, risk of ovarian malignancy algorithm, risk of malignancy index, and computed tomography or magnetic resonance imaging were compared. Forty-three (49.4%) benign tumors, 13 (14.9%) borderline malignant masses, and 31 (35.7%) cancers were pathologically confirmed. Forty-nine (56.3%) cases were positive for CTCs: 19/43 (44.2%) benign, 10/10 (100%) early-stage, and 14/21 (66.7%) advanced-stage cancer. CTC detection had sensitivities of 77.4%, 100%, and 100% for benign vs. all stage cancer (n = 74), benign vs. stage I–II cancer (n = 53), and benign vs. stage I cancer (n = 49), respectively. CTC detection had a specificity of 55.8% across all comparisons. The sensitivities of the other modalities assayed were decreased in stage I–II cancer and stage I cancer vs. benign masses. Receiver operating characteristic curves showed that CTCs, of which the area under the curve was modest in all stage cancer (0.655), had the widest area under the curve among the evaluated modalities in stage I–II cancer and stage I cancer (0.768 for both). In conclusion, our study findings suggest that preoperative CTCs could have a substantial role in differentiating early stage cancer from benign tumors for adnexal masses.