Adneksiyel Kitlelerde Malignite Riskinin Belirlenmesi
Özet
Adneksiyel kitlelerde malignite riskinin belirlenmesini ve uygun hasta yönetimini inceleyen bu metinde, kitlelerin her yaştaki kadında görülebilen solid veya kistik oluşumlar olduğu belirtilmektedir. Erken evre over kanserlerinde sağkalım oranı %90'lara çıksa da, hastaların sadece %15'i erken tanı alabilmektedir. Bu nedenle malignite risk skorlama sistemlerinin geliştirilmesi, aşırı tedavilerden kaçınılması ve doğru triyaj için hayati önem taşır. Risk belirlenmesinde kişisel/ailesel kanser öyküsü, genetik mutasyonlar (BRCA 1-2, Lynch sendromu) ve klinik semptomlar dikkate alınmalıdır. İlk tercih edilen görüntüleme yöntemi transvajinal ve transabdominal ultrasonografidir (USG). Ayırıcı tanıda DePriest morfolojik indeksi, IOTA basit kuralları ve O-RADS gibi ultrasonografik sınıflandırma sistemleri etkin şekilde kullanılmaktadır. Laboratuvar testlerinde ise CA 125 en sık başvurulan biyobelirteçtir ancak birçok benign durumda da yükselebildiğinden spesifitesi düşüktür. Bu kısıtlamayı aşmak için HE4 biyobelirteci ile OVA1, Overa ve ROMA gibi çoklu panel sistemleri geliştirilmiştir. Ayrıca Birleşik Krallık'ta yaygın kullanılan Malignite Riski İndeksi (RMI); menopoz durumu, USG bulguları ve CA 125 düzeyini harmanlar. IOTA grubunun bilgisayarlı ADNEX modeli ise kitlenin iyi huylu, borderline veya evre bazlı invaziv olma olasılıklarını öngörür. Kanada Jinekolojik Onkoloji Derneği (GOC) ve ACOG gibi otoriteler, yüksek riskli hastaların ve metastaz şüphesi taşıyan olguların hızla jinekolojik onkologlara sevk edilmesini önermektedir.
In this text examining the determination of malignancy risk in adnexal masses and appropriate patient management, it is stated that masses are solid or cystic formations that can be seen in women of all ages. Although the survival rate in early-stage ovarian cancers reaches 90%, only 15% of patients can be diagnosed early. Therefore, the development of malignancy risk scoring systems is vital to avoid overtreatment and ensure accurate triage. Personal/familial history of cancer, genetic mutations (BRCA 1-2, Lynch syndrome), and clinical symptoms should be considered in risk determination. The first choice imaging method is transvaginal and transabdominal ultrasonography (USG). In differential diagnosis, ultrasonographic classification systems such as DePriest morphological index, IOTA simple rules, and O-RADS are effectively used. In laboratory tests, CA 125 is the most frequently used biomarker, but its specificity is low as it can also increase in many benign conditions. To overcome this limitation, multi-panel systems like OVA1, Overa, and ROMA have been developed along with the HE4 biomarker. Additionally, the Risk of Malignancy Index (RMI), widely used in the United Kingdom, blends menopausal status, USG findings, and CA 125 levels. The computerized ADNEX model of the IOTA group predicts whether the mass is benign, borderline, or stage-based invasive. Authorities such as the Gynecologic Oncology Society of Canada (GOC) and ACOG recommend rapid referral of high-risk patients and cases with suspected metastasis to gynecologic oncologists.
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