Research Article| Volume 196, P60-63, January 2016

The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor

Published:November 24, 2015DOI:



      To evaluate the utility of tumor markers and complete blood count to increase the diagnostic accuracy to detect malignant cases that are intraoperatively reported as mucinous borderline ovarian tumors (BOT).

      Study design

      Patients who underwent laparotomy at our gynecologic oncology clinic between 2007 and 2015 for evaluation of an adnexal mass with an intraoperative frozen section report of mucinous BOT were retrospectively analyzed. Patients were grouped according to the final pathological diagnoses (malignant, borderline and benign), and were compared in terms of tumor marker levels and complete blood count parameters. Significant parameters were evaluated together with frozen section results, and were assessed for diagnostic accuracy.


      A total of 63 patients were included in the study. Of these, 41 patients had borderline, 11 patients had benign, and 11 patients had malignant mucinous ovarian tumors. Patient age, menopausal status, hemoglobin, platelet and lymphocyte counts were similar among the groups (p > 0.05). On the other hand, white blood cell, neutrophil counts and neutrophil/lymphocyte ratio (NLR) were significantly higher in malignant cases (p < 0.05). Similarly, CA125 and CA19-9 were significantly higher in malignant group (p < 0.05). When evaluated with the frozen section results, CA19-9 and NLR had the highest sensitivity to detect mucinous cancers (81 and 78 percent, respectively).


      In patients who have an intraoperative frozen section diagnosis of borderline mucinous ovarian tumors, CA19-9, NLR and CA125 were significant predictors of malignancy. In light of larger future studies, we believe that integrating these parameters into routine clinical practice may decrease the rate of under diagnosis.


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        • Kelly P.J.
        • Archbold P.
        • Price J.H.
        • Cardwell C.
        • McCluggage W.G.
        Serum CA19.9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype.
        J Clin Pathol. 2010; 63: 169-173
        • Hart W.R.
        Mucinous tumors of the ovary: a review.
        Int J Gynecol Pathol: Off J Int Soc Gynecol Pathol. 2005; 24: 4-25
        • Rodríguez I.M.
        • Prat J.
        Mucinous tumors of the ovary: a clinicopathologic analysis of 75 borderline tumors (of intestinal type) and carcinomas.
        Am J Surg Pathol. 2002; 26: 139-152
        • Ilvan S.
        • Ramazanoglu R.
        • Ulker Akyildiz E.
        • Calay Z.
        • Bese T.
        • Oruc N.
        The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses.
        Gynecol Oncol. 2005; 97: 395-399
        • Rose P.G.
        • Rubin R.B.
        • Nelson B.E.
        • Hunter R.E.
        • Reale F.R.
        Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors.
        Am J Obstet Gynecol. 1994; 171: 823-826
        • Twaalfhoven F.C.
        • Peters A.A.
        • Trimbos J.B.
        • Hermans J.
        • Fleuren G.J.
        The accuracy of frozen section diagnosis of ovarian tumors.
        Gynecol Oncol. 1991; 41: 189-192
        • Morice P.
        • Uzan C.
        • Fauvet R.
        • Gouy S.
        • Duvillard P.
        • Darai E.
        Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence.
        Lancet Oncol. 2012; 13: e103-e115
        • Song T.
        • Choi C.H.
        • Kim H.-J.
        • et al.
        Accuracy of frozen section diagnosis of borderline ovarian tumors.
        Gynecol Oncol. 2011; 122: 127-131
        • Kumpulainen S.
        • Kuoppala T.
        • Leminen A.
        • et al.
        Surgical staging, treatment, and follow-up of borderline tumors in different hospital categories: a prospective nationwide survey in Finland.
        Acta Obstet Gynecol Scand. 2007; 86: 610-614
        • Shih K.K.
        • Garg K.
        • Soslow R.A.
        • Chi D.S.
        • Abu-Rustum N.R.
        • Barakat R.R.
        Accuracy of frozen section diagnosis of ovarian borderline tumor.
        Gynecol Oncol. 2011; 123: 517-521
        • Menzin A.W.
        • Rubin S.C.
        • Noumoff J.S.
        • LiVolsi V.A.
        The accuracy of a frozen section diagnosis of borderline ovarian malignancy.
        Gynecol Oncol. 1995; 59: 183-185
        • Pinto P.B.
        • Andrade L.A.
        • Derchain S.F.
        Accuracy of intraoperative frozen section diagnosis of ovarian tumors.
        Gynecol Oncol. 2001; 81: 230-232
        • Houck K.
        • Nikrui N.
        • Duska L.
        • et al.
        Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis.
        Obstet Gynecol. 2000; 95: 839-843
        • Gol M.
        • Baloglu A.
        • Yigit S.
        • Dogan M.
        • Aydin C.
        • Yensel U.
        Accuracy of frozen section diagnosis in ovarian tumors: is there a change in the course of time?.
        Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc. 2003; 13: 593-597
        • Boriboonhirunsarn D.
        • Sermboon A.
        Accuracy of frozen section in the diagnosis of malignant ovarian tumor.
        J Obstet Gynaecol Res. 2004; 30: 394-399
        • Tempfer C.B.
        • Polterauer S.
        • Bentz E.-K.
        • Reinthaller A.
        • Hefler L.A.
        Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature.
        Gynecol Oncol. 2007; 107: 248-252
        • Taskiran C.
        • Erdem O.
        • Onan A.
        • et al.
        The role of frozen section evaluation in the diagnosis of adnexal mass.
        Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc. 2008; 18: 235-240
        • Rakhshan A.
        • Zham H.
        • Kazempour M.
        Accuracy of frozen section diagnosis in ovarian masses: experience at a tertiary oncology center.
        Arch Gynecol Obstet. 2009; 280: 223-228
        • Brun J.-L.
        • Cortez A.
        • Rouzier R.
        • et al.
        Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors.
        Am J Obstet Gynecol. 2008; 199 (244.e1–7)
        • Kim J.H.
        • Kim T.J.
        • Park Y.G.
        • et al.
        Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary.
        J Gynecol Oncol. 2009; 20: 176-180
        • Molina R.
        • Ojeda B.
        • Filella X.
        • et al.
        A prospective study of tumor markers CA 125 and CA 19.9 in patients with epithelial ovarian carcinomas.
        Tumour Biol: J Int Soc Oncodev Biol Med. 1992; 13: 278-286
        • Timmerman D.
        • Van Calster B.
        • Jurkovic D.
        • et al.
        Inclusion of CA-125 does not improve mathematical models developed to distinguish between benign and malignant adnexal tumors.
        J Clin Oncol: Off J Am Soc Clin Oncol. 2007; 25: 4194-4200
        • Tamakoshi K.
        • Kikkawa F.
        • Shibata K.
        • et al.
        Clinical value of CA125, CA19-9, CEA, CA72-4, and TPA in borderline ovarian tumor.
        Gynecol Oncol. 1996; 62: 67-72
        • Gotlieb W.H.
        • Soriano D.
        • Achiron R.
        • et al.
        CA 125 measurement and ultrasonography in borderline tumors of the ovary.
        Am J Obstet Gynecol. 2000; 183: 541-546
        • Gizzo S.
        • Berretta R.
        • Di Gangi S.
        • et al.
        Borderline ovarian tumors and diagnostic dilemma of intraoperative diagnosis: could preoperative He4 assay and ROMA score assessment increase the frozen section accuracy? A multicenter case–control study.
        BioMed Res Int. 2014; 2014: 803598
        • Yildirim M.A.
        • Seckin K.D.
        • Togrul C.
        • et al.
        Roles of neutrophil/lymphocyte and platelet/lymphocyte ratios in the early diagnosis of malignant ovarian masses.
        Asian Pac J Cancer Prev. 2014; 15: 6881-6885
        • Zanetta G.
        • Rota S.
        • Lissoni A.
        • Meni A.
        • Brancatelli G.
        • Buda A.
        Ultrasound, physical examination, and CA 125 measurement for the detection of recurrence after conservative surgery for early borderline ovarian tumors.
        Gynecol Oncol. 2001; 81: 63-66
        • Bozkurt M.
        • Yumru A.E.
        • Aral I.
        Evaluation of the importance of the serum levels of CA-125, CA15-3, CA-19-9, carcinoembryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy.
        Eur J Gynaecol Oncol. 2013; 34: 540-544
        • Dede M.
        • Gungor S.
        • Yenen M.C.
        • Alanbay I.
        • Duru N.K.
        • Haşimi A.
        CA19-9 may have clinical significance in mature cystic teratomas of the ovary.
        Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc. 2006; 16: 189-193
        • Kyung M.S.
        • Choi J.S.
        • Hong S.H.
        • Kim H.S.
        Elevated CA 19-9 levels in mature cystic teratoma of the ovary.
        Int J Biol Markers. 2009; 24: 52-56
        • Cho H.-Y.
        • Kyung M.S.
        Serum CA19-9 as a predictor of malignancy in primary ovarian mucinous tumors: a matched case-control study.
        Med Sci Monit: Int Med J Exp Clin Res. 2014; 20: 1334-1339
        • Poncelet C.
        • Fauvet R.
        • Yazbeck C.
        • Coutant C.
        • Darai E.
        Impact of serum tumor marker determination on the management of women with borderline ovarian tumors: multivariate analysis of a French multicentre study.
        Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2010; 36: 1066-1072