Abstract: Background and purpose: Ovarian masses with papillary projections diagnosed by ultrasound are suspected to be malignant, and there is a risk of overtreatment. Hasty operation would undoubtedly damage the ovarian function of young patients with reproductive needs. Therefore, the prediction of malignant risk of such special ovarian tumors may strive for the opportunity of delaying surgery for young patients with low malignant risk. The purpose of this study was to evaluate the values of the Copenhagen Index (CPH-I), carbohydrate antigen 12-5 (CA12-5) and human epididymis protein 4 (HE4) in predicting the malignant potential of ovarian masses with papillary projections diagnosed by ultrasound. Methods: The clinical data of 192 patients with ovarian tumors with papillary nodules detected by preoperative ultrasound in Obstetrics and Gynecology Hospital of Fudan University from Jul. 2015 to Jun. 2019 were collected. Clinical information included age, menopause status, number of papillary projections, maximum diameter of tumor, pathological classification and preoperative CA12-5, HE4 and CPH-I values. Receiver operating characteristic (ROC) curve was drawn to evaluate the abilities of CPH-I, CA12-5 and HE4 in differentiating benign from malignant ovarian tumors. Results: CPH-I, CA12-5 and HE4 discriminated well between the benign ovarian tumors and epithelial ovarian cancers (EOC), and the discrimination ability of CPH-I was superior to that of HE4 (P<0.01). CPH-I, CA12-5 and HE4 all discriminated well between benign ovarian tumors and malignant plus borderline ovarian tumors (EOC+BOT). The abilities of CPH-I and CA12-5 to discriminate between benign and EOC+BOT groups were significantly better than that of HE4 (P<0.001 and P<0.05, respectively). The results for the ≤5 cm group were similar to the results obtained when all ovarian masses were considered. CPH-I had high sensitivity, specificity, positive predictive value, and negative predictive value in discriminating between the benign and malignant ovarian masses. Conclusion: Tumor markers can differentiate between benign and malignant ovarian masses with papillary projections. In all, CPH-I had a better discrimination ability than CA12-5, and CA12-5 was better than HE4. For young patients who have small (≤5 cm) ovarian masses with papillary projections and fertility needs, follow-up opportunities are enabled by monitoring tumor markers and B-mode ultrasound.

Key words: CPH-I, CA12-5, HE4, Borderline ovarian tumor, Epithelial ovarian cancer