S Hameed - Department of Microbiology, College of Medicine, University of Basrah, Basrah, Iraq
H Abdulqader Jasim - Department of Microbiology, College of Medicine, University of Basrah, Basrah, Iraq
M Sharief - Department of Gynecology and Obstetrics, College of Medicine, University of Basrah, Basrah, Iraq

Ovarian carcinoma is one of the most common types of neoplasms in women and the fifth leading cause of cancer death among women worldwide. Adnexal masses are classified as simple or complicated and can be benign or malignant. No single biomarker has demonstrated high sensitivity and specificity for detecting early ovarian cancer. Therefore, the current study was designed to investigate the influence of using two biomarkers as a tool for diagnosis in patients with an adnexal mass. This prospective case-control study was carried out on female patients diagnosed by ultrasound and magnetic resonance imaging with adnexal masses and scheduled for surgery and healthy women as a control group (n=۵۰ each). The patients were in the age range of ۱۶-۸۰ years old and had attended the surgical rooms of Basrah hospitals, Basrah, Iraq, from January to July ۲۰۲۱. The levels of serum biomarkers were quantitatively assessed using the enzyme-linked immunosorbent assay. The serum concentration of the human epididymis protein ۴ (HE۴) biomarker exhibited significant differences between females with adnexal mass and healthy women. There was no significant association between neither the patient’s age nor the menopausal state and the serum level of HE۴. The serum level of HE۴ had a sensitivity of ۹۲% and a specificity of ۶۶% as a serum marker for the presence of adnexal mass with a positive predictive value of ۷۳% and a negative predictive value of ۸۹%. In this study, serum interleukin-۶ (IL-۶) had a sensitivity of ۳۰% and specificity of ۶۴% in determining patients with adnexal mass pathology. It was found that the level of IL-۶ was similar in all patients, compared to that in the control group. The median levels of serum HE۴ showed high value in patients in the age groups of ۲۱-۴۰, ۴۱-۵۰, and >۵۰ than in the control group; however, it was not statistically different (P=۰.۴۱۳). Human epididymis protein ۴ was the top biomarker representing a higher concentration in adnexal mass; moreover, it demonstrated the highest performance in all samples with Adnexal mass. The results of our study showed that combining more than one marker measurement increased both the sensitivity and specificity of distinguishing patients with adnexal mass pathology.

Adnexal mass, HE۴, IL-۶, Ovarian cancer