Abstract:

Objective To analyze the differences in clinical characteristics, imaging feature and laboratory data between patients with pelvic tuberculosis and ovarian cancer in order to improve the accuracy of pelvic tuberculosis diagnosis.Methods A total of 25 patients with pathologically confirmed pelvic tuberculosis in Shengjing Hospital of China Medical University from September 2013 to September 2018 were included as tuberculosis group. During the same period, 25 cases of age-matched ovarian epithelial carcinoma who were hospitalized in the same hospital were included as ovarian cancer group. The clinical symptoms and signs, imaging data and laboratory examination results between the two groups were compared and analyzed.Results The incidence of abdominal pain, abdominal distension and infertility were 40.0% (10/25), 36.0% (9/25) and 20.0% (5/25) in the pelvic tuberculosis group and 48.0% (12/25), 32.0% (8/25) and 0.0% in the ovarian cancer group; there were no significant differences between the two groups (χ ²=0.33, 0.09 and 3.56; P=0.569, 0.765 and 0.059, respectively). Pelvic ultrasound examination of patients indicated that the maximum diameter of mass in the pelvic tuberculosis group (median (quartile), M(Q₁,Q₃): 6.45 (4.70, 9.55)cm) was shorter than that in the ovarian cancer group (10.60 (7.40, 15.10)cm); the difference was statistically significant (Z=3.08, P=0.002). The positron emission tomography-computed tomography (PET-CT) showed that standard uptake value (SUV) of mass in the pelvic tuberculosis group (M(Q₁,Q₃): 8.00 (7.72, 8.28)) was lower than that of the ovarian cancer group (14.01 (12.53, 15.17)); the difference was statistically significant (Z=1.85, P=0.045). Laboratory examination results showed that human epididymis protein 4 (HE4) (M(Q₁,Q₃): 92.84 (75.20, 102.95)pmol/L) and carbohydrate antigen 724 values ( M ( Q_1 , Q_3 ): 1.24 (1.10, 2.83)kU/L) of the pelvic tuberculosis group were lower than those of the ovarian cancer group (267.38 (168.88, 489.70)pmol/L and 19.43 (2.31, 50.39)kU/L); the differences were statistically significant (Z=2.06 and 3.28, P=0.042 and 0.001, respectively).Conclusion The main clinical manifestations of pelvic tuberculosis and ovarian cancer were abdominal pain, abdominal distension and infertility. Pelvic mass in the pelvic tuberculosis patients was smaller compared with ovarian cancer patients. The SUV of mass indicated by PET-CT in the pelvic tuberculosis patients was lower compared with ovarian cancer patients. The increased HE4 value in the pelvic tuberculosis patients was not as significant as the ovarian cancer patients. It is difficult to diffe-rentiate pelvic tuberculosis and ovarian cancer in clinic. Pathological examination is required when necessary.

Key words: Tuberculosis, female genital, Ovarian neoplasms, Diagnosis, differential, Comparative study