Shotgun proteomics identifies serum fibronectin as a candidate diagnostic biomarker for inclusion in future multiplex tests for ectopic pregnancy.

Ectopic pregnancy (EP) is difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a 'pregnancy of unknown location' (PUL), and diagnosis and exclusion of EP is challenging due to a lack of reliable biomarkers. The objective of this study was to identify novel diagnostic biomarkers for EP. Shotgun proteomics, incorporating combinatorial-ligand library pre-fractionation, was used to interrogate pooled sera (n = 40) from women undergoing surgery for EP, termination of viable intrauterine pregnancy and management of non-viable intrauterine pregnancy. Western blot was used to validate results in individual sera. ELISAs were developed to interrogate sera from women with PUL (n = 120). Sera were collected at time of first symptomatic presentation and categorized according to pregnancy outcome. The main outcome measures were differences between groups and area under the receiver operating curve (ROC). Proteomics identified six biomarker candidates. Western blot detected significant differences in levels of two of these candidates. ELISA of sera from second cohort revealed that these differences were only significant for one of these candidates, fibronectin. ROC analysis of ability of fibronectin to discriminate EP from other pregnancy outcomes suggested that fibronectin has diagnostic potential (ROC 0.6439; 95% CI 0.5090 to 0.7788; P>0.05), becoming significant when 'ambiguous' medically managed PUL excluded from analysis (ROC 0.6538; 95% CI 0.5158 to 0.7918; P<0.05). Fibronectin may make a useful adjunct to future multiplex EP diagnostic tests.

Characterising pelvic masses using ultrasound.

The evaluation of a pelvic mass, detected at routine ultrasound or in the context of having acute symptoms, requires certain methodical steps. It is necessary to diagnose the primary site or origin of the lesion; understand whether the lesion is an intra- or an extra-peritoneal lesion; distinguish whether the structure of interest is 'functional' and transitory or if we are dealing with a persistent mass; attempt to discriminate between the benign or malignant nature of the lesion; formulate a specific diagnosis; and furthermore, in the case of a possible malignant mass, define the stage of the disease process. Transvaginal ultrasonography is a dynamic and interactive examination and besides an analysis of the echostructure, and 'elasticity' of a pelvic mass, it also permits an assessment of site-specific pain in different pelvic areas, and an evaluation of the movement of the mass in relation to adjacent structures. All these 'dynamic' features, together with morphological and vascular parameters, are essential for making a correct diagnosis. The features of acute ovarian pathology including torsion are not discussed in detail here. This article will concentrate on the characterisation of pelvic masses that may be encountered by any examiner in the course of an assessment of the female pelvis.