The predictive value of the first trimester combined test for gestational diabetes mellitus.

OBJECTIVES: To investigate the predictive importance of first trimester combined test markers pregnancy-associated plasma protein-A (PAPP-A), human chorionic gonadotropin ß (ß-hCG) and nuchal translucency (NT) for gestational diabetes mellitus (GDM). MATERIAL AND METHODS: Pregnant women which both first trimester combined test and GDM screening were performed during antenatal follow-up were included in this retrospective case-control study. The cases were divided into two groups as GDM screening positive and negative. Demographic, clinical and laboratory data of both groups were compared. Predictive tests were applied to the first trimester combined test data for the detection of GDM. RESULTS: A total of 378 patients, 171 (45.2%) in the control group and 207 (54.8%) in the GDM group. The age (control: 30.9 ± 5.2; GDM: 30.5 ± 5.1; p = 0.844) and NT (control: 1.254 ± 0.289; GDM: 1.319 ± 0.299; p = 0.074) data of the groups were statistically similar. MoM PAPP-A (GDM:0.967 ± 0.685; ontrol:1.191 ± 0.624; p < 0.001) and MoM f-ßhCG (GDM: 0.9 ± 0.602; control: 1.103 ± 0.746; p = 0.001) levels of the GDM group were lower than the control group. In the binary logistic regression model, MoM PAPP-A and MoM f-ßhCG variables were found to be effective on GDM. In the ROC analysis of these variables, the MoM PAPP-A (0.654) had the highest area under the curve. According to the optimum cut-off point (≤ 0.885) of the MoM PAPP-A, we found a sensitivity of 66.7% and a specificity of 65.50% for predicting GDM. CONCLUSIONS: Our study showed that serum PAPP-A and f-ßhCG MoM values, which are among the first trimester combined test parameters, can be used in the early pregnancy period for the prediction of GDM.

Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma.

OBJECTIVE: To evaluate whether a preoperative serum CA-125 level in patients with endometrial carcinoma can provide additional information in determining the stage of disease, and which cutoff value is optimal in this respect. STUDY DESIGN: Retrospective chart review of 147 women with pathologically proven endometrial carcinoma who were treated between January 1999 and May 2009. The associations of preoperative CA-125 levels with the tumor stage, histologic type and grade, and the lymph node positivity were examined. To determine the values of cutoff point levels for serum tumor marker CA-125, the levels of 20 IU/ml and 35 IU/ml were compared. RESULTS: High CA-125 levels significantly correlated with advanced stage and lymph node metastases. The ROC curve determined that the best cutoff value was 20 U/ml. The sensitivity and specificity of a CA-125 cutoff level of 20 U/ml were 75% and 69.51%, respectively, with a positive predictive value of 80.6% and negative predictive value of 84.9%. CONCLUSION: The current study suggests that measurement of preoperative CA-125 is a clinically useful test in endometrial carcinoma patients. CA-125 appears to be a significant independent predictor of the advanced stage of the disease as well as lymph node metastases. The results complement a growing body of literature that supports the relationship between CA-125 level and stage of disease but more studies are needed to establish the appropriate cutoff level for serum CA-125 in this respect.