{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T11:23:02Z","timestamp":1767612182809,"version":"build-2065373602"},"reference-count":59,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Adnexal masses are common in women across different age and hormonal states: pregnancy, premenopause, and postmenopause. Ovarian carcinoma, a malignancy arising in the adnexa, poses significant health risks. While malignancy risk increases with age and postmenopausal status, current methods for stratifying borderline cases remain inadequate, potentially leading to over- or undertreatment that may affect fertility or survival. Methods: This retrospective study was conducted with 318 adult women who were diagnosed with adnexal masses and underwent surgery at a university hospital between 2020 and November 2023. Patient data were retrieved from the hospital\u2019s electronic medical record system. Routinely measured preoperative serologic parameters\u2014carbohydrate antigen (CA)125, CA19-9, CA15-3, carcinoembryonic antigen (CEA), Alpha-fetoprotein (AFP), Lactate dehydrogenase (LDH), and fibrinogen-to-albumin ratio (FAR) levels\u2014were analyzed alongside final histopathological results. No procedures outside routine clinical practice were performed. Diagnostic performance of each marker was evaluated using receiver operating curve (ROC) analysis. Results: A total of 318 patients with adnexal masses were analyzed. The FAR levels were significantly elevated in malignant compared to borderline and benign groups (p &lt; 0.001), and FAR alone showed 47% sensitivity and 91% specificity for borderline tumors, whereas CA125 showed 70% sensitivity and 85% specificity. Multivariate models combining FAR, CA125, and CA15-3 achieved the highest diagnostic accuracy, with superior AUCs compared to single biomarkers. Conclusions: FAR is a simple, accessible inflammatory marker that complements CA125 by enhancing specificity. Combination of multiple markers with the highest sensitivity and specificity, together with FAR, may reduce the risk of both false negatives, offering a more balanced and accurate diagnostic tool for preoperative stratification of borderline tumor cases.<\/jats:p>","DOI":"10.3390\/diagnostics15182372","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T12:24:25Z","timestamp":1758198265000},"page":"2372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Power of the Fibrinogen-to-Albumin Ratio for Estimating Malignancy in Patients with Adnexal Masses: A Methodological Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3067-9125","authenticated-orcid":false,"given":"G\u00f6zde","family":"\u015eahin","sequence":"first","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0206-1697","authenticated-orcid":false,"given":"Ay\u015fe","family":"Haz\u0131rBulan","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatice Argun","family":"Atalm\u0131\u015f","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0130lkbal Temel","family":"Y\u00fcksel","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I\u015f\u0131k","family":"S\u00f6zen","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4016-0549","authenticated-orcid":false,"given":"Alper","family":"Ko\u00e7b\u0131y\u0131k","sequence":"additional","affiliation":[{"name":"Patology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9183-3558","authenticated-orcid":false,"given":"Nil\u00fcfer \u00c7etinkaya","family":"Kocadal","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0130smet","family":"Alk\u0131\u015f","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/OGX.0000000000000909","article-title":"Adnexal masses in pregnancy","volume":"76","author":"Kuller","year":"2021","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ygyno.2016.07.096","article-title":"Adnexal masses in children, adolescents and women of reproductive age in the netherlands: A nationwide population-based cohort study","volume":"143","author":"Hermans","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.18203\/2320-1770.ijrcog20241768","article-title":"Diagnosis and management of adnexal masses","volume":"13","author":"Prajapati","year":"2024","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kang, G.G., So, K.A., Hwang, J.Y., Kim, N.R., Yang, E.J., Shim, S.H., Lee, S.J., and Kim, T.J. (2022). Ultrasonographic diagnosis and surgical outcomes of adnexal masses in children and adolescents. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-08015-4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.jpag.2021.01.002","article-title":"Benign, borderline, and malignant pediatric adnexal masses: A 10-year review","volume":"34","author":"Xac","year":"2021","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Shoupe, D. (2016). Management of ovarian masses in the older woman. Handbook of Gynecology, Springer International Publishing.","DOI":"10.1007\/978-3-319-17002-2_92-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1080\/01443615.2020.1755625","article-title":"Diagnostic work-up in paediatric and adolescent patients with adnexal masses: An evidence-based approach","volume":"41","author":"Terzic","year":"2021","journal-title":"J. Obstet. Gynaecol. J. Inst. Obstet. Gynaecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1634\/theoncologist.2012-0139","article-title":"Diagnosis, treatment, and follow-up of borderline ovarian tumors","volume":"17","author":"Fischerova","year":"2012","journal-title":"Oncologist"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101965","DOI":"10.1016\/j.jogoh.2020.101965","article-title":"Borderline ovarian tumors: French guidelines from the cngof. Part 1. Epidemiology, biopathology, imaging and biomarkers","volume":"50","author":"Huchon","year":"2021","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/uog.23635","article-title":"Esgo\/isuog\/iota\/esge consensus statement on preoperative diagnosis of ovarian tumors","volume":"58","author":"Timmerman","year":"2021","journal-title":"Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol."},{"key":"ref_11","first-page":"676","article-title":"Diagnosis and management of adnexal masses","volume":"93","author":"Biggs","year":"2016","journal-title":"Am. Fam. Physician"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1007\/s00261-020-02812-z","article-title":"Contemporary guidelines for adnexal mass imaging: A 2020 update","volume":"46","author":"Stein","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1148\/radiol.2019191150","article-title":"O-rads us risk stratification and management system: A consensus guideline from the acr ovarian-adnexal reporting and data system committee","volume":"294","author":"Andreotti","year":"2020","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.ajog.2016.01.007","article-title":"Predicting the risk of malignancy in adnexal masses based on the simple rules from the international ovarian tumor analysis group","volume":"214","author":"Timmerman","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1001\/jamaoncol.2022.5969","article-title":"External validation of the ovarian-adnexal reporting and data system (o-rads) lexicon and the international ovarian tumor analysis 2-step strategy to stratify ovarian tumors into o-rads risk groups","volume":"9","author":"Timmerman","year":"2023","journal-title":"JAMA Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Watrowski, R., Obermayr, E., Wallisch, C., Aust, S., Concin, N., Braicu, E.I., Van Gorp, T., Hasenburg, A., Sehouli, J., and Vergote, I. (2022). Biomarker-based models for preoperative assessment of adnexal mass: A multicenter validation study. Cancers, 14.","DOI":"10.3390\/cancers14071780"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Matsas, A., Stefanoudakis, D., Troupis, T., Kontzoglou, K., Eleftheriades, M., Christopoulos, P., Panoskaltsis, T., Stamoula, E., and Iliopoulos, D.C. (2023). Tumor markers and their diagnostic significance in ovarian cancer. Life, 13.","DOI":"10.3390\/life13081689"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"196","DOI":"10.38053\/acmj.1243317","article-title":"Borderline ovarian tumors: Twenty years of experience at a tertiary center","volume":"5","author":"Sahin","year":"2023","journal-title":"Anatol. Curr. Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1177\/0300060518795582","article-title":"Factors associated with misdiagnosis of frozen section of mucinous borderline ovarian tumor","volume":"47","author":"Zhang","year":"2019","journal-title":"J. Int. Med. Res."},{"key":"ref_20","first-page":"316","article-title":"Factors affecting compliance of intraoperative frozen and final histopathology in borderline ovarian tumors: Retrospective cohort study","volume":"3","author":"Deniz","year":"2019","journal-title":"J. Surg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/cmi.2015.97","article-title":"Hepatocytes: A key cell type for innate immunity","volume":"13","author":"Zhou","year":"2016","journal-title":"Cell. Mol. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s10787-021-00820-z","article-title":"A brief, highly selective history of acute phase proteins as indicators of infection, inflammation and injury","volume":"29","author":"Powanda","year":"2021","journal-title":"Inflammopharmacology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/j.hoc.2021.07.011","article-title":"Disorders of fibrinogen and fibrinolysis","volume":"35","author":"May","year":"2021","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.ejcb.2011.09.008","article-title":"Hepatic acute phase proteins\u2014Regulation by il-6- and il-1-type cytokines involving stat3 and its crosstalk with nf-\u03bab-dependent signaling","volume":"91","author":"Bode","year":"2012","journal-title":"Eur. J. Cell Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1016\/j.jhep.2016.02.004","article-title":"Il-6 pathway in the liver: From physiopathology to therapy","volume":"64","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ward, E.S., Gelinas, D., Dreesen, E., Van Santbergen, J., Andersen, J.T., Silvestri, N.J., Kiss, J.E., Sleep, D., Rader, D.J., and Kastelein, J.J.P. (2022). Clinical significance of serum albumin and implications of fcrn inhibitor treatment in igg-mediated autoimmune disorders. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.892534"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4330\/wjc.v15.i1.13","article-title":"Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome","volume":"15","author":"Makkar","year":"2023","journal-title":"World J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e14049","DOI":"10.1111\/eci.14049","article-title":"Association between fibrinogen-to-albumin ratio and prognosis of patients with heart failure","volume":"53","author":"Xu","year":"2023","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Li, B., Deng, H., Lei, B., Chen, L., Zhang, X., and Sha, D. (2022). The prognostic value of fibrinogen to albumin ratio in malignant tumor patients: A meta-analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.985377"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"131","DOI":"10.4143\/crt.2020.330","article-title":"Systemic inflammatory biomarkers, especially fibrinogen to albumin ratio, predict prognosis in patients with pancreatic cancer","volume":"53","author":"Fang","year":"2021","journal-title":"Cancer Res. Treat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3281","DOI":"10.3748\/wjg.v24.i29.3281","article-title":"Prognostic significance of the fibrinogen-to-albumin ratio in gallbladder cancer patients","volume":"24","author":"Xu","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4557","DOI":"10.2147\/DMSO.S337986","article-title":"Fibrinogen to albumin ratio as an independent risk factor for type 2 diabetic kidney disease","volume":"14","author":"Wang","year":"2021","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_33","first-page":"1497","article-title":"Comparison of o-rads, gi-rads, and adnex for diagnosis of adnexal masses: An external validation study conducted by junior sonologists","volume":"41","author":"Lai","year":"2022","journal-title":"J. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Pan, R.K., Zhang, S.Q., Zhang, X.Y., Xu, T., Cui, X.W., Li, R., Yu, M., and Zhang, B. (2024). Clinical value of acr o-rads combined with ca125 in the risk stratification of adnexal masses. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1369900"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e000817","DOI":"10.1136\/bmjmed-2023-000817","article-title":"Adnex risk prediction model for diagnosis of ovarian cancer: Systematic review and meta-analysis of external validation studies","volume":"3","author":"Ledger","year":"2024","journal-title":"BMJ Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chen, Y., Li, Y., Su, H., and Lyu, G. (2024). Comparison of the value of the gi-rads and adnex models in the diagnosis of adnexal tumors by junior physicians. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1435636"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Chen, Y., and Zhang, J. (2025). Prognostic role of fibrinogen-to-albumin ratio in patients with gynecological cancers: A meta-analysis. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1580940"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s13048-019-0563-8","article-title":"Preoperative albumin-to-fibrinogen ratio predicts chemotherapy resistance and prognosis in patients with advanced epithelial ovarian cancer","volume":"12","author":"Yu","year":"2019","journal-title":"J. Ovarian Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e35240","DOI":"10.1097\/MD.0000000000035240","article-title":"Diagnostic value of ca125, he4, and systemic immune-inflammation index in the preoperative investigation of ovarian masses","volume":"102","author":"Song","year":"2023","journal-title":"Medicine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.ygyno.2020.12.006","article-title":"A novel diagnostic nomogram based on serological and ultrasound findings for preoperative prediction of malignancy in patients with ovarian masses","volume":"160","author":"Guo","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"512","DOI":"10.6004\/jnccn.2024.0052","article-title":"Nccn guidelines\u00ae insights: Ovarian cancer\/fallopian tube cancer\/primary peritoneal cancer, version 3.2024","volume":"22","author":"Liu","year":"2024","journal-title":"J. Natl. Compr. Cancer Netw. JNCCN"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"524","DOI":"10.5468\/ogs.21176","article-title":"Prognostic significance of tumor laterality in advanced ovarian cancer","volume":"64","author":"Yamada","year":"2021","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_43","unstructured":"Adhikari, L., and Hassell, L. (2025, May 19). Who Classification. Available online: https:\/\/www.pathologyoutlines.com\/topic\/ovarytumorwhoclassif.html."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Pelayo, M., Sancho-Sauco, J., Sanchez-Zurdo, J., Abarca-Martinez, L., Borrero-Gonzalez, C., Sainz-Bueno, J.A., Alcazar, J.L., and Pelayo-Delgado, I. (2023). Ultrasound features and ultrasound scores in the differentiation between benign and malignant adnexal masses. Diagnostics, 13.","DOI":"10.3390\/diagnostics13132152"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1002\/uog.17225","article-title":"Estimating risk of malignancy in adnexal masses: External validation of the adnex model and comparison with other frequently used ultrasound methods","volume":"49","author":"Meys","year":"2017","journal-title":"Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol."},{"key":"ref_47","first-page":"540","article-title":"Evaluation of the importance of the serum levels of ca-125, ca15-3, ca-19-9, carcinoembryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy","volume":"34","author":"Bozkurt","year":"2013","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"27","DOI":"10.14740\/cmmr8e","article-title":"Serum tumor markers for preoperative discrimination of benign and malignant adnexal masses","volume":"1","author":"Bacanakgil","year":"2017","journal-title":"Cell. Mol. Med. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1158\/1940-6207.CAPR-10-0402","article-title":"Large prospective study of ovarian cancer screening in high-risk women: Ca125 cut-point defined by menopausal status","volume":"4","author":"Skates","year":"2011","journal-title":"Cancer Prev. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1158\/1055-9965.EPI-11-0422","article-title":"A novel approach to predict the likelihood of specific ovarian tumor pathology based on serum ca-125: A multicenter observational study","volume":"20","author":"Valentin","year":"2011","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/COC.0000000000000383","article-title":"Clinical use and optimal cutoff value of ca15-3 in evaluation of adnexal mass: Retrospective cohort study and review of the literature","volume":"41","author":"Lavie","year":"2018","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Ruma, S.A., Vinod, R., Jain, S., Huhtinen, K., Hynninen, J., Leivo, J., Pettersson, K., Sundfeldt, K., and Gidwani, K. (2025). Muc1 and glycan probing of ca19-9 captured biomarkers from cyst fluids and serum provides enhanced recognition of ovarian cancer. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-86735-z"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e333","DOI":"10.5301\/jbm.5000139","article-title":"Ca 19-9 in evaluation of adnexal mass: Retrospective cohort analysis and review of the literature","volume":"30","author":"Lavie","year":"2015","journal-title":"Int. J. Biol. Markers"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e394","DOI":"10.5301\/jbm.5000158","article-title":"Cea in evaluation of adnexal mass: Retrospective cohort analysis and review of the literature","volume":"30","author":"Lavie","year":"2015","journal-title":"Int. J. Biol. Markers"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3381","DOI":"10.2147\/CMAR.S198419","article-title":"Prognostic significance of the ratio of fibrinogen and albumin in human malignancies: A meta-analysis","volume":"11","author":"Zhang","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Grebenciucova, E., and VanHaerents, S. (2023). Interleukin 6: At the interface of human health and disease. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1255533"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/jpen.1451","article-title":"Hypoalbuminemia: Pathogenesis and clinical significance","volume":"43","author":"Soeters","year":"2019","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Suri, A., Perumal, V., Ammalli, P., Suryan, V., and Bansal, S.K. (2021). Diagnostic measures comparison for ovarian malignancy risk in epithelial ovarian cancer patients: A meta-analysis. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-96552-9"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.3332\/ecancer.2023.1568","article-title":"Comparison of the diagnostic accuracy of he4 with ca125 and validation of the roma index in differentiating malignant and benign epithelial ovarian tumours among patients in lagos, nigeria","volume":"17","author":"Shittu","year":"2023","journal-title":"Ecancermedicalscience"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:45Z","timestamp":1760035665000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":59,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182372"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182372","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}