Selective venous sampling for androgen‐producing ovarian pathology

Abstract

Objective Multiple diagnostic modalities may be needed to establish the source of excessive androgen production in women. The role of selective venous catheterization in this process has not been established fully. Design A study of hyperandrogenaemic subjects and literature review. Patients Four hyperandrogenaemic women and an additional 132 previously reported cases with available testing data and a pathological diagnosis were evaluated. Measurements Serum androgens, diagnostic imaging and ovarian venous effluent sampling. Criteria to distinguish ovarian tumours from other ovarian conditions and to localize the lesion(s) were evaluated. Results Basal peripheral testosterone levels ≥ 4·51 nmol/l (≥ 130 ng/dl) discriminated ovarian tumours from benign causes of hyperandrogenism (sensitivity: 93·8%, 95% CI 85·0–98·2; specificity: 77·8%, 95% CI 66·4–86·7). Single lesions produced higher ipsilateral testosterone concentrations (612·6 ± 162·0 nmol/l; 17 653 ± 4670 ng/dl) compared to contralateral values (26·4 ± 5·2 nmol/l; 761 ± 150 ng/dl). In women with peripheral testosterone ≥ 4·51 nmol/l, a right‐to‐left (R:L) ovarian testosterone ratio ≥ 1·44 correctly identified all 18 women with right‐sided tumours and misclassified two with bilateral lesions; 12 out of 14 women with left‐sided or bilateral lesions had a lower R:L value. When this criterion was combined with a left‐to‐right (L:R) ovarian testosterone effluent ratio of > 15 to identify left‐sided tumours, overall 66% of women were correctly categorized. Conclusions Peripheral testosterone concentrations identified ovarian androgen‐producing tumours, and venous sampling could correctly localize 66% of these, suggesting a role for sampling when imaging studies are not revealing.