الفهرس 
Assessment of Cell-Free DNA Integrity Index To Differentiate Between Malignant and Benign Ovarian Tumors
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Abstract
DNA Integrity index (DNA Int) and cell-free DNA (cfDNA) represent promising biomarkers for
epithelial ovarian cancer (EOC) detection. Tumor necrosis produces DNA fractions of different
sizes, which contrasts apoptosis in normal tissue that releases smaller and more regular DNA
fragments. Using ALU gene primers in quantitative PCR, the amplified cfDNA is supposed to be
either short fragments of 115 bp (ALU 115) or long fragments of 247 bp (ALU 247). ALU levels
and DNA Int were determined in the plasma of 30 EOC patients, 30 benign cysts, and 15 healthy
individuals. The mean values of DNA Int, ALU115, and ALU247 were elevated in malignant
patients (0.51±0.09, 3.93 ng/ul ±1.93, 2.35 ng/ul ±1.1) respectively in comparison to healthy
females (0.37±0.05; p < 0.001, 2.56 ng/ul ±0.9; p=0.027, 1.26±0.44; p< 0.01). A significant
increase was shown in the mean values of DNA Int and ALU247 of EOC patients compared to
those with benign cysts (0.4±0.06, p <0.001; 1.69±0.66, p =0.008) respectively. The area under
the curve (AUC) for EOC versus healthy females achieved 0.913 (DNA Int), 0.696 (ALU115),
and 0.809 (ALU247) with sensitivities and specificities were (86.7% and 93.3%) for DNA Int,
(63.3% and 86.7%) for ALU115 and (76.7% and 86.7%) for ALU247 respectively. Furthermore,
comparing patients with EOC versus those with benign cysts gave AUC of 0.834 (DNA Int), 0.564
(ALU115), and 0.681 (ALU247) with sensitivities and specificities were (80% and 80%) for DNA
Int, (63.3% and 60%) for ALU115 and (60% and 80%) for ALU247 respectively. Higher DNA Int
and plasma ALU247 could help in the assessment of EOC, and their measurements seem to have
clinical value in diagnosis