Reply to comment of Prof. Artur Czekierdowski

I have read the letter by Professor Czekierdowski regarding the publication by Ciebiera et al. “Case report of ovarian torsion mimicking ovarian cancer as an uncommon late complication of laparoscopic supracervical hysterectomy” with great interest as it contains numerous significant statements that to some extent question our findings; therefore, I would like to refer to the comments as they were presented in the letter: • A black and white ultrasound scan was published because the scanner printer had some technical limitations and not because we had decided not to assess tumour blood supply; the scan plays only a representative function because we described the lesion in detail and we did not assume that our readers would want verify whether it was correct. • I am in strong opposition to the interpretation by Prof. Czekierdowski that age is a determining factor for the woman’s menopausal age. The age 50+ years is only an estimate with regard to the incidence of menopause in the population and this variable is presented in the literature in this context. In this case the oestradiol levels were measured (they were below the laboratory detection threshold – below 11.8 pg/ml and FSH 71.5 mIU/ml), therefore undoubtedly the patient was menopausal, whereas the He4 protein levels of 83.1 pmol/l in a 46-year-old female patient were definitely elevated. Undoubtedly, there has been a discussion in the literature about whether the cut-off point for this test can be the same for the whole population or whether it should vary depending on the age group (irrespective of the hormone status), but this discussion is far from conclusive [1, 2]. Nonetheless, I have not found any studies regarding a linear correlation between the Risk of Ovarian Malignancy Algorithm (ROMA) test results and the risk level in the literature. There is only mention of the cut-off point used to divide the population into lowand high-risk groups, so the expression “only slightly increased risk” used by Prof. Czekierdowski seems not to be accurate. • The Authors know and understand the International Ovarian Tumour Analysis (IOTA) terms and definitions, and also two of them have gained an IOTA Reply to comment of Prof. Artur Czekierdowski