Adding cancer antigen 125 screening to gray scale sonography for predicting specific diagnosis of benign adnexal masses in premenopausal women: is it worthwhile?

Juan Luis Alcázar, S. Guerriero, Stefano Guerriero, José Ángel Mínguez, S. Ajossa, Silvia Ajossa, Anna Maria Paoletti, Alvaro Ruiz-Zambrana, Álvaro Ruiz-Zambrana, M. Jurado, Matías Jurado
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2011 · vol. 30(10) , pp. 1381–1386 · doi:10.7863/jum.2011.30.10.1381 · PMID:21968488 · W1935948634
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Adding CA-125 screening to sonography did not improve specific diagnosis of benign adnexal masses, except for endometriomas, where it significantly increased diagnostic probability.

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Abstract

OBJECTIVES: The purpose of this study was to assess whether a single determination of the serum cancer antigen 125 (CA-125) level provides additional information to sonography for specific diagnosis of benign adnexal masses in premenopausal women. METHODS: We conducted a retrospective study comprising 1058 premenopausal women (mean age, 34.8 years) with histologically proven benign adnexal masses. All women had undergone transvaginal sonography and serum CA-125 determination within 1 week before surgery and tumor removal. According to "pattern recognition" analysis, a presumptive diagnosis was provided on gray scale transvaginal sonography for all masses. Positive and negative likelihood ratios were calculated for gray scale sonography and gray scale sonography plus CA-125. RESULTS: Eighty-five women had bilateral masses (1143 masses analyzed). In 7 women with bilateral masses, the histologic diagnoses of the masses were discordant and were excluded. Histologic diagnoses were as follows: endometrioma, n = 452; dermoid cyst, n = 180; serous cyst, n = 158; hemorrhagic cyst, n = 119; mucinous cyst, n = 54; hydrosalpinx, n = 37; and other, n = 109. The median CA-125 level was significantly higher in endometrioma (71.9 IU/mL; range: 5-2620 IU/mL) and hydrosalpinx (59.2 IU/mL; range, 5-601 IU/mL) compared to all other tumor types (P < .001). The CA-125 level was 35 IU/mL or higher in 74% of endometriomas, 58% of hydrosalpinges, 34% of hemorrhagic cysts, 18% of mucinous cysts, 14% of dermoid cysts, and 8% of serous cysts. The positive and negative likelihood ratios for sonography and sonography plus CA-125 (335 IU/mL) for each kind of tumor were not statistically different except for endometrioma, for which the positive likelihood ratio for sonography plus CA-125 (55.0; 95% confidence interval, 27.5-109.9) was significantly higher than for sonography alone (19.2; 95% confidence interval, 13.6-27.1). CONCLUSIONS: Cancer antigen 125 screening does not add useful information for specific diagnosis of benign adnexal tumors, except for endometrioma. An elevated CA-125 level significantly increases the probability of such a lesion.

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Condition tags

endometrioma

MeSH descriptors

Adnexal Diseases CA-125 Antigen Adnexal Diseases Adnexal Diseases Adolescent Adult Biomarkers, Tumor Biomarkers, Tumor CA-125 Antigen Chi-Square Distribution Confidence Intervals Female Humans Likelihood Functions Middle Aged Pattern Recognition, Automated Predictive Value of Tests Premenopause Retrospective Studies Statistics, Nonparametric

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