Diagnostic value of pelvic examination, ultrasound, and serum CA 125 in postmenopausal women with a pelvic mass. An international multicenter study

Abstract

Background. In a prospective study, the differential dignostic potential of peovic examination, ultrasound, and serum CA 125 assay in postmenopausal patients presenting with a pelvic mass was assessed. Methods. A total of 228 patients were evaluated preoperatively in an international, multicenter, prospective study using a standard protocol for pelvic examination, transvaginal (occasionally additional abdominal) ultra sound, and serum CA 125 determination with a cut‐off level of 35 U/ml. Results. Ninety‐five malignant (41.7%) and 127 benign (55.7%) pelvic tumors were found in addition to 6 borderline ovarian tumors (2. 6%) in the 228 patients. Seventy‐two patients had ovarian carcinoma, 49 of whom were International Federation of Gynecology and Obstetrics Stage III or IV. Borderline tumors were excluded from the statistical calculations. The individual accuracy of pelvic examination, ultrasound, and serum CA 125 in discriminating between benign and malignant pelvic masses was approximately the same (76, 74, and 77%, respectively). Using logistic regression analysis, the power of pelvic examination appeared to be the most relevant factor (adjusted odds ratio, 9. 2), followed by serum CA 125 (odds ratio, 5. 6), and ultrasound (odds ratio, 4. 9). Age appeared to be nonpredictive. No cancer was found in any patient in whom all three methods scored negative (n = 53; positive predictive value for malignancy = 0 and 95%; confidence interval, 0–7). Conclusions. The combined use of pelvic examination, ultrasound, and serum CA 125 leads to improved discrimination between malignant and benign pelvic masses, because malignancy can be excluded when all three examination methods are negative. A change to a more patient‐tailored surgical approach could be considered in those cases.

Clinical and technical evaluation of the ACS:OV serum assay and comparison with three other CA125-detecting assays

“…CA125 has a good diagnostic power in discriminating ovarian cancer and benign pelvic tumours, whether alone or in combination with parameters such as ultrasonography and physical examination 19 or CA15.3. 20 This diagnostic power is also evident from the area under the ROC curve (0.906+0.017) presented in Fig.…”

Risk of Malignancy Index 2 in Preoperative Evaluation of Ovarian Masses and Its Correlation With Histopathology

“…(17) In premenopausal patients, CA-125 was not accurate enough to predict malignancies and was falsely elevated in cases with haemorrhagic cyst, endometriosis and pelvic infections. (18)(19)(20) The sensitivity and specificity of CA-125 in predicting malignancy in the present study was 80.0% and 94.12% respectively, which was slightly better than studies conducted by Jose Carlos Compose et al (7) and Erhan Akturk et al (21) with sensitivity of 78.0% and 75.0%, while specificity of 75.0% and 75.0% respectively.…”

Guide de pratique en cas de découverte d'une masse annexielle

“…ε 3 3.7 Le CA-125 seul ne doit pas être utilisé comme test de dépistage La sensibilité de cet antigène tumoral n'est que de 50 % pour les stades I, alors qu'elle est de 90 % pour les stades II à IV (tab. 5) [48][49][50][51][52][53][54][55][56]. ε 3 Le CA-125 peut être élevé tant dans des conditions bénignes (règles, endométriose, myome, grossesse, infections pelviennes, affections hépatiques, gastro-intestinales ou péricar-diques) qu'en cas de cancers non ovariens (sein, endomètre, poumon, foie, vessie, pancréas, lymphome non-hodgkinien) [52,57].…”