CA-125 and carcinoembryonic antigen assay vs. cytodiagnostic experience in the classification of benign ovarian cysts.
OBJECTIVE
To compare the relative strengths of two factors involved in making an accurate differentiation between functional and epithelial ovarian cysts, along with their combination: (1) the cytologist's level of experience in interpreting ovarian cytology, (2) the use of the tumor markers carcinoembryonic antigen (CEA) and CA-125 in cyst fluid, and (3) a combination of (1) and (2).


METHODS
Papanicolaou-stained sediments from fluid aspirated from 31 resected ovarian cysts (6 functional and 25 epithelial) were blindly and independently evaluated by five pathologists with varying experience in ovarian cytology. Cyst fluid supernatant was used for CEA, enzyme-linked immunosorbent assay, and CA-125 radioimmunoassay; CEA levels > 5 ng/mL or CA-125 > 5,000 U/mL were considered elevated. Cysts were categorized cytologically and histologically as functional or epithelial and by tumor markers as "neither elevated" or "either or both elevated" (EBE).


RESULTS
The agreement of histologic diagnosis with each pathologist's cytologic diagnosis ranged from 53% to 84% (53%, 71%, 83%, 82%, 84%), corresponding to increasing level of experience. The percentage of agreement with EBE was 77%, whereas combined experienced pathologist's diagnosis and EBE was 87%. Kappa equaled .45 for experienced cytopathologist's diagnosis or EBE alone. Kappa equaled .53 when the pathologist or EBE diagnosed an epithelial cyst, indicating results unlikely to occur by chance.


CONCLUSIONS
The distinction of functional from epithelial ovarian cysts is best achieved by combining measurement of the tumor markers CEA and CA-125 with a high level of cytopathology experience.
Pinto
M M
MM
Department of Pathology, Bridgeport Hospital, Connecticut 06610, USA.
Greenebaum
E
E
Simsir
A
A
Kleinman
G M
GM
Portnoy
L M
LM
Garfinkel
R
R
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D018394:CA-125 Antigen / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D003585:Cell Biology; D018291:Cystadenoma, Mucinous / Q000473:pathology; D018293:Cystadenoma, Serous / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005497:Follicular Cyst / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D010048:Ovarian Cysts / Q000145:classification* / Q000473:pathology*; D010053:Ovary / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D018394:CA-125 Antigen; D002272:Carcinoembryonic Antigen