The role of CA125 in clinical practice.
BACKGROUND
CA125 is a high molecular weight glycoprotein, which is expressed by a large proportion of epithelial ovarian cancers. The sensitivity and specificity of CA125 are poor and there are no guidelines produced by the Royal College of Pathologists or the Association of Clinical Biochemists to aid clinicians and laboratories in its most appropriate use.


OBJECTIVE
To identify the patient population having a CA125 measurement and to determine its contribution to individual patient management.


METHODS
A retrospective case note audit looking at patients who had a CA125 measurement performed between April 2000 and April 2002.


RESULTS
The study comprised 799 patients; 751 (94%) were female and 48 (6%) male; 221 (29%) females and 22 (46%) males had an abnormal result. CA125 was mainly used to investigate a wide range of signs and symptoms, and few tests were for follow up or screening of ovarian cancer. In female patients having a CA125 for suspicion of malignancy/ovarian cancer, only 39 (20%) of the abnormal results were caused by ovarian cancer. False positive results were largely caused by another malignancy (48 cases; 26%), benign ovarian disease (26 cases; 14%), and benign gynaecological conditions, particularly leiomyomas (18 cases; 9%). The specificity of CA125 for ovarian cancer increased with concentrations >1000 kU/litre.


CONCLUSIONS
These results confirm the high false positive rate and poor sensitivity and specificity associated with CA125. The substantial inappropriate usage of CA125 has led to results that are useless to the clinician, have cost implications, and add to patient anxiety and clinical uncertainty.
Moss
E L
EL
Department of Obstetrics and Gynaecology, Queen's Hospital, Belvedere Road, Burton upon Trent, Staffordshire DE13 0RB, UK.
Hollingworth
J
J
Reynolds
T M
TM
D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000032:analysis*; D004739:England; D004812:Epidemiologic Methods; D005189:False Positive Reactions; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D011237:Predictive Value of Tests; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014600:Utilization Review
D018394:CA-125 Antigen
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