Discrimination between benign and malignant adnexal masses by specialist ultrasound examination versus serum CA-125.
BACKGROUND
Subjective evaluation of gray-scale and Doppler ultrasound findings (i.e., pattern recognition) by an experienced examiner and preoperative serum levels of CA-125 can both discriminate benign from malignant adnexal (i.e., ovarian, paraovarian, or tubal) masses. We compared the diagnostic performance of these methods in a large multicenter study.


METHODS
In a prospective multicenter study--the International Ovarian Tumor Analysis--1066 women with a persistent adnexal mass underwent transvaginal gray-scale and color Doppler ultrasound examinations by an experienced examiner within 120 days of surgery. Pattern recognition was used to classify a mass as benign or malignant. Of these women, 809 also had blood collected preoperatively for measurement of serum CA-125. Various levels of CA-125 were used as cutoffs to classify masses. Results from both assays were then compared with histologic findings after surgery.


RESULTS
Pattern recognition correctly classified 93% (95% confidence interval [CI] = 90.9% to 94.6%) of the tumors as benign or malignant. Serum CA-125 correctly classified at best 83% (95% CI = 80.3% to 85.6%) of the masses. Histologic diagnoses that were most often misclassified by CA-125 were fibroma, endometrioma, and abscess (false-positive results) and borderline tumor (false-negative results). Pattern recognition correctly classified 86% (95% CI = 81.1% to 90.4%) of masses of these four histologic types as being benign or malignant, whereas a serum CA-125 at a cutoff of 30 U/mL correctly classified 41% (95% CI = 34.4% to 47.5%) of them. Pattern recognition assigned a correct specific histologic diagnosis to 333 (59%, 95% CI = 54.5% to 62.8%) of the 567 benign lesions.


CONCLUSIONS
Pattern recognition was superior to serum CA-125 for discrimination between benign and malignant adnexal masses.
Van Calster
Ben
B
Department of Electrical Engineering, ESAT-SISTA, Katholieke Universiteit Leuven, Belgium.
Timmerman
Dirk
D
Bourne
Tom
T
Testa
Antonia Carla
AC
Van Holsbeke
Caroline
C
Domali
Ekaterini
E
Jurkovic
Davor
D
Neven
Patrick
P
Van Huffel
Sabine
S
Valentin
Lil
L
D000291:Adnexal Diseases / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D003937:Diagnosis, Differential; D005060:Europe; D005185:Fallopian Tube Neoplasms / Q000000981:diagnostic imaging* / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006176:Gynecology; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D010364:Pattern Recognition, Visual; D017698:Postmenopause; D011237:Predictive Value of Tests; D017697:Premenopause; D011446:Prospective Studies; D012107:Research Design; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D014621:Vagina; D000078329:Workforce
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen