title: The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors.
abstract: OBJECTIVE
  To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors.
  
  
  METHODS
  From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined.
  
  
  RESULTS
  There were 26 malignant tumors out of 141 ovarian tumors with a MI >/=5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively.
  
  
  CONCLUSIONS
  The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Chosun University, Gwangju, Korea.
authors.forename: Hyo Young
authors.initials: HY
authors.lastname: Jeoung
authors.forename: Han Song
authors.initials: HS
authors.lastname: Choi
authors.forename: Yo Sup
authors.initials: YS
authors.lastname: Lim
authors.forename: Min Young
authors.initials: MY
authors.lastname: Lee
authors.forename: Soo A
authors.initials: SA
authors.lastname: Kim
authors.forename: Sei Jun
authors.initials: SJ
authors.lastname: Han
authors.forename: Tae Gyu
authors.initials: TG
authors.lastname: Ahn
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Choi