title: A novel approach to predict the likelihood of specific ovarian tumor pathology based on serum CA-125: a multicenter observational study.
abstract: BACKGROUND
  The CA-125 tumor marker has limitations when used to distinguish between benign and malignant ovarian masses. We therefore establish likelihood curves of six subgroups of ovarian pathology based on CA-125 and menopausal status.
  
  
  METHODS
  This cross-sectional study conducted by the International Ovarian Tumor Analysis group involved 3,511 patients presenting with a persistent adnexal mass that underwent surgical intervention. CA-125 distributions for six tumor subgroups (endometriomas and abscesses, other benign tumors, borderline tumors, stage I invasive cancers, stage II-IV invasive cancers, and metastatic tumors) were estimated using kernel density estimation with stratification for menopausal status. Likelihood curves for the tumor subgroups were derived from the distributions.
  
  
  RESULTS
  Endometriomas and abscesses were the only benign pathologies with median CA-125 levels above 20 U/mL (43 and 45, respectively). Borderline and invasive stage I tumors had relatively low median CA-125 levels (29 and 81 U/mL, respectively). The CA-125 distributions of stage II-IV invasive cancers and benign tumors other than endometriomas or abscesses were well separated; the distributions of the other subgroups overlapped substantially. This held for premenopausal and postmenopausal patients. Likelihood curves and reference tables comprehensibly show how subgroup likelihoods change with CA-125 and menopausal status.
  
  
  CONCLUSIONS
  Our results confirm the limited clinical value of CA-125 for preoperative discrimination between benign and malignant ovarian pathology. We have shown that CA-125 may be used in a different way. By using likelihood reference tables, we believe clinicians will be better able to interpret preoperative serum CA-125 results in patients with adnexal masses.
authors: Department of Obstetrics and Gynecology, University Hospitals K.U. Leuven, Leuven, Belgium. ben.vancalster@esat.kuleuven.be
authors: Ben
authors: B
authors: Van Calster
authors: Lil
authors: L
authors: Valentin
authors: Caroline
authors: C
authors: Van Holsbeke
authors: Jing
authors: J
authors: Zhang
authors: Davor
authors: D
authors: Jurkovic
authors: Andrea Alberto
authors: AA
authors: Lissoni
authors: Antonia Carla
authors: AC
authors: Testa
authors: Artur
authors: A
authors: Czekierdowski
authors: Daniela
authors: D
authors: Fischerová
authors: Ekaterini
authors: E
authors: Domali
authors: Gregg
authors: G
authors: Van de Putte
authors: Ignace
authors: I
authors: Vergote
authors: Sabine
authors: S
authors: Van Huffel
authors: Tom
authors: T
authors: Bourne
authors: Dirk
authors: D
authors: Timmerman
mesh_terms: D000291:Adnexal Diseases / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen