title: Adding cancer antigen 125 screening to gray scale sonography for predicting specific diagnosis of benign adnexal masses in premenopausal women: is it worthwhile?
abstract: OBJECTIVE
  The purpose of this study was to assess whether a single determination of the serum cancer antigen 125 (CA-125) level provides additional information to sonography for specific diagnosis of benign adnexal masses in premenopausal women.
  
  
  METHODS
  We conducted a retrospective study comprising 1058 premenopausal women (mean age, 34.8 years) with histologically proven benign adnexal masses. All women had undergone transvaginal sonography and serum CA-125 determination within 1 week before surgery and tumor removal. According to "pattern recognition" analysis, a presumptive diagnosis was provided on gray scale transvaginal sonography for all masses. Positive and negative likelihood ratios were calculated for gray scale sonography and gray scale sonography plus CA-125.
  
  
  RESULTS
  Eighty-five women had bilateral masses (1143 masses analyzed). In 7 women with bilateral masses, the histologic diagnoses of the masses were discordant and were excluded. Histologic diagnoses were as follows: endometrioma, n = 452; dermoid cyst, n = 180; serous cyst, n = 158; hemorrhagic cyst, n = 119; mucinous cyst, n = 54; hydrosalpinx, n = 37; and other, n = 109. The median CA-125 level was significantly higher in endometrioma (71.9 IU/mL; range: 5-2620 IU/mL) and hydrosalpinx (59.2 IU/mL; range, 5-601 IU/mL) compared to all other tumor types (P < .001). The CA-125 level was 35 IU/mL or higher in 74% of endometriomas, 58% of hydrosalpinges, 34% of hemorrhagic cysts, 18% of mucinous cysts, 14% of dermoid cysts, and 8% of serous cysts. The positive and negative likelihood ratios for sonography and sonography plus CA-125 (335 IU/mL) for each kind of tumor were not statistically different except for endometrioma, for which the positive likelihood ratio for sonography plus CA-125 (55.0; 95% confidence interval, 27.5-109.9) was significantly higher than for sonography alone (19.2; 95% confidence interval, 13.6-27.1).
  
  
  CONCLUSIONS
  Cancer antigen 125 screening does not add useful information for specific diagnosis of benign adnexal tumors, except for endometrioma. An elevated CA-125 level significantly increases the probability of such a lesion.
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. jlalcazar@unav.es
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcázar
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Mínguez
authors.forename: Silvia
authors.initials: S
authors.lastname: Ajossa
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Paoletti
authors.forename: Alvaro
authors.initials: A
authors.lastname: Ruiz-Zambrana
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008875:Middle Aged; D010363:Pattern Recognition, Automated; D011237:Predictive Value of Tests; D017697:Premenopause; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D014621:Vagina
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen