title: CEA in evaluation of adnexal mass: retrospective cohort analysis and review of the literature.
abstract: BACKGROUND
  The aim of this study was to estimate the diagnostic accuracy of serum carcinoembryonic antigen (CEA) levels in conjunction with Ca125 in the triage of adnexal masses.
  
  
  METHODS
  This retrospective cohort study was carried out in 495 patients referred to the Gynecology Department at Carmel Medical Center due to adnexal mass, between 2005 and 2012. All patients underwent surgery with histopathologically confirmed diagnosis and preoperative measurements of serum Ca125 and CEA. For each marker, sensitivity, specificity, positive predictive value, negative predictive value and risk ratio were calculated.
  
  
  RESULTS
  Combination of CEA with Ca125, compared with Ca125 levels alone, yielded a nonsignificant effect on sensitivity (87.4% vs. 88.9%, respectively, p = 0.64) and specificity (79.3% vs. 74.3%, p = 0.18) in differentiating malignant from benign adnexal masses. CEA levels were higher in mucinous histological types, but were not helpful in detection of borderline tumors. Significantly higher CEA (21.4 ± 53.6 vs. 3.2 ± 11.9 ng/mL, p = 0.0002) and lower Ca125 values (103.9 ± 84.9 vs. 796 ± 1,331.5 U/mL, p = 0.0338) were demonstrated in the 17 metastatic cases compared with 181 primary ovarian malignancies.
  
  
  CONCLUSIONS
  The combination of the tumor markers CEA and Ca125 did not contribute significantly to the detection of malignant adnexal masses compared with Ca125 alone. As our results suggest that higher CEA levels could be useful in differentiating metastatic tumors from primary ovarian malignancy and in diagnosis of mucinous histology, this issue should be investigated in large, well-designed, prospective cohort trials.
authors.affiliation: Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa - Israel.|Genetics Institute, HaEmek Medical Center, Afula - Israel.
authors.forename: Lena
authors.initials: L
authors.lastname: Sagi-Dain
authors.affiliation: Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa - Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Lavie
authors.affiliation: Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa - Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Auslander
authors.affiliation: Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa - Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Sagi
mesh_terms: D000291:Adnexal Diseases / Q000097:blood* / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008565:Membrane Proteins / Q000097:blood*; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000097:blood* / Q000175:diagnosis; D010051:Ovarian Neoplasms / Q000097:blood* / Q000175:diagnosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D018394:CA-125 Antigen; D002272:Carcinoembryonic Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins