title: Preoperative measurement of serum C-reactive protein: is it useful in the differential diagnosis of adnexal masses?
abstract: BACKGROUND
  Serum biomarkers may help to discriminate malignant from benign adnexal masses with equivocal features on imaging. Adequate discrimination of such tumors is crucial for referring patients to either a specialized cancer center or a nonspecialized gynecology service.
  
  
  OBJECTIVE
  We aimed to investigate whether the preoperative level of serum C-reactive protein (CRP), alone or combined with CA125 and menopausal status in the Ovarian Score (OVS), is useful in the prediction of malignancy in women with ovarian tumors.
  
  
  METHODS
  This cross-sectional study included 293 patients who underwent surgery in a tertiary cancer center. Receiver operating characteristic (ROC) areas under the curves (AUC) for CRP, CA125 and OVS were calculated in different scenarios, as well as their sensitivity and specificity, using standard cutoff points (for CRP, 10 mg/L; for CA125, 35 U/mL).
  
  
  RESULTS
  CA125 and the OVS performed significantly better than CRP alone in the differentiation of benign disease from epithelial ovarian cancer (EOC) (AUC = 0.86 for CA125, 0.79 for OVS, and 0.73 for CRP). OVS and CRP alone were superior to CA125 only in the differentiation of borderline ovarian tumors from advanced stages of EOC and non-EOC. Sensitivity and specificity were 52.5% and 83%, respectively, for CRP, 77.9% and 66.7% for CA125, and 71.3% and 67.8% for OVS.
  
  
  CONCLUSIONS
  OVS is as good as CA125 in the differentiation of benign tumors from ovarian cancer. The addition of CA125 and menopausal status to CRP enhanced the relatively low discriminatory power of isolated CRP.
authors: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Adriana
authors: A
authors: Yoshida
authors: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Sophie F
authors: SF
authors: Derchain
authors: Special Procedures Laboratory, CAISM Hospital, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Denise R
authors: DR
authors: Pitta
authors: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Nathália
authors: N
authors: Crozatti
authors: Department of Pathologic Anatomy, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Liliana A L A
authors: LALA
authors: Andrade
authors: Special Procedures Laboratory, CAISM Hospital, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Rodrigo F
authors: RF
authors: da Silva
authors: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo - Brazil.
authors: Luis O
authors: LO
authors: Sarian
mesh_terms: D000291:Adnexal Diseases / Q000097:blood / Q000473:pathology* / Q000601:surgery; D000465:Algorithms; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D018394:CA-125 Antigen / Q000097:blood*; D000077216:Carcinoma, Ovarian Epithelial; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000556:secondary* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000097:blood / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D012372:ROC Curve
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D002097:C-Reactive Protein