The role of transvaginal ultrasonography and serum CA 125 assay combined with age and hormonal state in the differential diagnosis of pelvic masses

Purpose of investigation: To evaluate the ability of CA 125 and echography, alone and in combination with clinical parameters (age over 50 years and post-menopausal state), in the diagnosis of a malignant pelvic mass.

Methods: 125 women were enrolled and underwent echography and CA 125 assay. For each methodology, positive and negative predictive value, sensitivity, specificity, diagnostic accuracy, pre- and post-test probability and likelihood ratios were calculated.

Results: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy (DA) and positive likelihood ratio were identical for echography and CA 125 considered alone. Paired with the patient's age, the CA 125 assay showed better results than the associations echography-age (LR+ 26.9 vs 10.1) or CA 125-echography (LR+ 26.9 vs 17.8). Furthermore the combination of the postmenopausal state with CA 125 obtained the best result of a positive likelihood ratio (LR+ 29.7).

Conclusion: Our study pointed out that, in the prediction of a malignant adnexal mass, the best results were obtained from the association between CA 125 and menopause, probably because in this period there is a lower incidence of benign diseases related to this marker so that an increase of CA 125 level is more likely associated with a malignant mass.

CA 125; Echography; Ovarian cancer; Adnexal masses

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