Serum CA-125 is a good predictor of benign disease in patients with postmenopausal ovarian cysts

Aim: To determine whether serum CA-125 levels, in addition to tumor size and ultrasonographic findings can help in differentiating benign ovarian cysts from malignant disease.

Methods: All postmenopausal women who had undergone explorative laporatomy for a preoperative diagnosis of an adnexal cyst between January 1999 and February 2006 were included if serum CA-125 levels were below 50 IU/ml.

Results: Ninety-three patients with ovarian cysts and serum CA-125 levels lower than 50 IU/ml were included. Seventy-five (80%) of the patients (53 unilocular, 22 multilocular) had ovarian cysts < 13 cm. Of 18 patients with ovarian cysts > 13 cm, seven had unilocular and 11 had multilocular cysts. All the patients (n = 77) with a serum CA-125 level < 35 IU/ml had benign histopathology regardless of the tumor size or ultrasonic features. Among 16 patients with CA-125 levels between 35 and 50 IU/ml, two with unilocular cysts > 13 cm and nine with multilocular cysts (3 < 13 cm, 6 > 13 cm) had borderline histopathology.

Conclusion: We concluded that when unilocular ovarian cyst size is < 13 cm and serum CA-125 levels are below 35 IU/ml in a postmenopausal woman, the possibility of a benign etiology is most likely.

Menopause; Ovarian cyst; CA-125; Ultrasonography

[1] Bailey C.L., Ueland G.L., DePriest P.D., Gallion H.:'The mailgnant potential of small cystic ovarian tumors in women over 50 years of age". Gynecol. Oneal., 1998, 69, 3.

[2] Hausler M., Petru E., Ruppitsch U., Winter R.: "Die Yaginalsono­ graphie zur praoperativen Dignitatsbeurteilung von Ovarial­tumoren".Ultrascha/1 C/in. Pra.x, 1991, 6, 8.

[3] Granberg S., Norstrom A., Wikland M.: "Tumors in the lower pelvis as imaged by vaginal sonography". Gynecol. Oneal., 1990, 37, 224.

[4] Bast R.C. Jr, Klug T.L., St. Jhon E., Jenison E., Niloff J.M., Lazarus H. et al. .: "A radioimmunoassay using a monoclonal anti body to monitor the course of epithelial ovarian cancer". N. Engl J. Med., 1983, 308, 883.

[5] Chen D.X., Schwartz P.E., Li X.G., Yang Z.: "Evaluation of CA- 125 levels in differentiating malignant from benign tumors in patients with pelvic masses". Obstet. Gynecol., 1998, 72, 23.

[6] Maggino T., Gadducci A., D'Addario Y., Peconelli S., Lissoni A., Stella M.: "Prospective multicenter study on CA-125 in post­menopausal pelvic masses". Gynecol. Oneal., 1994, 54, 117.

[7] Malkasian G., Knapp R., Lavin P., Zurawski Y., Podratz K., Stan­hope R. et al.: "Preoperative evaluation of serum CA-125 levels in premenopausal and postmenopausal patients with pelvic masses discrimination of benign from malignant disease". Am. 1. Obstet Gynecol., 1988, I 59, 341.

[8] Valentin L.: "Gray scale sonography, subjective evalution of the color Doppler image and measurement of blood flow velocity for distinguishing benign and malignant tumors of suspected adnexal origin". Eur. J. Obstet. Gynecol. Reprod. Biol., 1997, 72, 63.

[9] Levine D., Gosink B., Wolf S., Feldesman M., Pretorius D "Simple Adnexal cysts: the national history in postmenopausal women". Radiology, 1992, 184, 653.

[10] Bailey C.L., Ueland F.R., Land G.L., DePriest P.D.: "The mahg­nant potential of small cystic ovarian tumors in women over 50 years of age". Gynecol. Oncol., 1998, 69, 3.

[11] Granberg S., Nordstrom A., Wikland M.: "Tumors in the lower pelvis as imaged by vaginal sonography". Gynecol. Oncol., 1990, 37, 224.

[12] Jacobs I., Bast R.: "The CA-125 tumor-associated antigen: a review of the literature". Hum. Reprod., 1989, 4, 1.

[13] Skates M., Manon U., MacDonald N., Rosenthal A.N., Oram D., Knapp R. et al.: "Calculation of the risk of ovarian cancer from serial CA-125 values for preclinic detection in postmenopausal women". 1. Clin. Oncol., 2003, 21, 206.

[14] Maggino T., 如dduci A., Daddario Y., Pecorelli S., Lissoni A., Stella M. et al.: "Prospective multicenter study on Ca-125 in post­menopausal pelvic masses". Gynecol. Oncol., I 994, 54, 117.

[15] Van Nagell J.R. Jr, DePriest P.D.: "Management of adnexal masses in postmenopausal women". Am. 1. Obstet. Gynecol., 2005, 193, 30.