Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.
J Ultrasound Med. 2011 Oct;30(10):1381-6. doi: 10.7863/jum.2011.30.10.1381.
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.
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.
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).
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.
本研究旨在评估血清肿瘤标志物 125（CA-125）水平单次检测对绝经前妇女附件良性肿块的超声特异性诊断是否有附加价值。
我们进行了一项回顾性研究，纳入了 1058 例经组织学证实的附件良性肿块的绝经前妇女（平均年龄 34.8 岁）。所有妇女均在术前 1 周内行经阴道超声和血清 CA-125 检测，并行肿块切除。根据“模式识别”分析，对所有肿块的灰阶超声进行推测性诊断。计算灰阶超声和灰阶超声加 CA-125 的阳性和阴性似然比。
85 例妇女有双侧肿块（分析 1143 个肿块）。在 7 例双侧肿块的妇女中，由于组织学诊断不一致而被排除。组织学诊断如下：子宫内膜异位囊肿 452 例；皮样囊肿 180 例；浆液性囊腺瘤 158 例；出血性囊肿 119 例；黏液性囊腺瘤 54 例；输卵管积水 37 例；其他 109 例。子宫内膜异位囊肿（71.9IU/ml；范围：5-2620IU/ml）和输卵管积水（59.2IU/ml；范围：5-601IU/ml）的中位 CA-125 水平明显高于其他所有肿瘤类型（P<0.001）。CA-125 水平为 35IU/ml 或更高见于 74%的子宫内膜异位囊肿、58%的输卵管积水、34%的出血性囊肿、18%的黏液性囊腺瘤、14%的皮样囊肿和 8%的浆液性囊腺瘤。除子宫内膜异位囊肿外，超声和超声加 CA-125（335IU/ml）对每种肿瘤的阳性和阴性似然比均无统计学差异，而超声加 CA-125（55.0；95%置信区间：27.5-109.9）对子宫内膜异位囊肿的阳性似然比明显高于超声单独检查（19.2；95%置信区间：13.6-27.1）。
CA-125 筛查对附件良性肿瘤的特异性诊断除子宫内膜异位囊肿外无附加信息。CA-125 水平升高显著增加了此类病变的可能性。
