Maggino T, Gadducci A, D'Addario V, Pecorelli S, Lissoni A, Stella M, Romagnolo C, Federghini M, Zucca S, Trio D
Obstetric and Gynecologic Institute, University of Padua, Italy.
Gynecol Oncol. 1994 Aug;54(2):117-23. doi: 10.1006/gyno.1994.1179.
The purpose of this study was to determine the diagnostic value of CA 125 in comparison with transabdominal ultrasound (US) in the evaluation of postmenopausal women with pelvic mass to detect malignant epithelial ovarian tumors. Postmenopausal patients with pelvic mass were studied with gynecologic examination, US and CA 125 determination. Three hundred eighty-eight patients were entered in the study. According to stratification based on US (probably benign, equivocal, possibly malignant) and CA 125 (< 35 U/ml, negative; between 35 and 65 U/ml, borderline; > 65 U/ml, positive), 290 patients were considered eligible for surgery. Specificity, sensitivity, positive and negative predictive value, and accuracy of US and CA 125 were calculated with respect to histological examination. Out of 290 operated patients, 134 had a benign ovarian pathology, 34 had extraovarian benign pathology, 106 had an ovarian malignancy, and 16 presented with an extraovarian malignant pathology. The results according to ovarian malignant pathology were as follows. CA 125 (> 65 U/ml): Specificity, 92.5%; sensitivity, 71.7%; accuracy, 83.3%. CA 125 (> 35 U/ml): Specificity, 82.0%; sensitivity, 78.3%; accuracy, 80.4%. US: Specificity, 77.6%; sensitivity, 84.9%; accuracy, 80.3%. Combination of US and CA 125 (> 65 U/ml): Specificity, 96.1%; sensitivity, 91.7%; accuracy, 94.3%. Determination of CA 125 is a highly specific method in predicting ovarian cancer in postmenopausal women with a pelvic mass. The association with US significantly improves the overall accuracy and may support therapeutical decision making by distinguishing between a significant percentage of women most likely to benefit from prompt intervention and women who may be managed following minor surgical diagnostic approach, such as fine-needle aspiration.
本研究的目的是确定在评估有盆腔肿块的绝经后妇女以检测恶性上皮性卵巢肿瘤时，CA 125相较于经腹超声（US）的诊断价值。对有盆腔肿块的绝经后患者进行妇科检查、超声检查和CA 125测定。388例患者纳入本研究。根据超声检查结果（可能为良性、不明确、可能为恶性）和CA 125水平（<35 U/ml，阴性；35至65 U/ml之间，临界值；>65 U/ml，阳性）进行分层，290例患者被认为适合手术。根据组织学检查计算超声和CA 125的特异性、敏感性、阳性和阴性预测值以及准确性。在290例接受手术的患者中，134例有良性卵巢病变，34例有卵巢外良性病变，106例有卵巢恶性肿瘤，16例有卵巢外恶性病变。根据卵巢恶性病变得出的结果如下。CA 125（>65 U/ml）：特异性为92.5%；敏感性为71.7%；准确性为83.3%。CA 125（>35 U/ml）：特异性为82.0%；敏感性为78.3%；准确性为80.4%。超声检查：特异性为77.6%；敏感性为84.9%；准确性为80.3%。超声和CA 125（>65 U/ml）联合检查：特异性为96.1%；敏感性为91.7%；准确性为94.3%。CA 125测定是预测有盆腔肿块的绝经后妇女卵巢癌的一种高度特异性方法。与超声联合使用可显著提高总体准确性，并可通过区分很大一部分最可能从及时干预中获益的女性和可能采用微小手术诊断方法（如细针穿刺）进行处理的女性，来支持治疗决策。
