Discrimination between benign and malignant adnexal masses by specialist ultrasound examination versus serum CA-125

J Natl Cancer Inst. 2007 Nov 21;99(22):1706-14. doi: 10.1093/jnci/djm199. Epub 2007 Nov 13.


Background: Subjective evaluation of gray-scale and Doppler ultrasound findings (i.e., pattern recognition) by an experienced examiner and preoperative serum levels of CA-125 can both discriminate benign from malignant adnexal (i.e., ovarian, paraovarian, or tubal) masses. We compared the diagnostic performance of these methods in a large multicenter study.

Methods: In a prospective multicenter study--the International Ovarian Tumor Analysis--1066 women with a persistent adnexal mass underwent transvaginal gray-scale and color Doppler ultrasound examinations by an experienced examiner within 120 days of surgery. Pattern recognition was used to classify a mass as benign or malignant. Of these women, 809 also had blood collected preoperatively for measurement of serum CA-125. Various levels of CA-125 were used as cutoffs to classify masses. Results from both assays were then compared with histologic findings after surgery.

Results: Pattern recognition correctly classified 93% (95% confidence interval [CI] = 90.9% to 94.6%) of the tumors as benign or malignant. Serum CA-125 correctly classified at best 83% (95% CI = 80.3% to 85.6%) of the masses. Histologic diagnoses that were most often misclassified by CA-125 were fibroma, endometrioma, and abscess (false-positive results) and borderline tumor (false-negative results). Pattern recognition correctly classified 86% (95% CI = 81.1% to 90.4%) of masses of these four histologic types as being benign or malignant, whereas a serum CA-125 at a cutoff of 30 U/mL correctly classified 41% (95% CI = 34.4% to 47.5%) of them. Pattern recognition assigned a correct specific histologic diagnosis to 333 (59%, 95% CI = 54.5% to 62.8%) of the 567 benign lesions.

Conclusion: Pattern recognition was superior to serum CA-125 for discrimination between benign and malignant adnexal masses.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adnexal Diseases / diagnostic imaging
  • Adult
  • Aged
  • Biomarkers, Tumor / blood*
  • CA-125 Antigen / blood*
  • Diagnosis, Differential
  • Europe
  • Fallopian Tube Neoplasms / diagnostic imaging*
  • Fallopian Tube Neoplasms / immunology*
  • Fallopian Tube Neoplasms / pathology
  • Fallopian Tube Neoplasms / surgery
  • Female
  • Gynecology*
  • Humans
  • Middle Aged
  • Ovarian Neoplasms / diagnostic imaging*
  • Ovarian Neoplasms / immunology*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery
  • Pattern Recognition, Visual*
  • Postmenopause
  • Predictive Value of Tests
  • Premenopause
  • Prospective Studies
  • Research Design
  • Sensitivity and Specificity
  • Ultrasonography, Doppler
  • Vagina
  • Workforce


  • Biomarkers, Tumor
  • CA-125 Antigen