Ultrasound criteria and CA 125 as predictive variables of ovarian cancer in women with adnexal tumors

Ultrasound Obstet Gynecol. 2012 Sep;40(3):360-6. doi: 10.1002/uog.11201.


Objectives: To evaluate the capacity to predict malignancy in women with adnexal tumors using CA 125 measurement and ultrasound criteria.

Methods: This was a cross-sectional study including 103 women with a total of 110 adnexal tumors. CA 125 level was measured in a sample of peripheral blood. Lesions were classified by ultrasound, using standardized predetermined criteria, as benign (B) or malignant (M). Those that could not be classified by these criteria were assessed subjectively. Histopathologic examination of surgical specimens was used as the gold standard.

Results: Of 110 tumors, 79 (71.8%) were benign and 31 (28.2%) were malignant on histopathology. Ultrasound criteria could be applied to 91 (82.7%) tumors, resulting in a sensitivity of 90%, specificity of 87%, positive predictive value (PPV) of 69% and negative predictive value (NPV) of 97%. In tumors not classifiable according to ultrasound criteria, subjective sonographic assessment gave a sensitivity of 67%, specificity of 80%, PPV of 75% and NPV of 73%. At a cut-off point of 37.4 U/mL, CA 125 had a sensitivity of 69%, a specificity of 87.8%, a PPV of 69% and a NPV of 88% for detection of malignancy. When CA 125 was associated with age and ultrasound criteria in a logistic regression model, the sensitivity and specificity increased in the subset of sonographically malignant tumors.

Conclusion: The majority of tumors were correctly classified using ultrasound criteria. CA 125 alone performed worse than did ultrasound in discriminating malignant from benign adnexal tumors. CA 125 measurement contributed to the diagnosis of malignancy, improving overall specificity, only in sonographically malignant tumors.

MeSH terms

  • Adult
  • CA-125 Antigen / blood*
  • Cross-Sectional Studies
  • Diagnosis, Differential
  • Female
  • Humans
  • Middle Aged
  • Ovarian Neoplasms / blood*
  • Ovarian Neoplasms / diagnostic imaging*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Ultrasonography, Doppler, Color / methods*


  • CA-125 Antigen