Predictive values of the ultrasound parameters, CA-125 and risk of malignancy index in patients with ovarian cancer

Abstract

Backgrounds: Assessment of predictive values for CA-125, ultrasound features (US) and risk of malignancy index (RMI) in ovarian malignancy.

Material and methods: 115 patients, divided into: 1) group-A (n = 41)--ovarian malignancy; group-B (n = 74)--benign ovarian tumor; 2) subgroup-CA(a) with low CA-125 (< 35 U/mL) (n = 64); subgroup-CA(b) with slightly elevated CA-125 (35-130 U/ml) (n = 26); subgroup-CA(c) with high CA-125 (> 130 U/ml) (n = 25).

Results: 1) patients of group-A were older (p < 0.05); CA-125 < 35 U/ml predominated in group-B (p < 0.001); 2) CA-125 < 35 U/ml showed relatively high NPV, sensitivity and specificity (82.8%; 0732; 0.716, respectively). Our proposed graduation of CA-125 into three grades: a) < 35 U/mL; b) 35-130 U/mL; c) > 130 U/mL increased the specificity for both parameters: CA125 = 35-130 U/mL up to 0.811, and for CA-125 > 130 U/mL up to 0.905, and PPV for the latter parameter up to 72.0%; 3) US: a) highest sensitivity, as indicator for best distinguishing of diseased patients, showed: rugged margins and presence of septum/vegetations (0.878; 0.897, respectively); b) highest specificity, as indicator for best distinguishing of healthy patients: clear distinguish ability of tumor from surrounding tissue and absence of ascites (0.811; 0.932, respectively); c) presence of ascites had highest PPP (100%) i.e. it was the best malignancy predictor; 4) RMI showed only relatively high NPV for RMI < or = 200 (76.8%); 4) additional analysis of RMI in correlation with proposed CA-125 gradation increased the predictive values of RMI: a) subgroup-CA(a): NPV and sensitivity for RMI < or = 200 (81.6%; 0.818, respectively) and NPV for RMI > 200 (86.7%); b) subgroup-CA(b): specificity for RMI < or = 200, as good indicator for distinguishing healthy patients (0.929); c) subgroup-CA(c): sensitivity for RMI > 200, as good indicator for distinguishing diseased patients (0.944).

Conclusion: CA-125 and US, as single criteria were not accurate. RMI is good indicator only in correlation with CA-125.