DIAGNOSTIC-VALUE OF PELVIC EXAMINATION, ULTRASOUND, AND SERUM CA-125 IN POSTMENOPAUSAL WOMEN WITH A PELVIC MASS - AN INTERNATIONAL MULTICENTER STUDY

Background. In a prospective study, the differential diagnostic potent ial of pelvic examination, ultrasound, and serum CA 125 assay in postm enopausal patients presenting with a pelvic mass was assessed. Methods . A total of 228 patients were evaluated preoperatively in an internat ional, multicenter, prospective study using a standard protocol for pe lvic examination, transvaginal (occasionally additional abdominal) ult rasound, and serum CA 125 determination with a cut-off level of 35 U/m l. Results. Ninety-five malignant (41.7%) and 127 benign (55.7%) pelvi c tumors were found in addition to 6 borderline ovarian tumors (2.6%) in the 228 patients. Seventy-two patients had ovarian carcinoma, 49 of whom were International Federation of Gynecology and Obstetrics Stage III or IV. Borderline tumors were excluded from the statistical calcu lations. The individual accuracy of pelvic examination, ultrasound, an d serum CA 125 in discriminating between benign and malignant pelvic m asses was approximately the same (76, 74, and 77%, respectively). Usin g logistic regression analysis, the power of pelvic examination appear ed to be the most relevant factor (adjusted odds ratio, 9.2), followed by serum CA 125 (odds ratio, 5.6), and ultrasound (odds ratio, 4.9). Age appeared to be nonpredictive. No cancer was found in any patient i n whom all three methods scored negative (n = 53; positive predictive value for malignancy = 0 and 95%; confidence interval, 0-7). Conclusio ns. The combined use of pelvic examination, ultrasound, and serum CA 1 25 leads to improved discrimination between malignant and benign pelvi c masses, because malignancy can be excluded when all three examinatio n methods are negative. A change to a more patient-tailored surgical a pproach could be considered in those cases.