The purpose of this study was to determine the diagnostic value of CA
125 in comparison with transabdominal ultrasound (US) in the evaluatio
n of postmenopausal women with pelvic mass to detect malignant epithel
ial ovarian tumors. Postmenopausal patients with pelvic mass were stud
ied with gynecologic examination, US and CA 125 determination. Three h
undred eighty-eight patients were entered in the study. According to s
tratification based on US (probably benign, equivocal, possibly malign
ant) and CA 125 (<35 U/ml, negative; between 35 and 65 U/ml, borderlin
e; >65 U/ml, positive), 290 patients were considered eligible for surg
ery. Specificity, sensitivity, positive and negative predictive value,
and accuracy of US and CA 125 were calculated with respect to histolo
gical examination. Out of 290 operated patients, 134 had a benign ovar
ian pathology, 34 had extraovarian benign pathology, 106 had an ovaria
n malignancy, and 16 presented with an extraovarian malignant patholog
y. The results according to ovarian malignant pathology were as follow
s. 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%; ac
curacy, 80.4%. US: Specificity, 77.6%; sensitivity, 84.9%; accuracy, 8
0.3%. Combination of US and CA 125 (>65 U/ml): Specificity, 96.1%; sen
sitivity, 91.7%; accuracy, 94.3%. Determination of CA 125 is a highly
specific method in predicting ovarian cancer in postmenopausal women w
ith a pelvic mass. The association with US significantly improves the
overall accuracy and may support therapeutical decision making by dist
inguishing between a significant percentage of women most likely to be
nefit from prompt intervention and women who may be managed following
minor surgical diagnostic approach, such as fine-needle aspiration. (C
) 1994 Academic Press, Inc.