DIFFERENTIAL-DIAGNOSIS OF PELVIC MASSES - USEFULNESS OF CA125, TRANSVAGINAL SONOGRAPHY AND ECHO-DOPPLER

The aim of this study was to define the clinical value of physical exa mination, CA125, transvaginal sonography and echo-Doppler in the preop erative diagnosis of adnexal masses. One hundred thirty patients with adnexal masses were prospectively studied. Diagnostic tests were perfo rmed during the week before surgery. Pre- and postmenopausal patients were evaluated separately. Surgical specimens were the gold standard. The best cut-off points for CA125 and resistance index (RI) were defin ed with receiver operating characteristic curves. Sensitivities for tr ansvaginal sonography (TVS) were: 87.5% and 82.6% for pre- and postmen opausal patients, while specifity was 75.4% and 64.7%, respectively. F or premenopausal patients the CA125 cut-off point that provides the be st clinical usefulnesses is 100 IU/ml, yielding 94.4% specificity and 53.3% sensitivity. In postmenopausal women 35 IU/ml provides the highe st accuracy and sensitivity. RI cut-off point, defined at 0.40, provid ed 76% accuracy and 94.8% specificity, in spite of a lower sensitivity . For postmenopausal patients, the cut-off point, defined at 0.60, has the highest accuracy and the best sensitivity-specificity ratio. Comb ination of TVS and CA125 were: 100% specificity in premenopausal and 9 1.1% in postmenopausal patients. Sensitivity increased when both resul ts were negative, 93.7% and 95.6% for pre- and postmenopausal patients , respectively. This study did not find the accuracy established by th e use of CA125 and TVS is increased by echo-Doppler and this technique should be reserved for cases included in research protocols.