CA-125 AND CARCINOEMBRYONIC ANTIGEN-ASSAY VS CYTODIAGNOSTIC EXPERIENCE IN THE CLASSIFICATION OF BENIGN OVARIAN CYSTS

OBJECTIVE: To compare the relative strengths of two factors involved i n making an accurate differentiation between functional and epithelial ovarian cysts, along with their combination: (1) the cytologist's lev el of experience in interpreting ovarian cytology, (2) the use of the tumor markers carcinoembryonic antigen (CEA) and CA-125 in cyst fluid, and (3) a combination of(1) and (2). STUDY DESIGN: Papanicolaou-stain ed sediments from fluid aspirated from 31 resected ovarian cysts (6 fu nctional and 25 epithelial) were blindly and independently evaluated b y five pathologists with varying experience in ovarian cytology. Cyst fluid supernatant was used for CEA, enzyme-linked immunosorbent assay, and CA-125 radioimmunoassay CEA levels >5 ng/mL or CA-125 >5,000 U/mL were considered elevated. Cysts were categorized cytologically and hi stologically as functional or epithelial and by tumor markers as ''nei ther elevated'' or ''either or both elevated'' (EBE). RESULTS: The agr eement of histologic diagnosis with each pathologist's cytologic diagn osis ranged from 53% to 84% (53%, 71%, 83%, 52%, 84%), corresponding t o increasing level of experience. Tile percentage of agreement with EB E was 77%, whereas combined experienced pathologist's diagnosis and EB E was 87%. Kappa equaled. 45 for experienced cytopathologist's diagnos is or EBE alone. Kappa equaled .53 when the pathologist or EBE diagnos ed an epithelial cyst, indicating results unlikely to occur by chance. CONCLUSION: The distinction of functional from epithelial ovarian cys ts is best achieved by combining measurement of the tumor markers CEA and CA-125 with a high level of cytopathology experience.