J Gynecol Oncol.  2008 Dec;19(4):229-235. 10.3802/jgo.2008.19.4.229.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors

• Jeoung HY
• Choi HS
• Lim YS
• Lee MY
• Kim SA
• Han SJ
• Ahn TG
• Choi SJ

• KMID: 2173411
• DOI: http://doi.org/10.3802/jgo.2008.19.4.229

Abstract

OBJECTIVE
To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors.
METHODS
From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined.
RESULTS
There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively.
CONCLUSION
The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

Keyword

Ultrasonogram (morphology indexing); CA-125 antigen; ROC curve; Teratoma

MeSH Terms

Abstracting and Indexing as Topic
CA-125 Antigen
Humans
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Teratoma
CA-125 Antigen

Figure

• 

  Fig. 1 Morphology indexing score.

• 

  Fig. 2 The ROC curve including ovarian teratomas. The cutoff range is a MI 6.5-7.5. It has a sensitivity 0.875-0.917 and 1-specificity 0.023-0.203. The cutoff range is CA-125 25.60-28.50. It has a sensitivity 0.958 and 1-specificity 0.203-0.215. MI: morphology indexing.

• 

  Fig. 3 Four sonographic findings of ovarian teratomas. Four types are a cystic pattern (A), a dense echo pattern with or without a cystic component (B), a pattern including a dense echogenic component with or without a cystic component (C), a densely echogenic tubercle associated with a cystic echo pattern (D).

• 

  Fig. 4 The ROC curve excluding ovarian teratomas. A cutoff range is a MI 6.5-7.5. It has a sensitivity 0.875-0.917 and a 1-specificity 0.046-0.138. MI: morphology indexing.

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