Ann Lab Med.  2020 Jan;40(1):40-47. 10.3343/alm.2020.40.1.40.

Clinical Usefulness of Cancer Antigen (CA) 125, Human Epididymis 4, and CA72-4 Levels and Risk of Ovarian Malignancy Algorithm Values for Diagnosing Ovarian Tumors in Korean Patients With and Without Endometriosis

• Shin KH
• Kim HH
• Kwon BS
• Suh DS
• Joo JK
• Kim KH

• KMID: 2457492
• DOI: http://doi.org/10.3343/alm.2020.40.1.40

Abstract

BACKGROUND
Tumor markers are useful for detection and preoperative evaluation of ovarian tumors. We evaluated the clinical usefulness of cancer antigen (CA) 125, human epididymis 4 (HE4), and CA72-4 levels and Risk of Ovarian Malignancy Algorithm (ROMA) values for differential diagnosis of malignant and borderline tumors among suspected ovarian tumors, and the effects of endometriosis on these tumor markers.
METHODS
In a total of 266 patients (213, 14, and 39 with benign, borderline and malignant tumors, respectively), CA125, HE4, and CA72-4 levels were measured, and ROMA values were calculated. Medians of each marker were compared among the three groups. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to analyze the diagnostic performance of each marker.
RESULTS
All markers were significantly higher in the malignant group than in the benign group. HE4 levels and ROMA values were significantly higher in the malignant group than in the borderline group. ROMA value had the highest AUC for distinguishing the malignant and borderline groups from the benign group in premenopausal (0.773) and postmenopausal (0.927) patients. CA125 level was significantly higher in patients with endometriosis than in those without (P<0.001), whereas HE4 and CA72-4 levels were not affected by endometriosis (P=0.128 and 0.271, respectively).
CONCLUSIONS
ROMA value is the best marker to distinguish malignant and borderline tumors from benign tumors in pre- and postmenopausal patients. HE4 and CA72-4 levels provide information on possible CA125 elevation due to endometriosis.

Keyword

Cancer antigen 125; Human epididymis 4; Cancer antigen 72-4; Risk of Ovarian Malignancy Algorithm; Ovarian tumor

MeSH Terms

Area Under Curve
Biomarkers, Tumor
Diagnosis, Differential
Endometriosis*
Epididymis*
Female
Humans*
Male
ROC Curve
Roma
Sensitivity and Specificity
Biomarkers, Tumor

Figure

• 

  Fig. 1 Serum marker levels and ROMA values according to the presence and absence of endometriosis in the benign group. (A) CA125, (B) HE4, (C) ROMA (premenopausal) value, (D) ROMA (postmenopausal) value, and (E) CA72-4 levels. The whiskers show the maximum and minimum values, with the exception of outliers (circles) and extremes (asterisks).Abbreviations: CA, cancer antigen; HE4, human epididymis 4; ROMA, Risk of Ovarian Malignancy Algorithm.

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