Role of CA125/CEA ratio and ultrasound parameters in identifying metastases to the ovaries in patients with multilocular and multilocular-solid ovarian masses.

OBJECTIVES: To investigate ultrasound features and the best cut-off value of CA125/CEA ratio to discriminate benign and primary malignant ovarian neoplasms from ovarian metastases in selected groups of morphological ovarian masses: multilocular masses with 5 or more locules and multilocular-solid masses.

METHODS: Patients with multilocular (≥5 locules) or multilocular-solid ovarian masses, operated on within three months from ultrasound, and tumor markers (CEA and CA125) available at diagnosis were retrospectively identified from three ultrasound centers. The masses were described using the International Ovarian Tumor Analysis terminology.

RESULTS: 350 (88.4%) patients with an ovarian neoplasm (including 99 benign, 43 borderline, 197 primary epithelial ovarian carcinomas, 7 malignant rare tumors and 4 other types of invasive ovarian tumor) and 46 (11.6%) patients with an ovarian metastasis were analyzed. At ultrasound, ovarian neoplasms were smaller than ovarian metastases (median of the largest diameter: 97, range 20-387 mm, versus 146, range 43-259 mm) (p<0.0001) and presented with a lower number of cysts with >10 locules (18.9% versus 54.3%) (< 0.0001). Receiver operating characteristic curve (ROC) analysis showed that the best cut-off value of CEA for predicting ovarian neoplasms versus ovarian metastases was 2.33 ng/mL. The predictive performance of the CEA cut-off value was: AUC 0.791 (95%CI 0.711-0870), accuracy 73.7%, sensitivity 73.1%, specificity 78.3%, PPV 96.2% and NPV 27.7%. The best cut-off value of CA125/CEA ratio for predicting ovarian neoplasms versus ovarian metastases was 11.92. The predictive performance of the CA125/CEA cut-off value was: AUC of 0.758 (95%CI 0.683-0.833), accuracy 79.8%, sensitivity 82.3%, specificity 60.9% PPV 94.1% and NPV 31.1% CONCLUSIONS: CA125/CEA ratio and CEA alone did not show any significant difference in distinguishing ovarian neoplasms (including benign and malignant) from ovarian metastases in masses with multilocular and multilocular-solid morphology. Therefore, in this morphological subgroup of ovarian masses, CEA alone is enough to use for differentiating between the ovarian neoplasms and ovarian metastases. This article is protected by copyright. All rights reserved.