Role of cancer antigen-125 in diagnosing malignant adnexal masses: a prospective observational study

Shazia Ashraf Khan, Shaista Rahi, Nahida Khan


Background: Adnexal masses present a diagnostic and therapeutic dilemma across age-groups. This study aimed to evaluate the performance of cancer antigen-125 (CA-125) in distinguishing between benign and malignant adnexal masses.

Methods: This was a prospective, observational, single tertiary-care center study, done in North India from January, 2011 till December, 2012. Serum CA-125 levels was obtained preoperatively in consecutive patients presenting with ultrasonography confirmed adnexal masses. The cut-off value between benign and malignant was taken as 35 IU/ml. Histopathological diagnosis was obtained in all patients.

Results: A total of 126 patients presented with adnexal masses, of which 100 were enrolled (mean age: 37.5±14.4 years, range: 18-80 years). Most of the masses were benign 81% (malignant=19%). Dermoid cyst (25.9%) and endometriomas (21%) were the most common benign masses. Serous (21%) and mucinous cystadeno-carcinoma (15.8%) were the most common malignant masses, more often seen in elderly, married, parous and post-menopausal patients. Mean CA-125 levels were significantly higher in malignant masses (257.30 [105.68-408.92] versus 19.26 [16.53-22.00], p<0.001). Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CA-125 for diagnosing malignant adnexal mass was 94.7%, 87.65%, 64.28%, 98.6%, and 88.91% respectively. The same was 100%, 85.1%, 54.5%, 100%, 87.3% in premenopausal and 85.7%, 100%, 100%, 93.3%, 95.2% in postmenopausal women respectively.

Conclusion: Benign masses form the bulk of the adnexal masses in all age groups. CA-125 levels has high sensitivity and negative predictive value in premenopausal patients while as high specificity and positive predictive value in postmenopausal patients.


Adnexal masses, Biomarkers, Cancer antigen -125, Ovarian malignancies

Full Text:



ACOG; Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007;110(1):201-14.

Drake J. Diagnosis and management of the adnexal mass. Am Fam Physician. 1998;57(10):2471-6.

Maggino T, Gadducci A, D’Addario V, Pecorelli S, Lissoni A, Stella M et al. Prospective multi-centre study on CA-125 in postmenopausal pelvic masses. Gynecol Oncol. 1994;54:117-23.

MalkasianJr GD, Knapp RC, Lavin PT, ZurawskiJr VR, Podratz KC, Stanhope CR et al. Preoperative evaluation of serum CA-125 levels in premenopausal and postmenopausal patients with pelvic masses: discrimination of benign from malignant disease. Am J Obstet Gynecol. 1988;59:341-6.

Milojkovik M, Hrogovic Z, Hrgovic I, Jonat W, Maass N, Bukovic D. Significance of CA-125 serum level in discrimination between benign and malignant masses in the pelvis. Arch Gynecol Obstet. 2004;269:176-80.

Medeiros LR, Rosa DD, Rosa MI, Bozzetti MC. Accuracy of ultrasonography with color Doppler in ovarian tumours. Int J Gynaecol Cancer. 2009;19(2):230-6.

Jain KA. Prospective evaluation of adnexal masses with endovaginal gray-scale and duplex and color Doppler ultrasonography: correlation with pathological findings. Radiology. 1994;191(1):63-7.

Jha R, Karki S. Histological pattern of ovarian tumors and their age distribution. Nepal Med College J. 2008;10(2):81-5.

Luxman D, Bergamn A, Sagi J, David M. The postmenopausal adnexal mass: correlation between ultrasonic and pathologic findings. Obstet Gynecol. 1991;77:726.

Anuradha Khanna, Shweta Garg, RC Shukla, Mohan Kumar. Color Doppler study for differentiation of ovarian adnexal masses. Singapore J Obstet Gynecol. 2002;33(1):35-39.

Gharwan H, Bunch KP, Annunziata CM. The role of reproductive hormones in epithelialovarian carcinogenesis. Endocr Relat Cancer. 2015;22(6):R339-63

Banu S, Khatun S, Shamsuddin L. Assessment of adnexal masses by transvaginalsonography and serum CA-125 assay in the pre and postmenopausal women. Bangladesh J Obstet Gynecol. 2009;24(2):56-62.

Alcazar JL, Errasti T, Zornoza A, Minguez JA, Galan MJ. Transvaginal color doppler ultrasonography, and CA-125 in suspicious adnexal masses. Int J Gynecol and Obstet Sept. 1999;66:255-261.

Erdogan N, Ozcelik B, Akgun M, Ozturk F. Doppler ultrasound assessment and CA-125 in the diagnosis of ovarian tumours. Int J Gynecol Obstet. 2005;91(2):146-50.

Mazhar SB, Jabeen K. Cross validation of Doppler ultrasound and gray scale imaging for discrimination of benign and malignant adnexal masses. JIMA. 2008;40:69-75.

Timor-Tritsch LE, Lerner JP, Monteagudo A, Santos R. Transvaginal ultrasonographic characterization of ovarian masses by means of color flow directed measurement and morphologic scoring system. Am J Obstet Gynecol. 1993;168:909.