Abstract:

Objective: In benign ovarian diseases, CA 125 is rarely over 1000 U/mL. When CA 125 level is over 1500 U/mL, the spesitificity for ovarian cancer rises to %99.1. In general, for both premenopausal and postmenopausal women, the sensitivity and specificity of CA 125 in predicting malignity is %78. In differentiating benign from malignant pelvic masses, CA 125 has limited specificity, so CA 125 has left room for improvement. In this study, our aim is to discuss the management of pelvic masses when preoperative CA 125 is extremely high and to show that CA 125 level can be elevated in benign diseases. Methods: From January 2005 to January 2013, 236 patients who had serum CA 125 levels over 450 U/mL in Dokuz Eylul University Biochemistry Department were recorded retrospectively. 67 patients had gynecological disease. From these 67 patients,33 patients were excluded becasue 7 had endometrium cancer, 4 had cervix cancer, 21 had peritonitis carsinomatosa and 1 had myoma uteri. 34 patients were found eligible for the study. Preoperative serum CA 125 levels, age, menopausal status, menopause time, the size and the location of the pelvic mass, pelvic examinations, imaging records were conducted from patient files. Results: 34 patients were analyzed and according to hystopatological diagnosis, 10 women (%29.4) had benign ovarien cyst and 24 patients (%70.6)had malignant ovarian tumour. In benign cases, 8 (%80) patients had endometriosis, 1 (%10) patient had dermoid cyst and 1 (%10) patient had serous cyst adenofibroma. In patients who had benign ovarian cysts, mean serum CA 125 level was 830.80 ± 395 (lowest 877, highest 1565), and in malignancy group, serum CA 125 level was değer 2027.04 ± 1649 (lowest 471, highest 6702). When benign cases were compared with malignant cases, women who had benign cysts were younger and mostly premenopausal. In addition, body mass index were found to be higher in malignant cases. Conclusion: In differantiating benign and malignant pelvic masses, there are several scoring systems which includes different tumour markers. CA 125 is the most sensitive and specific tumour marker for ovarian cancer, but still the predictive value is low. In conclusion, in the diagnosis of pelvic masses, preoperative CA 125 levels should be interpreted with patients’age, menopausal status, ultrasonography findings to improve the prediction value of CA 125 in malignant cases

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