THE ADNEXAL MASS : BENIGN OR MALIGNANT? VALUE OF PELVIC EXAINATION, ULTRASONOGRAPHY AND SERUM CA- 125

Abstract

Adnexal mass is a major health problem in gynecology .

Evaluation of adnexal mass is done mainly by clinical pelvic examination ultrasonography and serum CA-125.

Careful and accurate pelvic exan1ination gives valuable information about the nature of adnexal masses .

Transvaginal ultrasonography is better than trans abdominal route m evaluation of the nature of the adnexal mass.

Serum CA-125 gives very irriportant information about the nature of the adnexal mass but it increases • in other• non neoplastic conditions e.g indoemtriosis & PID .

This study includes fifty cases with neoplastic ovarian masses thirty five malignant and fi[Wen benign as proved by histopathology later on .

The fifty cases were submitted to careful clinical pelvic examination , ultrasonographic examination and serum CA-125 was measured for every case by radioimmunoassay technique .

It was found by statistical analysis that the specificity accuracy, positive

& negative predictive values of , ultrasonographic examination is better than clinical pelvic examination but if we combined clinical pelvic examination and ultrasonogr phic examination the sensitivity , specificity , accuracy , positive & negative predictive values are less than those of each examination alone .

It was found also that serum CA-125 at cut-off value of 35u/ml is better than clinical pelvic examination and ultrasonographic examination in discrimination between benign and malignant adnexal pathology in terms of sensitivity , specificity, accuracy , positive & negative predictive values .

The combination between ultrasonographic examination and serum CA-

125 also the combination of clinical pelvic examination, ultrasonographic examination and serum CA-125 give the best discrimination between benign & malignant adnexal masses to the degree that when clinical pelvic examination & ultrasonagraphic examination are negative for malignancy and serum CA- 125 < 35 ti/ml this means that the adnexal mass is 100 % benign and when clinical pelvic examination , ultrasonographic examination are positive for malignancy and s"erum CA-125 =::: 35 u/ml this means that the adnexal mass is most probably malignant mass .

So we recommend doing careful clinical pelvic examination ultrasonographic examination and measurement of serum CA-125 for every case of adnexal mass to discriminate between:•benign and malignant masses for proper management of every case .