The Value of Ultrasonography and Tumor Markers in the Differential Diagnosis of Postmenopausal Ovarian Cysts

Abstract

Aim: To evaluate the use of tumor markers in the differentiation of malignant and benign ovarian cysts in the postmenopausal period. Materials and Methods: The study included postmenopausal 46 patients with ovarian cysts that were assessed pre- and postoperatively using CA125 levels, ultrasonographic findings, and histopathological examination at the Obstetrics and Gynecology Clinic, Ankara Atatürk Training and Research Hospital. Results: Mean age of menopause onset was 46 years and mean duration of menopause was 11 years. Histopathological examination revealed that 28.3% of the ovarian cysts were malignant and 71.7% were benign. Of the malignant cysts, 84% were unilateral, with a mean diameter of 74.61 mm; mean diameter of the benign cysts was 58 mm. While 80% of cysts with a high CA125 value were malignant, 20% were benign. Pathological examination revealed that 96.8% of cysts with a normal CA125 value were benign and 3.2% were malignant. Mean CA125 values were 264 U/ml for malignant cysts and 14.2 U/ml for benign cysts. When pathological assessment was based only on ultrasonographic findings, 73.9% of the ovarian cysts were malignant and 26.1% were benign. While unilateral or bilateral localization in the ultrasonography was insignificant, the presence of a solid component was a good predictor of malignancy (P = 0.0001). Conclusions: In the differentiation of benign and malignant cysts in postmenopausal women, the presence of a solid component based on ultrasonography, cysts larger than 5-6 cm, and high CA125 values may be used as discriminative criteria. For those patients with cysts that are assumed to be benign follow-up may be an option for reducing the mortality and morbidity associated with surgery.