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. 2005 Mar;58(3):308-12.
doi: 10.1136/jcp.2004.018077.

The role of CA125 in clinical practice

E L Moss  1 , J Hollingworth, T M Reynolds
Affiliations

The role of CA125 in clinical practice

E L Moss et al. J Clin Pathol. 2005 Mar.

Abstract

Background: CA125 is a high molecular weight glycoprotein, which is expressed by a large proportion of epithelial ovarian cancers. The sensitivity and specificity of CA125 are poor and there are no guidelines produced by the Royal College of Pathologists or the Association of Clinical Biochemists to aid clinicians and laboratories in its most appropriate use.

Aim: To identify the patient population having a CA125 measurement and to determine its contribution to individual patient management.

Methods: A retrospective case note audit looking at patients who had a CA125 measurement performed between April 2000 and April 2002.

Results: The study comprised 799 patients; 751 (94%) were female and 48 (6%) male; 221 (29%) females and 22 (46%) males had an abnormal result. CA125 was mainly used to investigate a wide range of signs and symptoms, and few tests were for follow up or screening of ovarian cancer. In female patients having a CA125 for suspicion of malignancy/ovarian cancer, only 39 (20%) of the abnormal results were caused by ovarian cancer. False positive results were largely caused by another malignancy (48 cases; 26%), benign ovarian disease (26 cases; 14%), and benign gynaecological conditions, particularly leiomyomas (18 cases; 9%). The specificity of CA125 for ovarian cancer increased with concentrations >1000 kU/litre.

Conclusions: These results confirm the high false positive rate and poor sensitivity and specificity associated with CA125. The substantial inappropriate usage of CA125 has led to results that are useless to the clinician, have cost implications, and add to patient anxiety and clinical uncertainty.

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Figures

Figure 1
Figure 1
Distribution of abnormal CA125 results (n  =  243).
Figure 2
Figure 2
Indication for CA125 measurement in the female population (n  =  751).
Figure 3
Figure 3
Final diagnosis in women with an abnormal result being investigated with CA125 (n  =  191).
Figure 4
Figure 4
Imaging performed in women under investigation with CA125 (n  =  586). CT, computerised tomography; MRI, magnetic resonance imaging; USS, transvaginal ultrasound scan.
Figure 5
Figure 5
Departments using CA125 in the female population (n  =  751).
See this image and copyright information in PMC

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