Role of Ultrasound and CA-125 in Differentiating Benign and Malignant Ovarian Tumors: A Comparative Study

Ovarian tumors pose a significant clinical challenge due to their diverse presentations, ranging from benign cysts to highly aggressive malignancies. Early and accurate differentiation between benign and malignant ovarian tumors is crucial for determining appropriate clinical management and improving patient outcomes. However, the diagnosis of ovarian malignancies is often complicated by vague symptoms and the overlapping imaging features of benign and malignant masses. Ultrasound imaging is widely used for the initial evaluation of adnexal masses, providing valuable information about tumor morphology, but it is highly operator-dependent and may lack specificity when used alone. On the other hand, the tumor marker CA-125, though useful, has limitations in specificity, especially in premenopausal women and in benign conditions such as endometriosis and pelvic inflammatory disease (PID). This study aims to assess the combined diagnostic efficacy of ultrasound imaging and CA-125 serum levels in differentiating between benign and malignant ovarian tumors. A retrospective analysis was conducted on 200 patients presenting with ovarian masses at Sri Aurobindo Medical College & Post Graduate Institute, Indore, between 2015 and 2018. All patients underwent transabdominal and transvaginal ultrasound examinations, as well as CA-125 testing, with histopathological results used as the gold standard for diagnosis. The results demonstrated that while ultrasound alone exhibited a high sensitivity (91%) in detecting adnexal masses, its specificity was limited to 60%, leading to a significant number of false positives. CA-125 testing had a sensitivity of 90% and a specificity of 80%, but false positives were observed in several benign cases. When ultrasound findings suggestive of malignancy (solid components, irregular borders, papillary projections, ascites) were combined with elevated CA-125 levels (>35 U/mL), the specificity increased to 88%, with a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 85%. This combined approach significantly improved diagnostic accuracy, reducing the number of unnecessary surgeries for benign conditions. The study concludes that combining ultrasound imaging with CA-125 testing provides a more reliable and accurate method for differentiating between benign and malignant ovarian tumors. This approach enhances the ability to make informed clinical decisions regarding the management of ovarian masses, particularly in cases where individual diagnostic modalities may lack sufficient accuracy. Further research should focus on integrating additional biomarkers and advanced imaging techniques to further refine diagnostic protocols and improve early detection of ovarian cancer, ultimately leading to better patient outcomes.