Serum CA 125 levels and sonography in the pre‐operative assessment of myometrial invasion of endometrial cancer

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Abstract
To assess the value of elevated serum CA 125 levels and ultrasonography in predicting deep myometrial invasion of endometrial cancer. We assessed pre-operatively serum CA 125 levels and myometrial invasion by ultrasonography in women undergoing laparotomy because of endometrial cancer. The results were compared with histological determination of myometrial invasion of endometrial cancer. Invasion was classified as superficial (less than one-half of myometrium involved) or deep (more than one-half of myometrium involved). University hospital. Seventy-eight women with a histologically proved endometrial carcinoma confined to the uterus: nine had Stage IA disease, 45 Stage IB, five Stage IC, one Stage IIA, four Stage IIB and 14 Stage IIIA. The myometrial invasion was found to be superficial in 57 (73%) patients and deep (more than half) in 21 (27%), respectively. CA 125 levels were above 35 iu/l in 17 (21.8%) of 78 patients: nine (42.8%) of 21 with deep myometrial invasion and eight (14%) of 57 with superficial invasion (P < 0.01). The positive predictive value of an elevated CA 125 level for deep myometrial invasion was 52.9% and the negative predictive value 80.3%. Sonography correctly estimated invasion in 69 cases (88.5%). Deep invasion was assessed by ultrasound with a significantly (P < 0.01) higher sensitivity than CA 125 (95.2% vs. 42.8). Positive and negative predictive values for deep myometrial invasion of sonography were 71.4% and 98%, respectively. Ultrasonography was more accurate than serum CA 125 levels in predicting myometrial invasion of endometrial carcinoma.