Ann Lab Med 2020; 40(1): 40-47  https://doi.org/10.3343/alm.2020.40.1.40
Clinical Usefulness of Cancer Antigen (CA) 125, Human Epididymis 4, and CA72-4 Levels and Risk of Ovarian Malignancy Algorithm Values for Diagnosing Ovarian Tumors in Korean Patients With and Without Endometriosis
Kyung-Hwa Shin, M.D., Ph.D.1, Hyung-Hoi Kim, M.D., Ph.D.1, Byung Su Kwon, M.D., Ph.D.2,3, Dong Soo Suh, M.D.2,3, Jong Kil Joo, M.D.2,3, Ki Hyung Kim, M.D.2,3
1Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Korea; 2Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea; 3Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
Corresponding author: Hyung-Hoi Kim, M.D., Ph.D.
Department of Laboratory Medicine and and Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea
Tel: +82-51-240-7414 Fax: +82-51-247-6560 E-mail: hhkim@pusan.ac.kr
Received: January 30, 2019; Revised: April 10, 2019; Accepted: August 2, 2019; Published online: January 1, 2020.
© Korean Society for Laboratory Medicine. All rights reserved.

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Abstract
Background: Tumor markers are useful for detection and preoperative evaluation of ovarian tumors. We evaluated the clinical usefulness of cancer antigen (CA) 125, human epididymis 4 (HE4), and CA72-4 levels and Risk of Ovarian Malignancy Algorithm (ROMA) values for differential diagnosis of malignant and borderline tumors among suspected ovarian tumors, and the effects of endometriosis on these tumor markers.
Methods: In a total of 266 patients (213, 14, and 39 with benign, borderline and malignant tumors, respectively), CA125, HE4, and CA72-4 levels were measured, and ROMA values were calculated. Medians of each marker were compared among the three groups. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to analyze the diagnostic performance of each marker.
Results: All markers were significantly higher in the malignant group than in the benign group. HE4 levels and ROMA values were significantly higher in the malignant group than in the borderline group. ROMA value had the highest AUC for distinguishing the malignant and borderline groups from the benign group in premenopausal (0.773) and postmenopausal (0.927) patients. CA125 level was significantly higher in patients with endometriosis than in those without (P<0.001), whereas HE4 and CA72-4 levels were not affected by endometriosis (P=0.128 and 0.271, respectively).
Conclusions: ROMA value is the best marker to distinguish malignant and borderline tumors from benign tumors in pre- and postmenopausal patients. HE4 and CA72-4 levels provide information on possible CA125 elevation due to endometriosis.
Keywords: Cancer antigen 125, Human epididymis 4, Cancer antigen 72-4, Risk of Ovarian Malignancy Algorithm, Ovarian tumor



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