{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T11:39:05Z","timestamp":1782733145744,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,1,2]],"date-time":"2019-01-02T00:00:00Z","timestamp":1546387200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate ultrasound features and the best cut\u2010off value of the cancer antigen 125\/carcinoembryonic antigen (CA125\/CEA) ratio to discriminate ovarian metastases from benign and primary malignant ovarian neoplasms  in two selected groups of morphological ovarian masses, namely multilocular masses with five or more locules and multilocular\u2010solid masses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with multilocular (five or more locules) or multilocular\u2010solid ovarian masses, operated on within 3\u2009months of ultrasound examination, and with tumor markers (CEA and CA125) available at diagnosis, were identified retrospectively from three ultrasound centers. The masses were described using the International Ovarian Tumor Analysis (IOTA) terminology. Ultrasound and clinical characteristics were compared between those with an ovarian neoplasm (including benign and primary malignant neoplasms) and those with an ovarian metastasis. Receiver\u2013operating characteristics curve (ROC) analysis was used to evaluate the ability of CA125, CEA and CA125\/CEA to differentiate between ovarian neoplasms and ovarian metastases, and their predictive performance was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 350 (88.4%) patients with an ovarian neoplasm (including 99 benign, 43 borderline and 197 primary epithelial ovarian carcinomas, seven malignant rare tumors and four other types of invasive ovarian tumor) and 46 (11.6%) patients with an ovarian metastasis were analyzed. On ultrasound examination, ovarian neoplasms were smaller than ovarian metastases (median largest diameter, 97 (range, 20\u2013387) mm <jats:italic>vs<\/jats:italic> 146 (range, 43\u2013259) mm, respectively; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and presented with a lower number of cysts with &gt;\u200910 locules (18.9% <jats:italic>vs<\/jats:italic> 54.3%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). ROC curve analysis showed that the best cut\u2010off value of CEA for distinguishing between ovarian neoplasms and ovarian metastases was 2.33\u2009ng\/mL. The predictive performance of this CEA cut\u2010off value was: area under the curve (AUC), 0.791 (95% CI, 0.711\u20130.870); accuracy, 73.7%; sensitivity, 73.1%; specificity, 78.3%; positive predictive value (PPV), 96.2%; and negative predictive value (NPV), 27.7%. The best cut\u2010off value of CA125\/CEA for distinguishing between ovarian neoplasms and ovarian metastases was 11.92. The predictive performance of this CA125\/CEA cut\u2010off value was: AUC, 0.758 (95% CI, 0.683\u20130.833); accuracy, 79.8%; sensitivity, 82.3%; specificity, 60.9%; PPV, 94.1%; and NPV, 31.1%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CA125\/CEA ratio and CEA alone did not show any significant difference in their ability to distinguish  between ovarian neoplasms (including benign and malignant) and ovarian metastases in masses with multilocular and those with multilocular\u2010solid morphology. Therefore, in this morphological subgroup of ovarian masses, CEA alone is sufficient to differentiate between ovarian neoplasms and ovarian metastases. Copyright \u00a9 2018 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.19174","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T06:23:41Z","timestamp":1530858221000},"page":"116-123","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Role of CA125\/CEA ratio and ultrasound parameters in identifying metastases to the ovaries in patients with multilocular and multilocular\u2010solid ovarian masses"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5070-7245","authenticated-orcid":false,"given":"F.","family":"Moro","sequence":"first","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario A. Gemelli, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Pasciuto","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario A. Gemelli, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Djokovic","sequence":"additional","affiliation":[{"name":"Istituto di Ginecologia e Ostericia Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Di Legge","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario A. Gemelli, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Granato","sequence":"additional","affiliation":[{"name":"Istituto di Ginecologia e Ostericia Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. C.","family":"Moruzzi","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario A. Gemelli, IRCCS  Rome Italy"},{"name":"Gynecological Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine Charles University  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Mancari","sequence":"additional","affiliation":[{"name":"Preventive Gynecology Unit Division of Gynecology, European Institute of Oncology  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. F.","family":"Zannoni","sequence":"additional","affiliation":[{"name":"Institute of Histopathology Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Fischerova","sequence":"additional","affiliation":[{"name":"Gynecological Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine Charles University  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Franchi","sequence":"additional","affiliation":[{"name":"Preventive Gynecology Unit Division of Gynecology, European Institute of Oncology  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Scambia","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario A. 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