Diagnostic significance of cancer antigen 125/carcinoembryonic antigen ratio combined with IOTA-ADNEX model in discriminating between primary ovarian cancer and ovarian metastases.

BACKGROUND: Ovarian metastases (OMs) are relatively common and exhibit unfavorable biological characteristics. The present study sought to evaluate the diagnostic value of the International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model, the cancer antigen 125 (CA125)/carcinoembryonic antigen (CEA) ratio, and their combination in distinguishing OM from primary ovarian cancer (OC). METHODS: This retrospective study enrolled patients with histopathologically diagnosed OM and primary OC. OM was classified into three types based on ultrasound (US) findings. The risk of each mass was calculated using the ADNEX model. The two groups' clinical data, US characteristics, and ADNEX model risk were recorded and compared. The area under the receiver operating characteristic (ROC) curve (AUC) was employed to evaluate the diagnostic performance. RESULTS: OM originated most frequently from the intestinal tract (58.3%). In total, 52.8% (38/72) of OM cases were identified simultaneously with primary tumors, whereas 47.2% (34/72) were diagnosed after the primary tumor. About 22.2% (16/72) of OM cases were type A, 37.5% (27/72) were type B, and 40.3% (29/72) were type C. The ADNEX model, CA125/CEA ratio, and the combined CA125/CEA ratio of ADNEX were compared between the two groups. The diagnostic performance of the ADNEX combined CA125/CEA ratio was significantly superior to that of the model alone {AUC = 0.886 [95% confidence interval (CI): 0.836-0.936], sensitivity =0.736 (95% CI: 0.619-0.833), accuracy =0.843 (95% CI: 0.788-0.895)}. CONCLUSIONS: Both ADNEX and the CA125/CEA ratio alone can effectively distinguish OM from primary OC. Adding the CA125/CEA ratio to the IOTA-ADNEX model may improve its performance in differentiating between OM and primary OC.