Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma

Objective: To evaluate the accuracy of CA. 19.9 plasma levels (with or without CA 125 levels) combined with transvaginal ultrasonography in the differential diagnosis of endometrioma. Methods: One hundred eighteen consecutive premenopausal nonpregnant women had laparoscopy or laparotomy between November 1994 and November 1995 because of the presence of a persistent adnexal mass. They underwent transvaginal ultrasonography and measurement of CA 19.9 and CA 125 plasma levels within 2 clays before surgery. The ultrasonographic impression and the tumor marker values were compared with the histopathologic diagnosis. The overall agreement between. the test result and the actual outcome was calculated using the kappa statistic. Results: Transvaginal ultrasonography had a strong agreement between test result and surgery (kappa value 0.84), whereas the combined methods were associated with a lower kappa value (range 0.24-0.80). Conclusion: Transvaginal ultrasonography used alone is the most cost-effective method in the preoperative differential diagnosis of endometrioma.