Archives of Gynecology and Obstetrics

, Volume 290, Issue 1, pp 107–113

Evaluation of serum mesothelin in malignant and benign ovarian masses

  • Moustafa Ibrahim
  • Ahmed Bahaa
  • Ahmed Ibrahim
  • Amira Abd El Hakem
  • Ayman Abo-El Noor
  • Usama El Tohamy
Gynecologic Oncology



To evaluate the diagnostic accuracy of serum mesothelin levels in patients with ovarian masses in comparison to serum cancer antigen (CA) 125 levels.


This diagnostic accuracy study was conducted in a gynecological oncology unit at Ain Shams University Maternity hospital. Based on radiological and clinical findings, a total of 110 patients were consecutively recruited. Preoperative serum mesothelin levels were assessed using enzyme-linked immunosorbent assay (ELISA) technique, while CA125 levels were determined using electrochemiluminescence immunoassay. All patients underwent exploratory laparotomy. Preoperative serum levels of both markers were correlated to histopathological reports obtained from each patient.


A total of 96 patients were finally analyzed. Of the included 96 patients, 58 (60.4 %) had a benign ovarian lesion, while 38 (39.6 %) had a malignant lesion. The median serum CA125 levels were significantly higher in patients with malignant ovarian lesions than in patients with benign ovarian lesions [335.5 mIU/mL (range 60–1,127 mIU/mL) versus 33.65 mIU/mL (range 10.36–174 mIU/mL), P < 0.001]. The median serum mesothelin level was significantly higher in patients with malignant ovarian lesions than in patients with benign ovarian lesions [104.1 nmol/L (range 6.5–215.4 nmol/L) versus 12.65 nmol/L (range 6.5–102 nmol/L), P < 0.001]. The diagnostic sensitivity and specificity for mesothelin and CA125 were 97.4 and 98.3 % and 97.4 and 56.9 %, respectively. The combination of mesothelin with CA125 did not add predictive value to mesothelin compared with mesothelin alone [same sensitivity (97.4 %) and same specificity (98.3 %)]. Serum mesothelin levels rather than serum CA125 levels were a significant predictor of early-stage ovarian malignancy [Area under the curve = 0.732, 95 % confidence interval (0.543–0.921), P = 0.031].


In ovarian cancer, mesothelin seemed to have the same sensitivity, but a higher specificity than CA125. Combination of mesothelin and CA125 had no advantage over mesothelin alone. Mesothelin rather than CA125 was a significant predictor of early-stage ovarian cancer (stage I/II).


CA125 Mesothelin Ovarian cancer 



Area under the curve


Body mass index


Confidence interval


Computed tomography


Epithelial ovarian cancer


Enzyme linked immunosorbent assay




Interquartile range


Positive likelihood ratio


Negative likelihood ratio


Magnetic resonance imaging


Positive predictive value


Standard deviation


Receiver operator characteristic


  1. 1.
    American Cancer society (2009) Cancer Facts and Figures. American Cancer Society, Atlanta, pp 1–68Google Scholar
  2. 2.
    Moore RG, MacLaughlan S, Bast RCJR (2010) Current state of biomarker development for clinical application in epithelial ovarian cancer. Gynecol Oncol 116(2):240–245PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Hellstrom I, Helstrom KE (2011) fTwo novel biomarkers, mesothelin and HE4, for diagnosis of ovarian carcinoma. Expert Opin Med Diagn 5(3):227–240PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Grigoriu BD, Gregoire M, Chahine B, Scherpereel A (2008) New diagnostic markers for malignant pleural mesothelioma. Bull Cancer 95(2):177–184PubMedGoogle Scholar
  5. 5.
    Hassan R, Schweizer C, Lu KF, Schuler B, Remaley AT, Weil SC et al (2010) Inhibition of mesothelin CA125 interaction in patients with mesothelioma by the antimesothelin monoclonal antibody MORAb-009: implications for cancer therapy. Lung Cancer 68(3):455–459PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Terry K, Sluss P, Skates S, Mok S, Ye B, Vitonis A et al (2004) Blood and urine markers for ovarian cancer; a comprehensive review. Dis Markers 20:53–70PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Huhtinen K, Suvitie P, Hiissa J, Junnila J, Huvila J, Kujari H et al (2009) Serum HE4 concentration differentiates malignant ovarian tumours from ovarian endometriotic cysts. Br J Cancer 100(8):1315–1319PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    El Sherbini MA, Sallam MM, Shaban EA, El-Shalakany AH (2011) Diagnostic value of serum kallikrein-related peptidases 6 and 10 versus CA125 in ovarian cancer. Int J Gynecol Cancer 21(4):625–632PubMedCrossRefGoogle Scholar
  9. 9.
    Abdel-Azeez HA, Labib HA, Sharaf SM, Refai AN (2010) HE4 and mesothelin: novel biomarkers of ovarian carcinoma in patients with pelvic masses. Asian Pac J Cancer Prev 11(1):111–116PubMedGoogle Scholar
  10. 10.
    McIntosh MW, Drescher C, Karlan B, Scholler N, Urban N, Hellstrom KE et al (2004) Combining CA125 and SMR serum markers for diagnosis and early detection of ovarian carcinoma. Gynecol Oncol 95:9–15PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Moore RG, Brown AK, Miller MC (2008) The use of multiple novel tumour biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol 108:402–408PubMedCrossRefGoogle Scholar
  12. 12.
    Qiao N, Li H (2013) The value of mesothelin in the diagnosis and follow-up of surgically treated ovarian cancer. Eur J Gynaecol Oncol 34(2):163–165PubMedGoogle Scholar
  13. 13.
    Havrilesky LJ, Whitehead CM, Rubatt JM, Cheek RL, Groelke J, He Q et al (2008) Evaluation of biomarker panels for early stage ovarian cancer detection and monitoring for disease recurrence. Gynecol Oncol 110(3):374–382PubMedCrossRefGoogle Scholar
  14. 14.
    Badgwell D, Lu Z, Cole L, Fritsche H, Atkinson EN, Somers E et al (2007) Urinary mesothelin provides greater sensitivity for early stage ovarian cancer than serum mesothelin, urinary hCG free beta subunit and urinary hCG beta core fragment. Gynecol Oncol 106(3):490–497PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Moustafa Ibrahim
    • 1
  • Ahmed Bahaa
    • 1
  • Ahmed Ibrahim
    • 1
  • Amira Abd El Hakem
    • 2
  • Ayman Abo-El Noor
    • 1
  • Usama El Tohamy
    • 1
  1. 1.Obstetrics and GynecologyAin-Shams Faculty of MedicineCairoEgypt
  2. 2.Obstetrics and GynecologyNasser Institute Hospital for Research and TreatmentCairoEgypt

Personalised recommendations