The low sensitivity of CA-125 for early-stage epithelial ovarian carcinoma (EOC) necessitates more accurate biomarkers. This study evaluated the diagnostic accuracy of a panel combining CA-125 with apolipoproteins A1 and B (ApoA1, ApoB) for discriminating EOC from benign adnexal masses.

A prospective diagnostic accuracy study was conducted involving 60 patients with adnexal masses scheduled for surgery. Preoperative serum levels of CA-125 (chemiluminescent immunoassay, Abbott Architect), ApoA1, and ApoB (immunonephelometry, Siemens BN II) were measured. After excluding three non-epithelial malignancies, 57 patients (19 histologically confirmed EOC, 38 benign controls) were analyzed. Receiver operating characteristic (ROC) curve analysis, multivariate logistic regression, and decision curve analysis were performed.

The triple-marker panel (CA-125 + ApoA1 + ApoB) demonstrated a significantly higher area under the ROC curve (AUROC) of 0.980 (95% CI 0.952–1.000) compared to 0.952 (95% CI 0.912–0.992) for CA-125 alone (p = 0.028). The panel achieved a sensitivity of 100% in this cohort and a specificity of 86.8% at an optimal cutoff, correctly identifying all five stage I EOCs that were missed by CA-125. In multivariate analysis, ApoA1 was the strongest independent predictor of EOC (odds ratio [OR] 0.10, 95% CI 0.02–0.40, p = 0.001). Decision curve analysis confirmed the superior clinical utility of the panel across a wide range of threshold probabilities.

The CA-125/ApoA1/ApoB panel significantly outperforms CA-125 alone, offering high sensitivity for early-stage EOC detection. Utilizing standardized, automated assays, this panel presents a highly scalable triage tool for adnexal masses, especially in resource-limited settings. Multicenter validation is warranted to confirm these findings.