Extremely high serum CA19-9 level along with elevated D-dimer in assisting detection of ruptured ovarian endometriosis

Abstract

Background To clarify clinical importance of serum CA19-9, CA-125, and plasma D-dimer (D-D) levels in detecting spontaneously ruptured ovarian endometriosis (OE). Materials and Methods We retrospectively examined 173 patients with endometriosis out of 735 cases of OE between 2013 and 2019. Among these, 21 cases were diagnosed as “spontaneously ruptured” after surgery, while the remaining cases were unruptured. Venous blood was collected pre-operatively to detect CA19-9, CA-125, and D-D levels. A receiver operating characteristic curve analysis was applied to test clinical value of each marker. Results Among the 21 patients with ruptured OE, 16 had a history of pelvic cysts, 19 claimed sudden onsets of lower abdominal pain, and fluid accumulation were detected in cul-de-sac in only six participants by ultrasound. For serological investigation, both CA19-9 and D-D were significantly elevated in the ruptured OE group (343.09 ± 367.67 U/ml vs. 36.84 ± 40.01 U/ml, 3.39 ± 4.90 mg/L vs. 0.43 ± 0.29 mg/L, both p < .0001). The area under curve (AUC) value for the combination of CA19-9 and D-D was 0.975 (95% CI, 0.939 − 0.993), with specificity of 96.69%, and sensitivity of 85.71%. The combination of CA-125, CA19-9 and D-D showed the highest AUC value that up to 0.976 (95% CI, 0.940–0.993), with sensitivity of 95.24%, and specificity of 87.50%. Conclusion The combination of CA19-9 and D-D can be chosen as an effective and economical indicators to identify patients with spontaneously ruptured OE in pre-operation assessment. However, from the perspective of differential diagnosis, the combination of CA-125, CA19-9 and D-D is the best choice. Key messages Taking into account the economic effect, the combination of CA19-9 and D-D can be chosen as an effective indicators to identify patients with spontaneously ruptured OE in pre-operation assessment. From the perspective of differential diagnosis, the combination of CA-125, CA19-9 and D-D is the best choice to identify patients with spontaneously ruptured OE.

Clinical features of patients with previous spontaneous rupture of ovarian endometrioma operated electively: a case-control study

“…After the OMA developed spontaneous rupture, the levels of serum HE4 [15], CA125, CA199 and D-dimer will increase, of which the level of CA125 can be as high as thousands [12]. For the diagnosis of [11,12]. Because of the differences in enrolled participants and testing time, most patients in our cohort did not observe extremely high CA125 and CA19-9 as previously reported (Table 2).…”

“…As a very common gynecological disease and because of the formation of adhesions, OMA is not prone to twisting but has a chance of rupture. In previous studies, spontaneous rupture of OMA was also regarded as a rare condition, and the prevalence was reported to vary from 2.6 to 4.2% in the literatures [ 9 , 11 , 12 ]. Otherwise, the prevalence of spontaneous rupture of OMA in our study (9.0%) was higher than previous reports, which were mostly based on emergency surgeries and might underestimate the prevalence of this condition.…”

“…After the OMA developed spontaneous rupture, the levels of serum HE4 [ 15 ], CA125, CA199 and D-dimer will increase, of which the level of CA125 can be as high as thousands [ 12 ]. For the diagnosis of spontaneously ruptured OMA in laboratory testing, Dai et al recommended the combination of CA199 and CA125.…”

“…For the diagnosis of spontaneously ruptured OMA in laboratory testing, Dai et al recommended the combination of CA199 and CA125. Shuang et al recommended the triple test of CA125, CA19-9 and D-D, in which the double test of CA19-9 and D-D has the highest cost performance [ 11 , 12 ]. Because of the differences in enrolled participants and testing time, most patients in our cohort did not observe extremely high CA125 and CA19-9 as previously reported (Table 2 ).…”

“…Even they went to the emergency room, there might be no significant pelvic free fluid accumulation on ultrasound examination. After the OMA developed spontaneous rupture, the levels of serum HE4 [15], CA125, CA199 and D-dimer will increase, of which the level of CA125 can be as high as thousands [12]. For the diagnosis of [11,12].…”