Benign Ovarian Cysts with Raised CA-125 Levels: Do We Need to Evaluate the Fallopian Tubes?

Abstract Objectives It is not clearly known whether some benign (simple) ovarian cysts can convert into cancerous cysts. Size of cyst and wall abnormalities do predict the potentiality of malignancy. Not many studies have been done to explore the malignant potential of large-sized (> 5 cm) unilocular ovarian cysts without wall abnormalities. This study evaluated the correlation between ultrasonographic size of benign ovarian cysts and carbohydrate antigen 125 (CA-125) levels. Methodology Sixty (60) premenopausal women were recruited for the study preoperatively, based on transvaginal ultrasound (TVUS) findings present in the case record sheet received along with the CA-125 sample in the biochemistry laboratories. Those cases with elevated CA-125 levels were selected, where patients had unilocular ovarian cysts without wall abnormalities. CA-125 was done using ECLIA methodology (Cobas e411, Germany). Statistical correlation was calculated between the ovarian cyst size and CA-125 levels using Spearman’s Rho coefficient. Results Mean age group of subjects were 29.7 ± 7.3 years and mean value of CA-125 (normal < 35 IU/mL) was found to be increased: 118.0 ± 147.1 IU/mL so was the mean diameter of cysts (cut off ≤ 5 cm): 48.6 ± 59.8 cm. No correlation was found between CA-125 levels and volume of ovarian cyst (r = 0.005, p = 0.680) for all subjects. Conclusions The lack of correlation between size of ovarian cysts and CA-125 levels provides a hint that the ovarian cyst epithelium does not directly express CA-125 and it may come from sites like the fallopian tube. Thus, raised level of CA-125 in benign ovarian cyst should be followed-up more closely, demanding assessment of fallopian tubes for early diagnosis of ovarian cancer. Also, algorithms can be explored to include size of ovarian cyst and CA 125 levels to predict ovarian cancer.

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Transvaginal ultrasound and computed tomography combined with clinical parameters and CA-125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women

Ultrasound in Obstetrics and Gynecology ◽

10.1046/j.1469-0705.1997.09050339.x ◽

1997 ◽

Vol 9 (5) ◽

pp. 339-343 ◽

Cited By ~ 47

Author(s):

S. Guerriero ◽

G. Mallarini ◽

S. Ajossa ◽

A. Risalvato ◽

R. Satta ◽

...

Keyword(s):

Computed Tomography ◽

Differential Diagnosis ◽

Transvaginal Ultrasound ◽

Premenopausal Women ◽

Ca 125 ◽

Ovarian Cysts ◽

Clinical Parameters

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Improved specificity of the CA 125 enzyme immunoassay for ovarian carcinomas by use of the ratio of CA 125 to carcinoembryonic antigen.

Clinical Chemistry ◽

10.1093/clinchem/34.9.1849 ◽

1988 ◽

Vol 34 (9) ◽

pp. 1853-1857 ◽

Cited By ~ 16

Author(s):

J T Wu ◽

T Miya ◽

J A Knight ◽

D P Knight

Keyword(s):

Ovarian Cancer ◽

Carcinoembryonic Antigen ◽

Cancer Patients ◽

Ovarian Cyst ◽

Ca 125 ◽

Ovarian Cysts ◽

Malignant Diseases ◽

Ovarian Carcinomas ◽

The Mean ◽

Cyst Fluids

Abstract We found that ovarian cyst fluids contained carcinoembryonic antigen (CEA) and CA 19-9 and CA 125 tumor markers. However, only the ratio of CA 125 to CEA concentrations provided sufficient specificity to differentiate serous from mucinous cysts. For CEA measurement, our results suggested the use of a monoclonal CEA kit. When CEA was determined with a Hybritech monoclonal CEA kit, all ratios in mucinous ovarian cysts were less than 10 and most of the ratios were greater than 1000 in serous ovarian cysts. We also found that the ratio of CA 125 to CEA in serum could be used to differentiate ovarian from nonovarian malignant diseases when both sera contain increased CA 125 concentrations. The nonovarian malignancies consisted of colorectal, breast, lung, and pancreatic carcinomas. The mean ratio for serum from patients with nonovarian cancers was 0.94 (n = 19); for ovarian-cancer patients (n = 45), 916. Therefore, determining this ratio will greatly improve the specificity of the CA 125 test for ovarian cancer.

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Is HE4 Superior over CA-125 in the Follow-up of Patients with Epithelial Ovarian Cancer?

Current Drug Targets ◽

10.2174/1389450121666200425211732 ◽

2020 ◽

Vol 21 (10) ◽

pp. 1026-1033

Author(s):

Khalid El Bairi ◽

Said Afqir ◽

Mariam Amrani

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Survival Rates ◽

Carbohydrate Antigen ◽

Ca 125 ◽

Poor Survival ◽

Human Epididymis Protein 4 ◽

Carbohydrate Antigen 125 ◽

Improved Accuracy

Notwithstanding important advances in the treatment of epithelial ovarian cancer (EOC), this disease is still a leading cause of global high mortality from gynecological malignancies. Recurrence in EOC is inevitable and it is responsible for poor survival rates. There is a critical need for novel effective biomarkers with improved accuracy compared to the standard carbohydrate antigen-125 (CA-125) for follow-up. The human epididymis protein 4 (HE4) is used for early detection of EOC (ROMA algorithm) as well as for predicting optimal cytoreduction after neoadjuvant chemotherapy and survival outcomes. Notably, the emerging HE4 is a promising prognostic biomarker that has displayed better accuracy in various recent studies for detecting recurrent disease. In this mini-review, we discussed the potential of HE4 as an accurate predictor of EOC recurrence.

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Ultrasound screening of ovarian cancer

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2019-0022 ◽

2019 ◽

Vol 41 (3) ◽

Author(s):

Marcel Bäumler ◽

Delphine Gallant ◽

René Druckmann ◽

Walther Kuhn

Keyword(s):

Ovarian Cancer ◽

Sensitivity And Specificity ◽

Transvaginal Ultrasound ◽

Serum Marker ◽

Carbohydrate Antigen ◽

Average Risk ◽

Ultrasound Screening ◽

Carbohydrate Antigen 125 ◽

Contrast Enhanced ◽

Long Term Follow Up

AbstractOvarian cancer has a high mortality rate. The most common serous type spreads rapidly throughout the peritoneal cavity when 5-year survival is 10%. If diagnosed in earlier stages where the cancer is still confined to the ovary, this survival rate is about 90%. This is the reason to be interested in screening at earlier stages in the average-risk general population. Thus, annual transvaginal ultrasound (TVS) alone or as a multimodal screening test following serum carbohydrate antigen 125 (CA125) has been investigated. Ultrasound lacks sensitivity and specificity; new contrast-enhanced approaches might improve these. When the serum marker is combined with ultrasound and interpreted by a rise in the level rather than by a fixed cut-off, improved sensitivity and specificity and a late but not significant reduction in mortality are observed. Further investigations could highlight the interest of a shorter than annual screening, of a long-term follow-up and new contrast-enhanced ultrasound techniques.

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