CA-125 in women with endometriosis

The serum CA-125 level is elevated in most women with endometriosis. Although tests are readily available to measure the marker, simple modifications of the present assays are required to improve and standardize the quality of the measurements. The serum test has low sensitivity and would not be appropriate for general screening purposes, but in clinical situations that have a relatively high prevalence of endometriosis, CA-125 determinations have acceptable sensitivities and very high specificities. The concentrations of CA-125 correlate with both the severity and the clinical course of the disease. In women with diagnosed endometriosis, use of serial CA-125 determinations to monitor the course of the disease shows much promise in early studies. The changes in the CA-125 levels can offer additional information to the clinician about the status of the endometriosis, but how much this information will assist in the management and improve the outcome of treatment must await the results of prospective studies.     

CA-125 levels in endometriosis

CA-125 is a cellular antigen detected in many patients with ovarian cancer, but it has also been detected in patients with endometriosis. Preoperative CA-125 levels were drawn from 113 patients before they underwent laparoscopy. Patients were categorized into diagnostic groups on the basis of pathologic findings. CA-125 levels in patients with evidence of intraabdominal adhesions were not statistically different from those in patients with normal pelvic anatomy. However, patients with advanced endometriosis had significantly elevated levels of CA-125 when compared with patients with normal pelvic anatomy (P less than 0.05). The clinical and immunologic implications of elevated CA-125 levels in patients with advanced endometriosis are discussed.     

Progesterone increases serum CA-125 in endometriosis

Serum level of CA-125 was monitored up to 48 hours after injection of 125 mg P-in-oil into patients with or without endometriosis in the follicular phase of their menstrual cycle. Circulating CA-125 levels remained unchanged at around 5 U/ml during the observation period in patients without endometriosis; however, a significant elevation was observed at 30 hours after injection in those patients with endometriosis (from 19.6 U/ml before injection to 30.0 U/ml at 30 hours after injection, P less than 0.05).     

Menstrual cyclicity of CA-125 in patients with endometriosis.

OBJECTIVE: To examine the serum levels of CA-125 in the menstrual, follicular, and luteal phases of the menstrual cycle in women with endometriosis and to determine if serum CA-125 levels drawn during menses improve the clinical utility of the test in diagnosing endometriosis. DESIGN: Serum CA-125 was measured in the menstrual, follicular, and luteal phases of the cycle preceding surgery. CA-125 levels for each phase were categorized by postoperative diagnosis and endometriosis stage. SETTING: The reproductive endocrine unit of a tertiary care university-affiliated hospital. PATIENTS: A total of 65 patients were recruited from the Fertility and Endocrine Unit and the Gynecology Service of Brigham and Women's Hospital. MAIN OUTCOME MEASURE: Serum CA-125 levels were measured by an immunoradiometric assay and were stratified by menstrual cycle phase, diagnosis, and stage of endometriosis. The menstrual cycle phase was confirmed by serum estradiol and progesterone measurements. RESULTS: Serum CA-125 levels in patients with stages II to IV endometriosis were significantly elevated in the menstrual phase compared with levels drawn in the nonmenstrual follicular and luteal phases. The sensitivity and specificity of CA-125 for the diagnosis of endometriosis were not significantly better in the menstrual than in the follicular or luteal phases. CONCLUSIONS: Despite menstrual cyclicity of CA-125, measurement of serum CA-125 during menses does not improve the clinical utility of the test in the diagnosis of endometriosis.     

Serum CA-125 in women with endometriosis and chronic pelvic pain

Since serum CA-125 concentrations are increased in women with endometriosis, the authors evaluated CA-125 levels to determine whether this serum test would be useful in differentiating between pelvic pain due to endometriosis and other causes. During a 30-month period, 163 women who had had pelvic pain for at least 3 months had a CA-125 level obtained prior to surgery. Serum CA-125 was measured by an immunoradiometric assay. Of the 82 women with endometriosis, 66 (80%) had CA-125 concentrations greater than or equal to 16 U/ml (95% upper limit). The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 52, 86, 100, and 100%, respectively. Of the 81 women without endometriosis, 5 (6%) had elevated concentrations. With the use of serum CA-125 determinations for the detection of endometriosis, the sensitivity was 80%, the specificity was 94%, and the accuracy was 93% when the prevalence of endometriosis was 50%. The authors conclude that determination of CA-125 levels may assist in the evaluation and treatment of women with chronic pelvic pain.     

Elevated serum concentrations of CA-125 in patients with advanced endometriosis

CA-125 is a high-molecular-weight glycoprotein that is expressed on the cell surface of some derivatives of embryonic coelomic epithelium. Based on results of an immunoradiometric assay developed to detect CA-125 in peripheral blood, 82% of patients with ovarian cancer and less than 1% of apparently healthy controls have elevated peripheral blood levels of CA-125. Because endometriotic lesions are likely to be derivatives of embryonic coelomic epithelium, the authors investigated serum CA-125 levels in patients with endometriosis. Preoperative serum CA-125 concentrations were measured in 147 patients undergoing diagnostic laparoscopy or laparotomy. Serum CA-125 concentrations were elevated in patients with stage III or IV endometriosis, compared with controls with negative diagnostic laparoscopies (66.5 +/- 14.5 versus 8.20 +/- 0.59 U/ml, mean +/- standard error of the mean; P less than 0.001). Fifty-four percent of patients with stage III or IV endometriosis and 0% of the controls had CA-125 levels greater than 35 U/ml. Occasional patients with stage II endometriosis (13%), leiomyomata uteri (14%), and chronic pelvic inflammatory disease (5%) also had serum CA-125 concentrations greater than 35 U/ml. Immunocytochemical techniques demonstrated the presence of CA-125 on the cell surface of endometriotic lesions.     

CA-125 monitored therapy with GnRH analogue of pelvic endometriosis.

Thirteen patients affected by endometriosis have been treated with GnRH analogue Buserelin. CA-125 serum levels have been monitored before, during and after treatment. Analysis of data suggests the hypothesis of an individualized follow up by means of repeated assays of CA-125 and their reference to pre and post treatment graphs.     

Serum and peritoneal lavage fluid CA-125 levels in endometriosis

Serum and peritoneal lavage fluid CA-125 levels were assayed in 20 women with endometriosis and 20 control women at the time of laparoscopy. Serum levels of CA-125 were significantly higher in women with endometriosis. Peritoneal lavage fluid CA-125 levels were significantly higher than serum levels but showed no significant difference between control and endometriosis patients. Peritoneal lavage fluid CA-125 did not follow expected dilution curves when attempts were made to validate the assay. Serum CA-125 levels were a more sensitive indicator of endometriosis, than peritoneal lavage fluid CA-125 levels.     

Serum CA-125 and 17 beta-estradiol in patients with external endometriosis on danazol

Serum concentration of CA-125 and 17 beta-estradiol (E2) were measured by radioimmunoassay in 40 patients with stage III or IV endometriosis to evaluate their usefulness in assessing the outcome of disease. Patients were categorized into good responders and poor responders depending on the result of the second-look laparoscopy 8 weeks after danazol therapy. CA-125 decreased significantly in all subjects after initiation of treatment. However, after 12 weeks of treatment a significant increase (p less than 0.05) in serum CA-125 was noted in the poor-response subjects as compared to the good-response subjects. In addition, 8 weeks after treatment CA-125 levels in the poor-response group were significantly higher (p less than 0.001) than in the good-response group. On the other hand, in the good-response group, E2 levels decreased for 8 weeks during danazol therapy to return to almost basal levels after 12 weeks, while in the poor-response group E2 levels did not change as compared to pretreatment levels. We conclude that the determination of CA-125 and E2 may be helpful in assessing the response of patients with advanced endometriosis on danazol treatment.     

Serum levels of CA-125 in patients with endometriosis: a preliminary report

Seven out of 8 patients with endometriosis demonstrated levels of CA-125 antigen above 35 U/ml. None of 15 patients with other benign gynecologic diagnoses demonstrated elevated levels. This antigen has been proposed as a tumor marker for epithelial carcinoma and other gynecologic neoplasms. However, it cannot be used to differentiate clinically between cancer and endometriosis.     

The levonorgestrel-releasing intrauterine device reduces CA-125 serum levels in patients with endometriosis

This study compared the long-term effects of the levonorgestrel-releasing intrauterine device with those of GnRH agonist administration on serum levels of CA-125 in patients with endometriosis. The levonorgestrel-releasing intrauterine device was found to be as efficient as GnRH agonist in reducing CA-125 serum levels.     

Serum CA-125 antigen levels increase during menses

Serum CA-125 antigen levels were measured by radioimmunoassay before and during menses in women with and without endometriosis. Mean CA-125 levels were significantly increased in both groups during menses. Samples obtained during menses represent a potential source of elevated levels and false positive results.     

Serum CA-125 in preoperative patients at high risk for endometriosis

OBJECTIVE: To investigate the factors contributing to the elevated level of CA-125 in endometriosis and to study whether CA-125 assay is useful to identify women who require preoperative bowel preparation. METHODS: A total of 685 women undergoing surgery for endometriosis between July 1988 and June 1999 were studied. Preoperative serum CA-125 levels were compared between various pelvic conditions using F statistics. Multiple regression was employed to determine significant correlates of elevated serum CA-125, and the receiver operating characteristic curve was applied to assess the utility of serum CA-125 in preoperative preparation. Based on the two-sample Student t test, the sample size required to detect a difference in mean serum CA-125 levels of one-half of one standard deviation with a power of 90% when the sample size ratio of the two groups was 1:50 was 675 with a significance level of 5%. RESULTS: The mean serum CA-125 levels (IU/mL) for American Society of Reproductive Medicine stages I, II, III, and IV endometriosis were 18.8 +/- 0.9, 40.3 +/- 2.8, 77.1 +/- 3.5, and 182.4 +/- 14.0, respectively. CA-125 levels were significantly increased with advanced stages (P <.001, F test). Furthermore, serum CA-125 levels were significantly higher in patients with more extensive adhesions to the peritoneum, omentum, ovary, fallopian tube, colon, and cul-de-sac, or with ruptured endometrioma (P <.001, F test). We then classified patients with at least one of the three factors including dense omentum adhesion, ruptured endometrioma, and complete cul-de-sac obliteration as the high-risk group that required preoperative bowel preparation, and the others as the low-risk group. Receiver operating characteristic curve analyses set a cutoff point of 65 IU/mL, which gave a sensitivity of 76%, a specificity of 71%, a positive predictive value of 76%, and a negative predictive value of 93.2%. CONCLUSION: Our results suggest that preoperative CA-125 assay is useful to decide which women should receive preoperative bowel preparation. Endometriosis patients with preoperative CA-125 levels higher than 65 IU/mL are at high risk for severe pelvic adhesions that warrant thorough preoperative bowel preparation.     

Endometrial antibodies versus CA-125 for the detection of endometriosis

Detection of endometrial antibodies using an indirect immunofluorescence method along with a well-established human endometrial carcinoma cell line was evaluated and compared with CA-125 for detecting endometriosis. Two hundred two patient sera from the infertility, gynecological, and gynecological oncology services were evaluated. The sensitivity for antibody testing was 83.1% with a specificity of 78.8%, in contrast to a sensitivity of 27.3% and a specificity of 82.6% for CA-125. These preliminary findings offer promise that antibody detection methods may be a useful adjunct in the diagnosis of endometriosis.     

The use of CA-125 in the diagnosis and management of endometriosis

CA-125, a cell-surface antigen, was measured by a radioimmunoassay in the serum of 414 women to determine its potential usefulness in the diagnosis and management of endometriosis. In women with minimal, mild, moderate, and severe endometriosis, the mean levels (+/- standard deviation) were 13.6 +/- 6.8, 22.8 +/- 15.5, 27 +/- 17, and 50 +/- 28 U/ml, respectively, and were significantly higher than mean levels (7.8 +/- 4.1) in 46 women with a normal laparoscopic examination. Higher mean CA-125 values also were observed in acute pelvic inflammatory disease, unexplained fertility, and pregnancy and during menstruation. The mean CA-125 value in women with treated endometriosis and a negative second-look laparoscopy was significantly lower than in women with untreated endometriosis. With the use of the 95% upper limit of 16 U/ml, the test had a sensitivity of 53% and specificity of 93%. The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 27%, 68%, 73%, and 100%, respectively. Changes in the CA-125 levels correlated with the clinical course of endometriosis in 37 of 44 (84%) women (P less than 0.001). The determination of CA-125 levels may assist in the evaluation and treatment of women with endometriosis.