Serum CA-125 in Preoperative Patients at High Risk for Endometriosis

Ya-Min Cheng, Shan‐Tair Wang, Cheng‐Yang Chou
In: Obstetrics & Gynecology · 2002 · vol. 99(3) , pp. 375–380 · doi:10.1097/00006250-200203000-00003 · W4250507955
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Serum CA-125 levels significantly correlate with endometriosis severity and adhesions, suggesting a cutoff of 65 IU/mL can identify patients needing preoperative bowel preparation.

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Abstract

In Brief 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. Preoperative serum CA-125 values higher than 65 IU/mL in endometriosis patients are related to thick pelvic adhesions.

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endometriosisendometrioma

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