title: CA 19-9 in evaluation of adnexal mass: retrospective cohort analysis and review of the literature.
abstract: OBJECTIVE
  The aim of this study was to estimate the diagnostic accuracy of serum marker CA 19-9 levels in the triage of adnexal masses.
  
  
  METHODS
  This retrospective cohort study was carried out in patients referred to the Gynecology Department at Carmel Medical Center due to adnexal masses. All patients underwent preoperative measurements of serum CA 125 and CA 19-9 and surgery with histopathologically confirmed diagnosis.
  
  
  RESULTS
  Between January 2005 and December 2012, 503 patients with adnexal masses were evaluated with serum tumor markers. Combination of CA 19-9 with CA 125, compared with CA 125 levels alone, suggested a nonsignificant effect on sensitivity (86.9% vs. 88.9%, respectively, p = 0.54) or specificity (79.5% vs. 73.5%, p = 0.1) in differentiating malignant from benign adnexal masses. CA 19-9 was not helpful in detecting mucinous histological types or borderline tumors. Mean CA 19-9 levels were higher in metastatic cases compared with primary ovarian malignancy (488.7 ± 1,457 vs. 46.3 ± 149.8 U/mL, respectively, p = 0.001). In mature cystic teratomas, mean CA 19-9 levels were higher and CA 125 levels were lower than in ovarian carcinoma (p = 0.049 and p = 0.0012, respectively).
  
  
  CONCLUSIONS
  The combination of the tumor markers CA 19-9 and CA 125 did not contribute significantly to the detection of malignant adnexal masses compared with CA 125 alone. As our results suggest that higher CA 19-9 levels could be helpful in differentiating metastatic tumors from primary ovarian malignancy; this issue should be investigated in large well-designed prospective cohort trials.
authors.affiliation: Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa - Israel.
authors.forename: Lena
authors.initials: L
authors.lastname: Sagi-Dain
authors.forename: Ofer
authors.initials: O
authors.lastname: Lavie
authors.forename: Ron
authors.initials: R
authors.lastname: Auslander
authors.forename: Shlomi
authors.initials: S
authors.lastname: Sagi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D002277:Carcinoma / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006106:Granulosa Cell Tumor / Q000097:blood / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000000981:diagnostic imaging; D010049:Ovarian Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary; D017698:Postmenopause; D011237:Predictive Value of Tests; D017697:Premenopause; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D013724:Teratoma / Q000097:blood / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen