Elevated serum CA 19-9 level, combined with D-dimer, could detect the presence of ruptured ovarian endometriosis

Abstract

Background: Ovarian endometriosis (OE) is a common type of endometrioma, which is a benign disease of gynecology. For the diagnosis of OE, ultrasonography is a very effective and straightforward. OE rupture is rare, and there is still a lack of a non-invasive and effective method for diagnosis. Elevated serum CA19-9 or CA-125 levels are typically applied as biomarkers for malignancy, besides, the CA-125 and CA19-9 levels have been recommended as a useful marker for the diagnosis of endometriosis. We aimed to clarify the clinical importance of serum CA19-9, CA-125 level, and plasma D-dimer (D-D) for detecting spontaneously ruptured ovarian endometriosis.Results: Among the 21 patients of rupture OE, 16 with a history of detected pelvic cysts, 19 claimed sudden onset of lower abdominal pain, however, only 6 patients detected fluid accumulation in the cul-de-sac by ultrasound. For the serological investigation, the serum CA19-9 was significantly elevated in the ruptured OE group (343.09±367.67 U/ml vs. 36.84±40.01U/ml, P<0.0001). D-D was also abnormally elevated in the ruptured OE group (3.39±4.90 mg/L vs. 0.43 ± 0.29 mg/L, P <0.0001). The AUC value for the combined CA19-9 and D-D was 0.975 (95% CI, 0.939 -0.993), with the highest specificity of 96.69, and sensitivity of 85.71.Conclusion: The combination of serum CA19-9 and plasma D-D levels could serve as an effective biomarker to identify patients with spontaneously ruptured ovarian endometriosis pre-operatively in the context of clinical assessment.