Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis

Abstract

The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients' and tumor characteristics were evaluated. Four electronic databases were searched for articles published up to September 2019. Trials that evaluated the significance of elevated CA 19-9 in patients with ovarian MCTs and publications with > 20 patients were considered eligible for inclusion. Seven studies that included 995 patients with an ovarian MCT who were evaluated with elevated (n = 364) or normal (n = 631) CA 19-9 levels were included. Mean tumor size was significantly increased in patients with elevated CA 19-9 levels (p = 0.038). The rate of ovarian torsion was significantly increased in the elevated CA 19-9 group (p = 0.04). The present study highlights the importance of CA 19-9 as a marker in the diagnosis of MCT, and a meta-analysis supports that it could raise a high degree of clinical suspicion of early recognition of torsion and early surgical management due to complications related to increased size. Nonetheless, the diagnostic value of CA 19-9 is still limited and CA 19-9 can still serve only as a supplementary diagnostic tool in patients with MCTs.

Carbohydrate antigen 19-9 — tumor marker: Past, present, and future

“…Particularly in premenopausal women where preserving fertility is crucial, the higher preoperative diagnostic accuracy of adnexal masses is needed. Preoperative CA 19-9 has potential diagnostic utility, if supplementary to imaging[ 120 ] and other tumor markers. In a study by Cho et al [ 121 ] involving 322 patients, OMCTs were associated with isolated elevation of CA 19-9, whereas cancers were associated more with a simultaneous elevation of CA 19-9 and CA 125[ 121 ].…”

“…Elevated CA 19-9 can also predict complications and guide management. A meta-analysis by Prodromidou et al [ 120 ] involving 995 patients in nine studies demonstrated a correlation between elevated CA 19-9 levels and significantly larger mean size of OMCT and ovarian torsion[ 120 ]. These studies, however, did not screen for concomitant conditions causing raised CA 19-9.…”

Extreme elevation of CA 19–9 levels in mature cystic teratoma without any complications: A case report

“…Herein, we report the level of CA 19–9 can be extremely increased in the case of benign ovarian teratoma without any complications. CA 19–9, also known as cancer antigen 19–9, is a tetrasaccharide carbohydrate that has been suggested as a prognostic tumor marker in patients with pancreatic cancer [ 7 ]. Besides malignancies, CA 19-9 levels may also increase in benign pancreatobiliary, hepatic, and pulmonary diseases; thyroiditis; diabetes mellitus; autoimmune diseases; and gynecologic diseases such as endometriosis and mucinous ovarian tumors [ 7 , 8 ].…”

“…CA 19–9, also known as cancer antigen 19–9, is a tetrasaccharide carbohydrate that has been suggested as a prognostic tumor marker in patients with pancreatic cancer [ 7 ]. Besides malignancies, CA 19-9 levels may also increase in benign pancreatobiliary, hepatic, and pulmonary diseases; thyroiditis; diabetes mellitus; autoimmune diseases; and gynecologic diseases such as endometriosis and mucinous ovarian tumors [ 7 , 8 ]. The increase in CA 19-9 levels in benign diseases can be explained by inflammation and proliferation of non-tumorous tissue or metabolic malfunction [ 8 ].…”

Mucinous borderline ovarian tumour with torsion and micro-invasion and associated with high serum level of carbohydrate antigen 19-9: a case report

“…Nonetheless, one study reported correlation between tumour diameter and bilaterality and the highest CA19-9 level of 25 590 U/mL in a case 17 . In dermoid cysts, elevated CA19-9 levels may be caused by rupture and leakage from the cyst wall into the blood stream or a weakened cyst wall in a larger diameter cyst 18 , may be related to torsion of the ovary and to the extent of the necrosis 14 , and may be an indicator for early surgical intervention owing to higher risks of torsion and larger cyst size 19 .…”