New method: are tumor markers in vaginal-washing fluid significant in the diagnosis of primary ovarian carcinoma?

Objective: Ovarian cancer is the seventh most common cancer in women worldwide, with nearly a quarter of a million women diagnosed every year. The serum tumor markers cancer antigens CA 125, CA 19-9, and carcinoembryonic antigen (CEA) are potentially of clinical value for the diagnosis of ovarian cancer. A diagnostic tool that is noninvasive, simple to perform, and specific is needed to predict primary ovarian cancer. The purpose of this study was to evaluate the diagnostic sensivitity and specificity of vaginal-washing tumor markers CA 125, CA 19-9, and CEA for diagnosis of primary ovarian cancer. Materials and Methods: In the current prospective study, 30 patients with advanced primary ovarian cancer and 30 patients with benign ovarian cysts were enrolled. The vaginal-washing fluid samples were obtained the day before surgery and were immediately centrifuged and stored at -80 °C until analysis. Measurements of CA 125, CA 19-9, and CEA were determined using fully-automated chemiluminescent microparticle immunoassays. Results: The vaginal fluid concentrations of CA 125, CA 19-9, and CEA in patients with primary ovarian carcinoma were significantly higher (p < 0.001) compared to those in patients with benign adnexal masses (p < 0.001). In the ROC curve analysis, the optimal cut-off values for the detection of primary ovarian cancer were >295 for CA 125 (p < 0.001), > 101 for CA 19-9 (p < 0.001), and >135 for CEA (p < 0.001). Conclusion: Vaginal-washing tumor markers CA 125, CA 19-9, and CEA are simple, noninvasive, and reliable diagnostic tests for the detection of primary ovarian cancer.

Vaginal-washing tumor markers; CA 125; CA 19-9; CEA.

[1] Lacey J.V., Sherman M.E.: “Ovarian neoplasia”. In: Robboy S.L., Mutter G.L., Prat J., Bentley R.C., Russel P. Anderson M.C. (eds). Robboy’s pathology of the female reproductive tract, 2nd ed. Oxford: Churchill Livingstone Elsevier, 2009, 601.

[2] Barnholtz-Sloan J.S., Schwartz A.G., Qureshi F., Jacques S., Mal-one J., Munkarah A.R.: “Ovarian cancer: changes in patterns at di-agnosis and relative survival over the last three decades”. Am. J. Obstet. Gynecol., 2003, 189, 1120.

[3] Carlson K.J., Skates S.J., Singer D.E.: “Screening for ovarian can-cer”. Ann. Intern. Med., 1994, 121, 124.

[4] Canney P.A., Wilkinson P.M., James R.D., Moore M.: “CA19-9 as a marker for ovarian cancer: alone and in comparison with CA125”. Br. J. Cancer, 1985, 52, 131.

[5] Alanbay I., Akturk E., Coksuer H., Ercan M., Karaşahin E., Dede M., et al.: “Comparison of risk of malignancy index (RMI), CA125, CA 19-9, ultrasound score and menopausal status in borderline ovarian tumor”. Gynecol. Endocrinol., 2012, 28, 478.

[6] Kaijser J., Bourne T., Valentin L., Sayasneh A., Van Holsbeke C., Vergote I., et al.: “Improving strategies for diagnosing ovarian cancer: a summary of the International Ovarian Tumor Analysis (IOTA) studies”. Ultrasound Obstet. Gynecol., 2013, 41,9.

[7] Prat J.: “Staging classification for cancer of the ovary, fallopian tube, and peritoneum”. Int. J. Gynaecol. Obstet., 2014, 124, 1.

[8] Bast R.C. Jr.: “Status of tumor markers in ovarian cancer screening”. J. Clin. Oncol., 2003, 21, 129.

[9] Tholander B., Taube A., Lindgren A., Sjöberg O., Stendahl U., Kiviranta A., et al.: “Pretreatment serum levels of CA-125, carcinoem-bryonic antigen, tissue polypeptide antigen, and placental alkaline phosphatase, in patients with ovarian carcinoma, borderline tumors, or benign adnexal masses: relevance for differential diagnosis”. Gynecol. Oncol., 1990, 3, 26.

[10] Inoue M., Fujita M., Nakazawa A., Ogawa H., Tanizawa O.: “Sialyl-Tn, sialyl-Lewis Xi, CA 19-9, CA 125, carcinoembryonic antigen, and tissue polypeptide antigen in differentiating ovarian cancer from benign tumors”. Obstet. Gynecol., 1992, 79, 434.

[11] Bozkurt M., Yumru A.E., Aral I.: “Evaluation of the importance of the serum levels of CA-125, CA15-3, CA-19-9, carcinoembryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy”. Eur. J. Gynaecol. Oncol., 2013, 34, 540.