Yonsei Med J.  2013 Sep;54(5):1241-1247. 10.3349/ymj.2013.54.5.1241.

Clinical Significance of Serum CA-125 in Korean Females with Ascites

• Bae SY
• Lee JH
• Park JY
• Kim DM
• Min BH
• Rhee PL
• Kim JJ

• KMID: 1793174
• DOI: http://doi.org/10.3349/ymj.2013.54.5.1241

Abstract

PURPOSE
Mycobacterium tuberculosis is endemic in Korea. Because tuberculous peritonitis is characterized by ascites, abdominal pain, abdominal mass and elevation of serum CA-125, it can be confused with ovarian malignancies. The aim of this study was to evaluate the significance of serum CA-125 level in the differential diagnosis of tuberculous peritonitis and ovarian malignancy in a Mycobacterium tuberculosis-endemic area.
MATERIALS AND METHODS
The medical records of patients diagnosed with tuberculous peritonitis (n=48) or epithelial ovarian malignancy (n=370) at Samsung Medical Center from January 2000 to October 2009 were retrospectively reviewed.
RESULTS
Median serum CA-125 level in the epithelial ovarian cancer group was significantly higher than that in the tuberculous peritonitis group (p< or =0.01). Only one patient (2.1%) in the tuberculous peritonitis group had a serum CA-125 level over 2000 U/mL. However, 109 patients (29.5%) in the epithelial ovarian cancer group had a serum CA-125 level over 2000 U/mL. At the CA-125 ranges of 400 to 599 and 600 to 799, the proportions of those with tuberculous peritonitis were 24% and 21.9%, respectively. At a serum CA-125 level over 1000 U/mL, however, the proportion of tuberculous peritonitis was much lower (2.1%).
CONCLUSION
Tuberculous peritonitis should be considered in the evaluation of female patients with ascites and high serum CA-125.

Keyword

Ascites; epithelial ovarian cancer; tuberculous peritonitis; serum CA-125

MeSH Terms

Ascites/*blood
CA-125 Antigen/*blood
Diagnosis, Differential
Female
Humans
Multivariate Analysis
Ovarian Neoplasms/blood/*diagnosis
Peritonitis, Tuberculous/blood/*diagnosis
Republic of Korea
Retrospective Studies
CA-125 Antigen

Figure

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  Fig. 1 Methods of final diagnosis in patients with tuberculous peritonitis. Fifty-nine percent of the patients underwent a surgical procedure to arrive at the final diagnosis. Eight percent of the patients were diagnosed by clinical features as well as AFB stain and culture. TB, tuberculous.

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  Fig. 2 Distribution of serum CA-125 levels in patients with tuberculous peritonitis and ovarian epithelial malignancy in Korean women with ascites.

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  Fig. 3 Proportions of tuberculous peritonitis and ovarian epithelial malignancy by serum CA-125 level. The proportion of patients in the tuberculous peritonitis group begins to decline at the CA-125 level of 800 and suddenly drops to 2.1% at CA-125 levels over 1000 U/mL. TB, tuberculous.

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  Fig. 4 ROC curve for diagnosing ovarian cancer from tuberculous peritonitis. At the serum CA-125 level of 943, the sum of the sensitivity and specificity was highest. ROC, receiver operating characteristic.

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  Fig. 5 A case of tuberculous peritonitis. (A) A 68-year old woman came to the hospital with abdominal distention which developed 2 months prior. CT scan was taken and the first impression was peritoneal carcinomatosis. (B) Laparoscopy was done and the histology showed chronic granulomatous inflammation with multinucleated giant cells. (C) No ascites were seen at the follow-up CT scan, 4 months after taking anti-Mycobacterium medication.

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