Ovarian Torsion May Be Associated with Significant Elevations of CA-125

M. Callahan, A. Sayers, H. Geisler, G. Sutton

   Objective: Two patients recently presented with pelvic masses, pain, and CA-125 elevation who were found to have adnexal torsion at exploratory laparotomy. Patients with torsion of the adnexa typically present with acute abdomen and a pelvic mass; emergent surgery generally precludes serologic evaluation. A retrospective investigation of the relationship between torsion and CA-125 levels was undertaken.

   Methods: A retrospective, single-hospital record review was performed. Patients with the ICD-9 code 620.5, “torsion of ovary, ovarian pedicle, or fallopian tube” from 7/1/97 to 6/30/02 were evaluated. Sixty-two patients were identified. Nine patients were excluded (3- no records could be located, 2-CA-125 levels unavailable, 1-unable to view records, 1-male patient, and 2-torsion not confirmed surgically), leaving 53 patients from whom date could be collected. The records were reviewed for demographic characteristics, CA-125 levels, operative reports, and surgical pathological diagnoses.

   Results: Fifty-three patients were included in the study. Eleven of 53 (20.8%) had CA-125 levels performed. Forty-two of 58 (79.2%) did not have a CA-125 evaluation prior to emergent surgery. Of the 11 patients with preoperative CA-125 levels, six (54.5%) were less than 35 units/ml and five (45.5%) had abnormal values. Abnormal CA-125 determinations wer 49, 130, 570, 823, and 2449 units/ml (mean 804.2 and median 570 units/ml).

   Conclusion: These data illustrate that most patients with suspected adnexal torsion are treated emergently and preoperative CA-125 levels are not performed. However, of patients with torsion and preoperative CA-125 evaluation, almost half will have values exceeding the normal range of <35 units/ml and some will have marked elevations of the marker. This can create diagnostic confusion in a patient with a pelvic mass and elevated CA-125. It should be noted that within a subset of patients, usually younger, who have a pelvic mass and elevated CA-125, there will be those in whom these findings can be ascribed to adnexal torsion.