Pelvic inflammatory disease: Correlation of severity with CA-125 levels

OBJECTIVE: To determine whether elevated levels of cancer antigen 125 (CA- 125) correlate with the severity and clinical outcome of pelvic inflammatory disease. STUDY DESIGN: CA-125 levels were measured prospectively in 36 women with pelvic inflammatory disease using a commercial immunoassay. Initial inclusion criteria were abdominal tenderness, cervical motion tenderness and adnexal tenderness. Patients then were categorized into three groups based on the severity of the illness. Group 1 included patients with (1) temperature ≥38.0 but <38.5° C or (2) WBC count ≥10 but < 15 x 10 ³ cells/μL. Group 2 included patients with (1) temperature ≥38.5° C or (2) WBC count ≥15 x 10 ³ cells/μL. Group 3 included patients who fulfilled the same criteria as group 2 but who also had an adnexal mass. Differences in CA-125 levels were compared statistically using the unpaired Student t test. RESULTS: All patients with the diagnosis of pelvic inflammatory disease had CA-125 levels >30 U/mL, with a range of 48-656. Moreover, the levels were significantly different among the three groups (group 1 vs. 2, P = .002; 1 vs. 3, P = .001; 2 vs. 3, P = .001), and a correlation between severity of disease and CA-125 levels was found. All patients with a presumed pelvic abscess had CA-125 levels in the range for neoplastic processes. CONCLUSION: Elevated CA-125 levels correlate with the severity of pelvic inflammatory disease and outcome. Pelvic inflammatory disease must be considered in the differential diagnosis of elevated CA-125 levels and pelvic masses.