CA 125 Levels Above 100: A Marker for Deep Infiltrating Endometriosis

Abstract

Objectives:  To evaluate serum CA-125 levels above 100 U/mL as a marker for DIE in patients undergoing laparotomy at Bach Christian Hospital, Abbottabad.

Methodology: This cross-sectional study was conducted from January 2023 to August 2024 on women admitted for laparotomy. Preoperative serum CA-125 was measured using electrochemiluminescence immunoassay. Intraoperative findings were documented, and disease staging was performed according to the revised American Society for Reproductive Medicine (rASRM) criteria. Patients were categorized into early-stage (I–II) and advanced-stage (III–IV) disease. Statistical analysis included chi-square test, independent t-test, and ROC curve analysis to determine the diagnostic accuracy of CA-125 ?100 U/mL in predicting DIE.

Results: There were 160 patients in total with mean age of 31.4 ± 6.2 years.  Infertility was the most common presenting condition (65%), followed by dysmenorrhea (42%), and chronic pelvic discomfort (48%).  Patients with advanced-stage cancer had considerably higher mean CA-125 values (124.6 ± 28.4 U/mL) than those with early-stage disease (58.2 ± 21.7 U/mL, p < 0.001). Among patients with DIE, 72% had serum CA-125 levels above 100 U/mL, compared to 12% in those without DIE (p < 0.001). ROC analysis demonstrated an area under the curve (AUC) of 0.82, with CA-125 ?100 U/mL yielding 76% sensitivity and 89% specificity for detecting DIE.

Conclusion: Serum CA-125 levels above 100 U/mL are strongly associated with deep infiltrating and advanced-stage endometriosis, providing high specificity and predictive value. It may serve as a cost-effective adjunct in preoperative evaluation, surgical planning, and patient counseling, particularly in resource-constrained healthcare settings.