The Use of CEA CA12-5 and CA19-9 as Serum Tumor Markers to Differentiate Subtypes of Mucinous Ovarian Tumors
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Abstract
Background: Mucinous ovarian tumors are classified into benign, borderline, and malignant types, each with distinct histologic and surgical implications. Ultrasound can detect these tumors but has limited accuracy in differentiating subtypes. The role of tumor markers—carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and cancer antigen 19-9 (CA 19-9)— is still under investigation, and more research is needed to determine their diagnostic accuracy and clinical usefulness in the management of ovarian cancer.
Objective: To evaluate the diagnostic performance of serum tumor markers CEA, CA-125, and CA 19-9 in distinguishing between benign, borderline, and malignant subtypes of mucinous ovarian tumors.
Methods: This retrospective study analyzed clinical and pathological data from 294 patients diagnosed with mucinous ovarian tumors who underwent surgery at Maharat Nakhon Ratchasima Hospital between January 2015 and December 2021. Preoperative serum levels of CA 19-9, CA-125, and CEA were recorded and analyzed. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve analysis.
Results: Among the patients, 164 (55.8%) had benign tumors, 74 (25.1%) had borderline tumors, and 56 (19.1%) had malignant tumors. Serum CEA showed the strongest association with borderline or malignant pathology (risk ratio = 2.3, 95% CI: 1.8–3.0) and had the highest diagnostic accuracy (AUC = 0.738). CA 19-9 and CA-125 had lower AUC values (0.679 and 0.682, respectively). When used individually, all markers had limited sensitivity and specificity. However, the combination of CEA and CA 19-9 yielded a specificity of 97.2% and a PPV of 94.3% for diagnosing borderline or malignant tumors. When all three markers were within normal ranges, the sensitivity and NPV for excluding malignancy were 81.9% and 70.0%, respectively.
Conclusions: CEA, CA 19-9, and CA-125 are useful serum tumor markers in differentiating subtypes of mucinous ovarian tumors. While individual markers show limited diagnostic performance, a multi-marker approach significantly enhances diagnostic accuracy and supports more informed preoperative decision-making.
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