Nonspecific Tumor Markers in the Era of Value Based Medicine: Role of CA 19-9 in the Pelvic Mass Workup [18OP]

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Abstract

INTRODUCTION:

When encountering an obscure pelvic mass, the usual tumor markers, CA 125 and CEA, are obtained to evaluate for the presence of ovarian and colon cancer. Some physicians order a CA 19-9 level and we do not know if this has clinical importance to assist in the diagnosis. Does this test offer valuable information or does it add confusion and additional workup when found to be elevated? Studies have shown that CA 19-9 elevation is associated with a fat component, and mesodermal tissue derivative, that is present in many various cancers.

METHODS:

3,370 women were retrospectively identified using CPT codes for pelvic mass and CA 19-9. Initial analysis reviewed the subspecialty of the primary investigator using CA 19-9 in their initial workup, and its correlation to a gynecologic pathology. In the cases where an OBGYN was the primary investigator additional tumor markers, age, race, menopausal status, imaging, surgical interventions and final pathology were further analyzed.

RESULTS:

Out of 3,370 women 982 had abnormal CA 19-9. The subspecialties that utilized CA 19-9 the most in their initial work up was Hematology Oncology 29.6%, Gastrointestinal 16%, and Internal Medicine 15.7%. Of the 9% of cases that Gynecologist that ordered CA 19-9, it was noted that 56% additionally ordered ultrasound and CT, while 14% ordered US, CT and MRI at the time of initial workup. Further analysis revealed that in both postmenopausal and premenopausal women with normal CA 19-9, compared to abnormal CA19-9 showed no statistical significance in distinguishing benign versus malignant etiology.

CONCLUSION:

Majority of adnexal masses are benign, the main goal of diagnostic evaluation is to exclude malignancy. Value based medicine is implemented to help improve health care quality, and efficient utilization of health care resources. Based on this retrospective analysis the use of CA 19-9 in evaluation of a pelvic mass does not offer information that directly improves patient outcome, but rather correlates to the increased misuse of health care resources.

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