What are the implications of ovaries with increased vascularity on ultrasound and elevated Carcinoembryonic Antigen (CEA) levels?

From the Guidelines

I strongly recommend that you consult with your healthcare provider immediately for a comprehensive evaluation and management plan, as increased ovarian vascularity on ultrasound combined with elevated CEA levels may indicate ovarian cancer or other serious conditions. The combination of increased ovarian vascularity on ultrasound and elevated CEA levels is a concerning finding that requires prompt medical attention. According to the most recent guidelines, a definitive diagnosis of ovarian cancer requires pathological examination by an expert pathologist of tumour samples from either a diagnostic biopsy or, preferably, a surgical specimen 1.

Key Considerations

• Elevated CEA levels can be associated with various cancers, including ovarian cancer, as well as non-cancerous conditions like inflammation, smoking, or certain benign diseases 1.
• The sensitivity and specificity of CA-125, a commonly used tumor marker for ovarian cancer, are limited, and it can be elevated in non-cancerous diseases of the ovaries and other cancers 1.
• Transvaginal ultrasound (TVU) can detect small ovarian masses, but its performance in detecting ovarian cancer is poor, especially in average-risk or high-risk women 1.

Recommended Next Steps

• Consult with a healthcare provider for a comprehensive pelvic exam, transvaginal ultrasound, CT scan, MRI, or CA-125 blood test to further evaluate the findings.
• A gynecologic oncologist consultation may be necessary depending on initial results.
• Do not delay seeking medical attention, as early diagnosis of any serious condition improves treatment outcomes.
• Self-diagnosis or waiting to see if symptoms resolve is not recommended with these clinical findings.

The most recent and highest quality study, published in 2023, emphasizes the importance of a comprehensive work-up, including detailed history, clinical examination, serum CA-125, and imaging studies, such as transabdominal and transvaginal US, and CT of the thorax, abdomen, and pelvis, for the diagnosis and management of ovarian cancer 1.

From the Research

Implications of Ovaries with Increased Vascularity on Ultrasound and Elevated CEA Levels

• Ovarian cancer has a high mortality rate, and early detection is crucial for improving survival rates 2.
• Ultrasound is a valuable tool for differentiating between benign and malignant ovarian masses, with a sensitivity of 92% and specificity of 96% using the International Ovarian Tumor Analysis Simple Rules 2.
• Elevated Carcinoembryonic Antigen (CEA) levels are associated with mucinous ovarian cancers, and CEA is used as a tumor marker in conjunction with imaging for identifying ovarian cancer 3.
• A study found that CEA alone is sufficient to differentiate between ovarian neoplasms and ovarian metastases in masses with multilocular and multilocular-solid morphology, with a best cut-off value of 2.33 ng/mL 4.
• Increased vascularity on ultrasound is a high-risk feature for ovarian cancer, and when combined with elevated CEA levels, it may indicate a higher risk of malignancy 3.
• The predictive values of ultrasound parameters, CA-125, and the risk of malignancy index (RMI) can be used to assess the risk of ovarian cancer, with RMI being a good indicator only in correlation with CA-125 5.

Diagnostic Considerations

• The combination of ultrasound findings, including increased vascularity, and elevated CEA levels should be considered when evaluating the risk of ovarian cancer 3, 4.
• The International Ovarian Tumor Analysis Simple Rules and the Assessment of Different NEoplasias in the adneXa model can be used to classify ovarian masses as benign, malignant, or indeterminate, and to determine the risk of malignancy 2.
• Further evaluation, including CT, PET, and MRI, may be necessary to characterize ovarian lesions and determine the extent of disease 3.