Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration.

P R Koninckx, Philippe R. Koninckx, Christel Meuleman, C Meuleman, D Oosterlynck, D J Oosterlynck, F J Cornillie, Freddy Cornillie
Fertility and Sterility · 1996 · vol. 65(2) , pp. 280–7 · PMID:8566249 · W110940740
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A clinical examination during menstruation combined with plasma CA-125 concentration accurately diagnoses deep endometriosis, ovarian endometriosis, and cul-de-sac obliteration.

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Abstract

OBJECTIVES: To evaluate a clinical examination during menstruation and plasma CA-125 concentrations to diagnose deep endometriosis. DESIGN: Prospective study in 61 women scheduled for a laparoscopy, a retrospective study in 140 women with deep endometriosis, and a clinical validation study in 16 women with painful pelvic nodularities during menstruation. SETTING: University Hospital Gasthuisberg, a tertiary referral center. RESULTS: In the retrospective study, deep endometriosis was detected by routine clinical examination in only 36% of women. Lesions infiltrating deeper than 15 mm were detected in 50%. In the prospective study pelvic nodularities were detected by routine clinical examination in 4 women but were detected in 22 by clinical examination during menstruation. The latter was highly reliable to diagnose deep endometriosis, cystic ovarian endometriosis, and cul-de-sac obliteration. CA-125 concentrations were higher during menstruation and correlated with deep endometriosis and with deep and cystic ovarian endometriosis. Nodularities at clinical examination or follicular phase CA-125 concentrations > 35 U/mL are useful to decide that a bowel preparation should be given, achieving a sensitivity of 87% and a specificity of 83%. In the clinical validation study, deep endometriosis was found in 14 of 16 women. CONCLUSION: Clinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

CA-125 Antigen Endometriosis Menstruation CA-125 Antigen Endometriosis Endometriosis Female Humans Prospective Studies Retrospective Studies Sensitivity and Specificity

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