The association between clinical manifestation, biochemical marker (ca125) and diagnostic laparoscopy or \nlaparotomy findings with/without histopathological confirmation in the diagnosis of endometriosis \n

Objective \nThis study was performed to create a scoring system name Cli-Endomet, which \nsuggestive of endometriosis, by evaluating the association between the medical history, \nclinical examination, ultrasound findings and biochemical marker ( CA 125 ). \nMethodology \nThis was a cross sectional study, performed over 18 months duration from November \n1st, 2011 until April 31st 2013. 176 patients with pelvic pain, which include \ndysmenorrhea, dyspareunia, ovulation pain, dyschezia or any chronic non-specific \npelvic pain were recruited into the study. Detailed history and a thorough clinical \nexamination were performed on each patient. A transvaginal ultrasound scan was \nperformed and 2 mls of blood was taken from each patients either during menstruation \nor late luteal phase to determine the level of serum CA 125. All patients were then \nbeen subjected to either laparoscopy or laparotomy operation and/or tissue biopsy was \ntaken for histopathology examination whenever was possible. In the presence of \nendometriosis, the staging of disease was determined using revised American Society \nof Reproductive Medicine (rASRM) scoring system. The clinical criterias which were \nstrongly associated with diagnosis of endometriosis were extracted from statistical \nmodel, and were transformed for development of the clinical criteria scoring system, \nthe Cli-Endomet. \nResults \nAmong 176 patients recruited, 103 of them (58.5%) were confirmed to have \nendometriosis. The clinical manifestations and CA 125 level were analyzed via simple \nlogistic regression then followed by multiple logistic regression, to determine the \nassociation between clinical presentation, CA 125 and endometriosis. The ROC \n(Receiver Operating Characteristic) curve of CA 125 was plotted and the cutoff points \nof CA 125 level in association with endometriosis were 50 to 200 U/mL with p value < \n0.001. The clinical parameters which were statistically significant were dysmenorrhea \n( especially severe type, p < 0.015 ), ultrasonography finding of ovarian mass (if \npresent) with ground-glass appearance or thick with sediments content ( p < 0.001 ) \nand CA 125 level ( p < 0.001 ). From this analysis results, a scoring system Cli- \nEndomet was then developed. \nConclusion \nCliEndomet scoring system, which takes into consideration of several significant clinical \nparameters, can be used as an alternative tool that suggestive of endometriosis. \nHowever, the accuracy of CliEndomet is not fully validated yet. Should it proven to be \naccurate, it may avoid patient from unnecessary diagnostic surgical procedure and \nfurther medical treatment may be instituted accordingly. \n