Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis

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Peritoneal fluid interleukin-6 levels effectively discriminate moderate to severe endometriosis, with 79% test effectiveness for this subgroup.

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The study measured multiplex cytokine concentrations (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ) in peritoneal fluid from women with minimal to mild endometriosis (n=10), moderate to severe endometriosis (n=26), and 42 controls, using extended ROC curve analysis to assess diagnostic performance. Only IL-6 and IL-10 were significantly higher in endometriosis overall, with higher IL-6 and IL-10 specifically in the moderate to severe group but not in minimal to mild disease, and ROC analysis showing IL-6 discriminated while IL-10 did not. For moderate to severe endometriosis, IL-6 achieved an area under the curve with adequate sample size for 90% power, and extended ROC incorporating analysis cost yielded an optimal IL-6 cutoff with high specificity and a positive likelihood ratio, giving 79% effectiveness. The paper notes that further studies are needed to determine utility for early-stage detection, and this paper relates directly to endometriosis by evaluating peritoneal IL-6 as a diagnostic marker for detecting the condition, particularly moderate to severe disease.

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Abstract

PURPOSE: To determine, with extended receiver operating characteristic (ROC) curve analysis, the diagnostic value of cytokines showing significantly different peritoneal concentrations between women with and without endometriosis. METHODS: Multiplex cytokine concentration measurement of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ levels in peritoneal fluid of women with minimal to mild (n = 10) and moderate to severe (n = 26) endometriosis, and 42 controls. RESULTS: Only IL-6 and IL-10 concentrations were significantly higher in endometriosis patients than in controls. Specifically, significantly higher IL-6 and IL-10 levels were found in moderate to severe but not in minimal to mild endometriosis as compared to controls. For evaluation of diagnostic significance, ROC analysis determined discriminating parameters for IL-6, while those calculated for IL-10 were useless. Importantly, ROC analysis for IL-6 levels limited to women with moderate to severe endometriosis showed the highest area under the curve with the sample size sufficient to achieve 90 % power of the test. Finally, extended ROC including cost of analysis for this group of patients determined the optimal cut-off leading to high specificity and positive likelihood ratio resulting in 79 % effectiveness of the test. CONCLUSIONS: While our outcomes show moderate usefulness of peritoneal IL-6 levels in discrimination of moderate to severe endometriosis, further studies might be needed to determine the usefulness of peritoneal IL-6 levels in detection of early stages of endometriosis, as such a finding would be more relevant in clinical decision making.
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Abstract

Purpose To determine, with extended receiver operating characteristic (ROC) curve analysis, the diagnostic value of cytokines showing significantly different peritoneal concentrations between women with and without endometriosis.

Methods

Multiplex cytokine concentration measurement of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ levels in peritoneal fluid of women with minimal to mild (n = 10) and moderate to severe (n = 26) endometriosis, and 42 controls.

Results

Only IL-6 and IL-10 concentrations were significantly higher in endometriosis patients than in controls. Specifically, significantly higher IL-6 and IL-10 levels were found in moderate to severe but not in minimal to mild endometriosis as compared to controls. For evaluation of diagnostic significance, ROC analysis determined discriminating parameters for IL-6, while those calculated for IL-10 were useless. Importantly, ROC analysis for IL-6 levels limited to women with moderate to severe endometriosis showed the highest area under the curve with the sample size sufficient to achieve 90 % power of the test. Finally, extended ROC including cost of analysis for this group of patients determined the optimal cut-off leading to high specificity and positive likelihood ratio resulting in 79 % effectiveness of the test.

Conclusions

While our outcomes show moderate usefulness of peritoneal IL-6 levels in discrimination of moderate to severe endometriosis, further studies might be needed to determine the usefulness of peritoneal IL-6 levels in detection of early stages of endometriosis, as such a finding would be more relevant in clinical decision making. Similar content being viewed by others

References

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N40701132/0313 (to A.C.), and 2P05E 02929 (to M.G.). Conflict of interest We declare that we have no conflict of interest. Author information Authors and Affiliations Corresponding author Electronic supplementary material Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Wickiewicz, D., Chrobak, A., Gmyrek, G.B. et al. Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis. Arch Gynecol Obstet 288, 805–814 (2013). https://doi.org/10.1007/s00404-013-2828-6 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-013-2828-6

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Condition tags

endometriosis

MeSH descriptors

Ascitic Fluid Endometriosis Interleukin-6 Adult Ascitic Fluid Biomarkers Biomarkers Case-Control Studies Cytokines Cytokines Endometriosis Endometriosis Female Humans Interleukin-10 Interleukin-10 Interleukin-6 ROC Curve Severity of Illness Index Up-Regulation

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