Keywords
Endometriosis, Pelvic pain, Infertility, Dysmenorrhea, CA-125 antigenAbstract
CONTEXT AND OBJECTIVE: Serological testing for CA125 has been widely used to detect endometriosis and to monitor its progression. However, controversy still exists regarding the usefulness of the plasma CA125 assay for diagnosing endometriosis. Furthermore, some authors have described superficial endometriosis as a cyclical and normal phenomenon in women’s lives, and have indicated that development and progression of this disease would only occur in some women as a result of immunological changes. This study aimed to determine the frequency of endometriosis and the correlation between serum CA125 levels and the presence of endometriotic lesions in the peritoneum of asymptomatic fertile patients. DESIGN AND SETTING: Cross-sectional study at the Family Planning outpatient clinic of Faculdade de Medicina do ABC. METHODS: Eighty asymptomatic fertile patients who underwent tubal sterilization surgery were studied. Blood and peritoneum samples were collected. CA125 levels were measured from blood samples, and peritoneum biopsies were studied using histopathological tests. RESULTS: Histopathological evaluation of the peritoneum revealed that 16.25% of the patients had minimal or mild endometriosis. There was no statistically significant difference in CA125 levels between patients with and without endometriosis. CONCLUSION: The presence of endometriotic lesions in the peritoneum of fertile patients supports the hypothesis that incidental findings of minimal or mild endometriosis may not be of clinical significance, and that the progression of the disease probably occurs as a result of immunological and genetic abnormalities. Serum CA125 levels did not show any diagnostic significance with regard to detecting the disease.
Downloads
References
Missmer SA, Cramer DW. The epidemiology of endometriosis. Obstet Gynecol Clin North Am. 2003;30(1):1-19, vii.
Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod. 1991;6(4):544-9.
Amaral VF, Ferriani RA, Sá MF, et al. Positive correlation between serum and peritoneal fluid CA-125 levels in women with pelvic endometriosis. Sao Paulo Med J. 2006;124(4):223-7.
Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril. 2003;79(4):1023-7.
Stratton P, Winkel C, Premkumar A, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril. 2003;79(5):1078-85.
Kitawaki J, Ishihara H, Koshiba H, et al. Usefulness and limits of CA-125 in diagnosis of en- dometriosis without associated ovarian endometriomas. Hum Reprod. 2005;20(7):1999- 2003.
Renner SP, Strick R, Oppelt P, et al. Evaluation of clinical parameters and estrogen receptor alpha gene polymorphisms for patients with endometriosis. Reproduction. 2006;131(1): 153-61.
Abrão MS, Podgaec S, Filho BM, Ramos LO, Pinotti JA, de Oliveira RM. The use of biochemi- cal markers in the diagnosis of pelvic endometriosis. Hum Reprod. 1997;12(11):2523-7.
Vercellini P, Trespidi L, Panazza S, Bramante T, Mauro F, Crosignani PG. Laparoscopic uterine biopsy for diagnosing diffuse adenomyosis. J Reprod Med. 1996;41(4):220-4.
Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endo- metriosis. Obstet Gynecol. 2002;99(3):375-80.
Harada T, Kubota T, Aso T. Usefulness of CA19-9 versus CA125 for the diagnosis of endome- triosis. Fertil Steril. 2002;78(4):733-9.
Somigliana E, Viganò P, Tirelli AS, et al. Use of the concomitant serum dosage of CA 125, CA 19-9 and interleukin-6 to detect the presence of endometriosis. Results from a series of reproductive age women undergoing laparoscopic surgery for benign gynaecological condi- tions. Hum Reprod. 2004;19(8):1871-6.
Hoeger KM, Guzick DS. An update on the classification of endometriosis. Clin Obstet Gyne- col. 1999;42(3):611-9.
Abrao MS, Neme RM, Carvalho FM, Aldrighi JM, Pinotti JA. Histological classification of endo- metriosis as a predictor of response to treatment. Int J Gynaecol Obstet. 2003;82(1):31-40.
Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997,67(5):817-21.
Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-99.
Bulun SE, Zeitoun KM, Takayama K, Sasano H. Estrogen biosynthesis in endometriosis: mo- lecular basis and clinical relevance. J Mol Endocrinol. 2000;25(1):35-42.
Pittaway DE, Rondinone D, Miller KA, Barnes K. Clinical evaluation of CA-125 concentrations as a prognostic factor for pregnancy in infertile women with surgically treated endometrio- sis. Fertil Steril. 1995;64(2):321-4.
Koninckx PR. Is mild endometriosis a condition occurring intermittently in all women? Hum Reprod. 1994;9(12):2202-5.
Bon GG, Kenemans P, Dekker JJ, et al. Fluctuations in CA 125 and CA 15-3 serum concen- trations during spontaneous ovulatory cycles. Hum Reprod. 1999;14(2):566-70.
Koninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril. 1992;58(5):924-8.
Niloff JM, Knapp RC, Jones G, Schaetzl EM, Bast RC Jr. Recombinant leukocyte alpha inter- feron in advanced ovarian carcinoma. Cancer Treat Rep. 1985;69(7-8):895-6.
Falconer H, Bambra CS, Chai D, Cornillie FJ, Hill JA, D’Hooghe TM. The effect of endometrio- sis, cycle stage, lymphocyte suppression and pregnancy on CA-125 levels in peritoneal fluid and serum in baboons. Hum Reprod. 2005;20(11):3033-8.
Johansson J, Santala M, Kauppila A. Explosive rise of serum CA 125 following the rupture of ovarian endometrioma. Hum Reprod. 1998;13(12):3503-4.
Koninckx PR, Meuleman C, Oosterlynck D, Cornillie FJ. Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration. Fertil Steril. 1996;65(2):280-7.
Nisolle M, Nervo P. Endométriose stade I et II: implications physiopathologiques, cliniques et thérapeutiques [Physiopathology and therapeutic management of stage I and II endome- triosis]. J Gynecol Obstet Biol Reprod (Paris). 2003;32(8 Pt 2):S11-4.
Barbosa CP, de Souza AM, Bianco B, Christofolini DM, Mafra FA, de Lima GR. OC-125 im- munostaining in endometriotic lesion samples. Arch Gynecol Obstet. 2009 [Epub ahead of print].
Nezhat F, Allan CJ, Nezhat C, Martin DC. Nonvisualized endometriosis at laparoscopy. Int J Fertil. 1991;36(6):340-3.
Nisolle M, Casanas-Roux F, Anaf V, Mine JM, Donnez J. Morphometric study of the stromal vascularization in peritoneal endometriosis. Fertil Steril. 1993;59(3):681-4.
Balasch J, Creus M, Fábregues F, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod. 1996;11(2):387-91.