Diagnosis of endometriosis in women with chronic pelvic pain

Daher RMF, R. M. F. Daher, Rosa-e-Silva JC, J. C. Rosa-e-Silva, Júlio César Rosa e Silva, O B Poli-Neto, Poli-Neto OB, Omero Benedicto Poli‐Neto, F. J. Candido-dos-Reis, Candido-Dos-Reis FJ, Francisco José Cândido dos Reis, AA Nogueira, Nogueira AA, A A Nogueira
Clinical and experimental obstetrics & gynecology · 2016 · vol. 43(4) , pp. 512–515 · doi:10.12891/ceog2082.2016 · PMID:29734538 · W2915406620
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Elevated CA-125 levels combined with dysmenorrhea accurately and presumptively diagnose endometriosis in women with chronic pelvic pain, allowing for early treatment without laparoscopy.

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This cross-sectional study analyzed medical records of women with chronic pelvic pain who underwent laparoscopy at a single university hospital (August 1999 to January 2009) to assess whether CA-125 levels combined with clinical history and the neutrophil/lymphocyte (N/L) ratio could predict endometriosis. The authors found CA-125 was significantly higher in those with endometriosis, and that pairing elevated CA-125 with dysmenorrhea improved sensitivity, while dyspareunia, subfertility, and the N/L ratio were not useful predictors in this cohort. Using a CA-125 cut-off of 20 IU/ml, they reported a predictive value of 97.6%, with performance estimates based on ROC curve comparisons. This paper is centrally about endometriosis — it evaluates CA-125 with dysmenorrhea and the N/L ratio for presumptive diagnosis in women with chronic pelvic pain.

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Abstract

PURPOSE OF INVESTIGATION: To assess the accuracy of CA-125 determination associated with clinical history and of the neutrophil/lymphocyte (N/L) ratio for a presumptive diagnosis of endometriosis in women with chronic pelvic pain (CPP). MATERIALS AND METHODS: This was a cross-sectional study of data from the medical records of women with CPP submitted to laparoscopy from August 1999 to January 2009 at the University Hospital. The performance of the evaluation of CA-125 and of the N/L ratio for the prediction of endometriosis was compared based on the corresponding ROC curves and their 95% confidence intervals. RESULTS: CA-125 levels were significantly higher in women with CPP and endometriosis and their association with a complaint of dysmenorrhea improved their sensitivity. For a cut-off of 20 IU/ml, the predictive value for a diagnosis of endometriosis in women with CPP was 97.6%. Dyspareunia, subfertility, and N/L ratio were not useful for a diagnosis of endometriosis in women with CPP. CONCLUSION: The association of elevated CA-125 levels with a complaint of dysmenorrhea is adequate in a presumptive and accurate diagnosis of endometriosis in this specific group of women with CPP, permitting an early institution of clinical treatment without the need of previous laparoscopic confirmation.
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Abstract

Purpose of investigation: To assess the accuracy of CA-125 determination associated with clinical history and of the neutrophil/lymphocyte (N/L) ratio for a presumptive diagnosis of endometriosis in women with chronic pelvic pain (CPP). Materials and Methods: This was a cross-sectional study of data from the medical records of women with CPP submitted to laparoscopy from August 1999 to January 2009 at the University Hospital. The performance of the evaluation of CA-125 and of the N/L ratio for the prediction of endometriosis was compared based on the corresponding ROC curves and their 95% confidence intervals. Results: CA-125 levels were significantly higher in women with CPP and endometriosis and their association with a complaint of dysmenorrhea improved their sensitivity. For a cut-off of 20 IU/ml, the predictive value for a diagnosis of endometriosis in women with CPP was 97.6%. Dyspareunia, subfertility, and N/L ratio were not useful for a diagnosis of endometriosis in women with CPP. Conclusion: The association of elevated CA-125 levels with a complaint of dysmenorrhea is adequate in a presumptive and accurate diagnosis of endometriosis in this specific group of women with CPP, permitting an early institution of clinical treatment without the need of previous laparoscopic confirmation.

Keywords

- CA-125 - Diagnosis - Endometriosis - Dysmenorrhea - Chronic pelvic pain

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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Chronic Pain Endometriosis Pelvic Pain Adult CA-125 Antigen CA-125 Antigen Chronic Pain Chronic Pain Cross-Sectional Studies Endometriosis Endometriosis Endometriosis Endometriosis Female Humans Pelvic Pain Pelvic Pain

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