Diagnostic accuracy of combination of CA125 for endometriosis: A network meta-analysis

BACKGROUND: Currently, CA125 combined with other biomarkers significantly outperforms CA125 alone in diagnosing endometriosis (EM), but the efficiency of combined diagnosis remains unclear. This network meta-analysis compared the accuracy of CA125 combined with different biomarkers in diagnosing EM. OBJECTIVES: The aim of this study was to conduct a network meta-analysis (NMA) to evaluate the diagnostic accuracy of CA125 combined with different biomarkers for EM. METHODS: Data were sourced from PubMed, Embase, Cochrane Library, and Web of Science databases. This meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies that compared the diagnostic accuracy between CA125 plus other biomarkers and CA125 alone (control) in patients with suspected EM were included. The agreement between CA125 alone and in combination with other biomarkers was assessed. NMA was performed, and the surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of which combination would be the most effective diagnostic method. The CINeMA tool was used to assess the quality of the included studies. RESULTS: Direct comparison and inconsistency test and NMA were performed, and SUCRA values were obtained. A total of 10 articles were eligible for inclusion. CA125+CA19+IL-6 showed the highest SUCRA value in terms of sensitivity, positive predictive value and precision, followed by CA125+NLR. The quality of the included evidence was classified as moderate. CONCLUSION: This meta-analysis shows that CA125+CA199+IL-6 might be more efficient for diagnosing EM compared with other diagnostic methods.