Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration

Philippe R. Koninckx, Christel Meuleman, Didier J. Oosterlynck, Freddy Cornillie
In: Fertility and Sterility · 1996 · vol. 65(2) , pp. 280–287 · doi:10.1016/s0015-0282(16)58086-8 · W4295691139
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This study investigated the diagnostic utility of clinical pelvic examination during menstruation and plasma CA-125 levels for deep endometriosis.

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Abstract

ObjectivesTo evaluate a clinical examination during menstruation and plasma CA-125 concentrations to diagnose deep endometriosis.DesignProspective study in 61 women scheduled for a laparoscopy, a retrospective study in 140 women with deep endometriosis, and a clinical validation study in 16 women with painful pelvic nodularities during menstruation.SettingUniversity Hospital Gasthuisberg, a tertiary referral center.ResultsIn the retrospective study, deep endometriosis was detected by routine clinical examination in only 36% of women. Lesions infiltrating deeper than 15 mm were detected in 50%. In the prospective study pelvic nodularities were detected by routine clinical examination in 4 women but were detected in 22 by clinical examination during menstruation. The latter was highly reliable to diagnose deep endometriosis, cystic ovarian endometriosis, and cul-de-sac obliteration. CA-125 concentrations were higher during menstruation and correlated with deep endometriosis and with deep and cystic ovarian endometriosis. Nodularities at clinical examination or follicular phase CA-125 concentrations > 35 U/mL are useful to decide that a bowel preparation should be given, achieving a sensitivity of 87% and a specificity of 83%. In the clinical validation study, deep endometriosis was found in 14 of 16 women.ConclusionClinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.

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