Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration.
OBJECTIVE
To evaluate a clinical examination during menstruation and plasma CA-125 concentrations to diagnose deep endometriosis.


METHODS
Prospective 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.


METHODS
University Hospital Gasthuisberg, a tertiary referral center.


RESULTS
In 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.


CONCLUSIONS
Clinical 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.
Koninckx
P R
PR
University Hospital Gasthuisberg, University of Leuven, Department of Obstetrics and Gynaecology, Belgium.
Meuleman
C
C
Oosterlynck
D
D
Cornillie
F J
FJ
D018394:CA-125 Antigen / Q000097:blood*; D004715:Endometriosis / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008598:Menstruation; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D018394:CA-125 Antigen