Laboratory testing for endometriosis.
BACKGROUND
Typically, endometriosis is diagnosed surgically by laparoscopy. CA-125 is the principal serum marker used in the diagnosis and management of late-stage endometriosis. The search for a body fluid marker of early stage disease has included studies of serum, peritoneal fluid (PF), and/or tissue levels of secretory proteins, cell adhesion molecules, cytokines, tumor necrosis and vascular endothelial growth factors (VEGFs), chemokines, antiendometrial antibodies, autoantibodies to oxidized lipoproteins, aromatase P-450 expression, cytokeratins, and hormone receptors. We compared the diagnostic accuracy and clinical utility of these various types of substances in the non-surgical identification of patients with endometriosis.


METHODS
We reviewed the MEDLINE database for all publications on serum, peritoneal fluid and tissue markers of endometriosis.


RESULTS
Except for serum interleukin (IL)-6 and peritoneal fluid tumor necrosis factor (TNF)-alpha levels, the diagnostic accuracy of other markers of endometriosis was either similar or worse than that of CA-125 (sensitivity 24-94%; specificity 83-93%). The diagnostic accuracy of IL-6 and TNF-alpha was 90-100% (sensitivity) and 67-89% (specificity).


CONCLUSIONS
CA-125 has limited diagnostic accuracy in the identification of early stage endometriosis and none of the other markers we reviewed dramatically outperformed CA-125 in this regard with the possible exception of serum IL-6 and peritoneal fluid TNF-alpha levels.
Bedaiwy
Mohamed A
MA
Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH 44195, USA.
Falcone
Tommaso
T
D001202:Ascitic Fluid / Q000737:chemistry; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood / Q000378:metabolism; D004715:Endometriosis / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D005260:Female; D005819:Genetic Markers / Q000235:genetics; D006801:Humans
D015415:Biomarkers; D018394:CA-125 Antigen; D005819:Genetic Markers