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Menstrual and Uterine Disorders
Table 3: Conditions Other than Endometriosis operating curve (ROC) showed a poor diagnostic performance: at a
Associated with Elevated Serum CA-125
specificity of 90%, a sensitivity of 28% was reported. If the sensitivity
was increased to 50%, the specificity dropped to 72%.
37
Therefore, it
Gynaecological Conditions Non-gynaecological Conditions
was concluded that the routine use of serum CA-125 cannot be
Benign Conditions
advocated as a diagnostic tool to exclude the diagnosis of
Menstruation Liver disease and cirrhosis
endometriosis in patients with chronic pelvic pain or infertility, and that
Endometriosis Ascites
CA-125 may be more useful in evaluating recurrent disease or the
Adenomyosis Colitis and diverticulitis
success of a surgical treatment. Another important limitation of the use
Pelvic inflammation Post-operative period
of CA-125 as a diagnostic marker for endometriosis is linked to the
Functional ovarian cysts Congestive heart failure
Ovarian hyperstimulation Pericarditis and pleural effusion
evidence that its concentration is also high in women with other
Ovarian neoplasms Diabetes
gynaecological disorders, notably ovarian carcinoma (see Table 3).
38
Lupus and polyarteritis nodosa
Mesothelioma, sarcoidosis and
Other tumour markers have also been investigated, such as CA-19–9,
tuberculosis whose serum levels are elevated in patients with malignant and
Renal disease
benign ovarian tumours and in those with ovarian ‘chocolate cysts’.
39
Malignant Conditions There are a limited number of reports on the significance of serum
Ovarian and endometrial cancer Breast CA-19–9 levels in the diagnosis of endometriosis; however, its clinical
Fallopian tube cancers and Colon
utility is not superior to that of CA-125.
40
germ cell tumours
Adenocarcinoma of the cervix Lung
sICAM-1 is a member of the immunoglobulin supergene family of
Pancreas
adhesion molecules, affecting inflammatory and immune responses and
Source: Gallup and Talledo, 1997.
38
expressed by the human endometrium and endometriotic implants.
41
Serum concentrations of sICAM-1 were found to be significantly higher in
So, do symptoms and signs of endometriosis allow the diagnosis of women with deep peritoneal endometriosis than in those without the
either location or type of endometriosic implants? Recently, it was disease and with superficial endometriosis. Comparing the clinical
demonstrated that women experiencing abdominopelvic pain, usefulness of sICAM-1 with that of CA-125, it was revealed that sICAM-1
menstrual-related symptoms (dysmenorrhoea and menorrhagia), had a sensitivity and specificity of 19 and 97%, respectively, while CA-125
symptoms related to sexual intercourse (dyspareunia and post-coital had a sensitivity and specificity of 14 and 92%, respectively. When both
bleeding), ovarian cysts and subfertility have a high risk of having markers were used concomitantly, the sensitivity and specificity were
endometriosis, especially if they experience more than one of these increased to 28 and 92%, respectively, so that it was speculated that
symptoms; they also share a high medical consultation rate in the integrated measurement both of CA-125 and sICAM-1 may be helpful in
three years leading to diagnosis, probably as a consequence of the specifically identifying women with deep infiltrating endometriosis.
42
symptoms experienced.
7
Biochemical Markers
It was concluded that the
Based on the fact that the pathogenesis of endometriosis calls to mind measurement of urocortin may
the putative role of local, and likely also systemic, inflammatory and
be useful for the differential diagnosis
angiogenetic processes, as well as the role of several growth factors,
1
numerous studies have focused on markers of inflammation, cell of endometrioma compared with
growth and angiogenesis in the peritoneal fluid and/or serum of
other benign ovarian cysts.
women who have the disease. Indeed, several growth factors (vascular
endothelial growth factor,
25
insulin-like growth factor I
26
), cytokines and
other molecules with immune activity (interleukin [IL]-6,
27
IL-8,
28
tumour Urocortin is a member of the corticotropin-releasing hormone (CRH)
necrosis factor-α,
29
Fas ligand,
30
macrophage migration inhibitory family of peptides, which are involved in the modulation of the immune
factor;
31
macrophage chemotactic protein-1,
32
regulated on activation system and participate in the ad hoc regulation of inflammatory
normal T-cell-expressed and -secreted,
33
epithelial neutrophil- phenomena.
43
Urocortin is expressed
44
and secreted
45
by the human
activating peptide-78,
34
interferon-γ
35
) have been shown to be more endometrium, where it participates in the mechanisms of endometrial
consistently different in women with endometriosis than in controls. decidualisation
45
and implantation,
46
as well as by endometriotic
However, their measurement still lacks clinical usefulness. implants.
47
Plasma urocortin was measured in women with ovarian
endometrioma and in women with benign, non-endometriotic ovarian
In contrast, the measurement of tumour markers (CA-125 and CA-19–9) cysts with the aim of evaluating the diagnostic accuracy of its
and molecules involved in the regulation of immune function measurement for the diagnosis of endometriosis. Levels were twice as
(intercellular-adhesion molecule-1 [sICAM-1] and urocortin) also high in women with endometrioma than in the control group, and
has some clinical utility in the diagnosis of endometriosis. Women significantly higher in the cystic content of endometriomas than in the
with endometriosis often have high (>35IU/ml) serum CA-125 peritoneal fluid and plasma. Moreover, it was found that elevated
concentrations.
36
In a meta-analysis performed to assess the diagnostic plasma urocortin levels detected 88% of the cases of endometrioma
performance of serum CA-125 in detecting endometriosis, it was with 90% specificity, whereas CA-125 detected only 65% of the cases
revealed that in women with infertility or pelvic pain the sensitivity of with the same specificity. Therefore, it was concluded that the
CA-125 ranged from 4 to 100% and its specificity from 38 to 100% for measurement of urocortin may be useful for the differential diagnosis
the diagnosis of any stage of endometriosis. However, the receiver of endometrioma compared with other benign ovarian cysts.
47
10 EUROPEAN OBSTETRICS & GYNAECOLOGY
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