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

被引:122
作者
Koninckx, PR [1 ]
Meuleman, C [1 ]
Oosterlynck, D [1 ]
Cornillie, FJ [1 ]
机构
[1] CENTOCOR DIAGNOST,HEVERLEE,BELGIUM
关键词
endometriosis; deep endometriosis; CA-125; diagnosis;
D O I
10.1016/S0015-0282(16)58086-8
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objectives: To evaluate a clinical examination during menstruation and plasma CA-125 concentrations to diagnose deep endometriosis. Design: 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. Setting: 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. Conclusion: 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.
引用
收藏
页码:280 / 287
页数:8
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