Abstract
Study objective
To assess the diagnostic accuracy of serum Cancer Antigen 125 (CA 125) ≥ 30 units/milliliter (u/ml) for diagnosing endometriosis in symptomatic women.
Study design
Prospective observational cohort study including patients with symptoms of pelvic
pain or subfertility undergoing elective diagnostic laparoscopy at two tertiary referral
hospitals. We excluded patients suspected to have other gynecological pathology. We
evaluated the accuracy of serum CA 125 (index test) with histologically confirmed
endometriosis (reference standard).
Main results
Fifty-eight consecutive women recruited between October 2013 to March 2015. Women
with endometriosis had a higher CA 125 level than those without endometriosis (mean
54.7 +/−71.6 vs 16.2 +/− 8.0). The specificity of CA 125 ≥ 30 u/ml was 96% (95% CI 81.7–99.9%) and sensitivity was 57% (95% CI 37.4–74.5%). The
positive likelihood ratio for the histological presence of endometriosis with a CA
125 ≥ 30 u/ml was 15.8 (95% CI 2.3-112) providing a post-test probability of 94% (95% CI 71%–99%)
in women with pelvic pain or subfertility. The area under the curve, 0.85 (95% CI
0.74–0.96) indicates high test accuracy.
Conclusions
CA 125 ≥ 30 u/ml is highly predictive of endometriosis in women with symptoms of pain and/or subfertility.
CA 125 should be considered as a rule-in test for expediting the diagnosis and management
of endometriosis, CA 125 <30 u/ml is, however, unable to rule out endometriosis.
Keywords
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Article info
Publication history
Published online: December 05, 2016
Accepted:
December 3,
2016
Received in revised form:
November 20,
2016
Received:
August 26,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
