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Hum. Reprod. Advance Access published online on May 12, 2005
Human Reproduction, doi:10.1093/humrep/deh890
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received November 5, 2004
Revised February 18, 2005
Accepted February 28, 2005

Article

Usefulness and limits of CA-125 in diagnosis of endometriosis without associated ovarian endometriomas

Jo Kitawaki 1*, Hiroaki Ishihara 1, Hisato Koshiba 1, Miyo Kiyomizu 1, Mariko Teramoto 1, Yui Kitaoka 1, and Hideo Honjo 1

1 Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan

* To whom correspondence should be addressed.
Jo Kitawaki, E-mail: kitawaki{at}koto.kpu-m.ac.jp


  Abstract

BACKGROUND: The aim of this study was to evaluate the diagnostic significance of CA-125 for endometriosis without ovarian endometriomas. METHODS: Preoperative serum CA-125 levels were measured in 775 consecutive women diagnosed by laparoscopy or laparotomy with endometriosis, adenomyosis, leiomyomas, or normal pelvis. RESULTS: Receiver operating characteristic curve analysis revealed that the area under the curve for endometriosis without endometriomas was 0.788, significantly smaller than that for endometriosis with endometriomas (0.935, P<0.05). In diagnosis of endometriosis without endometriomas, both the maximal accuracy of 78.8% and the maximal diagnostic value of 61.2% were obtained at the cutoff value of 20 U/mL. Negative predictive value was 78.0% at the cutoff value of 20 U/mL, whereas positive predictive value was 92.9% at the cutoff value of 30 U/mL. This range is clearly superior to the empirical single cutoff of 35 U/mL. CONCLUSIONS: In the diagnosis of endometriosis without endometriomas, combined use of two cutoff values for CA-125, 20 and 30 U/mL, provides improved diagnostic performance. However, the accuracy of using only CA-125 testing for diagnosis is still limited. Serum CA-125 testing can be done during initial screenings of women with possible endometriosis.

Keywords: adenomyosis; CA-125; diagnosis; endometriosis; leiomyoma; ovarian endometriomas.
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