COMMENTARY

Is There a Better Way to Diagnose Endometriosis?

Peter Kovacs, MD, PhD

Disclosures

October 20, 2016

Viewpoint

From a histologic point of view, endometriosis is benign, but the associated symptoms can significantly affect quality of life. Surgical or medical treatments are available.[3] Timely initiation of therapy can slow down progression and, therefore, could significantly improve quality of life.

The need for an invasive procedure to establish the correct diagnosis, however, may cause delays during patient care. It would be much easier to use a simple noninvasive test to establish the correct diagnosis. Patients and providers are more likely to accept it, and an early diagnosis would allow the treatment to get started more quickly.

CA 125 originates from coelomic epithelium and may be elevated in diseases affecting the ovaries, tubes, peritoneum, or lungs. In cases of pelvic inflammatory disease, the value is elevated too. Its level tends to be elevated in endometriosis, but other conditions that are also associated with increased values still need to be ruled out.

A positive, noninvasive screening test could be used to select patients for further diagnostic steps, including laparoscopy to confirm endometriosis, assess its stage, and decide on the best therapeutic route. This review found an overall 52.4% sensitivity with a cut-off of 30 IU/mL, which means that this cut-off falsely identifies a good proportion of patients as having endometriosis. In addition, a negative test does not rule out endometriosis; therefore one is still left with the dilemma of whether to proceed with surgical exploration or to try empirical treatment for the given symptom.

Obviously, there is need for noninvasive markers with better sensitivity and specificity that could offer a true help during the work-up of the symptomatic patient. Two recent Cochrane Reviews drew the conclusion that noninvasive markers are not sensitive and specific enough to significantly add to the care of symptomatic patients suspected of having endometriosis.[4,5]

Abstract

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