Diagnostic value of serum CA-125, CA 19-9, IL-13 and TNF-alpha in endometriosis and prediction of its severity

ABSTRACT

Endometriosis is one of the most common benign gynecological disorders affecting more than 10% of women of reproductive age A non-surgical diagnostic approach would be of great benefit to both physicians and women alike. To test the diagnostic potential of serum biochemical markers CA-125, CA 19-9, IL-13 and TNF-alpha conditions as well as to predict its severity. Cross- sectional study. Obstetric and Gynecology Department, Kasr El-Aini hospital - Cairo University. Ninety one consecutive non-pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic pain. Serum biochemical markers CA-125, CA 19-9, IL-13 and TNF-alpha were measured using specific kits and techniques for each in the 91 patients. According to the results of laparoscopic and histopathological examination the study population were divided into 4 groups early endometnosis, advanced endometrosis, non-endometriotic pelvic inflammations/adhesions and patients with normal findings respectively. Accuracy of the study markers in differentiating between the various pathological situations was calculated, to predict the specificity of each marker, to distinguish endometriosis from other clinical conditions and to predict its severity. Serum CA 125 in group of patients with early endometriosis [26 patients] showed significant difference when compared to the control group [16 patients]. Also significant difference of serum CA125, CA 19-9 and TNF- between cases of advanced endometriosis [14 patients] compared to PID and control groups, [51 patients]. This same significant difference was also detected with TNF-alpha between group of early endometriosis and compared to PID and control groups. CA 19-9 showed significant difference in its level in group of early endometriosis compared to other groups. After combining cases with endometriosis, the three serum biochemical markers which slowed significant difference when compared to other groups were CA-125, CA 19-9 and TNF-alpha while JL-B showed no significant difference. The accuracy of the serum biochemical markers CA-125, CA 19-9 and TNF-alpha regarding the sensitivity and specificity were 79.962, 75.82 and 93.4 respectively. TNF-alpha is characterized by perfect sensitivity while both CA-125 ed CA 19-9 have perfect specificity. Combining the results of assaying serum TNF-alpha plus any of the other markers CA 125 or CA 19-9 will have 100 accuracy in distinguishing cases with endometriosis from those with non-endometriotic lesions. Only serum level of CA 19-9 can distinguish between cases with early and advanced endometriosis