CA 125 as a diagnostic and prognostic marker fro endometriosis: systematic review and meta-analysis

Postgraduate Thesis uoadl:1314694 316 Read counter

Unit:
Κατεύθυνση Έρευνα στην Γυναικεία Αναπαραγωγή
Library of the School of Health Sciences
Deposit date:
2016-05-20
Year:
2016
Author:
Αργυρίδης Σάββας
Supervisors info:
Επίκουρος Καθηγητής Νικόλαος Βραχνής
Original Title:
CA 125 as a diagnostic and prognostic marker fro endometriosis: systematic review and meta-analysis
Languages:
English
Translated title:
CA 125 ως διαγνωστικός και προγνωστικός δείκτης ενδομητρίωσης: συστηματική ανασκόπηση και μετα-ανάλυση
Summary:
BACKGROUND: Endometriosis affects approximately 6-10% of reproductive aged
women, with
significantly higher rates among infertile or chronic pelvic pain sufferers. It
is a disease that often
remains undiagnosed because it requires histological confirmation. According to
its
manifestations (adhesions, endometriomas) is classified as minimal, mild
moderate and severe
(stages I-IV). Various modalities have been proposed over the years in order to
diagnose
endometriosis, but histological confirmation remains the gold standard. Several
serum
biomarkers have also been evaluated as possible diagnostic and prognostic
examinations in
order to avoid surgical confirmation. CA 125 is the most studied and promising
one as several
studies show, despite the fact that several benign gynecological conditions may
affect its serum
levels.
PURPOSE:The identification of serum CA 125 sensitivity, specificity and
positive predictive value
for endometriosis diagnosis and stage correlation, as well as the correlation
of other biomarkers
such as CA 19-9 to CA 125 levels.
METHODS:A systematicliterature search was conducted of electronic databases in
order to
identify published or accepted for publication articles relevant to the subject.
RESULTS:The systematic review yielded 423 citations and after screening the
title and abstract,
56 were assessed on full text. Out of these articles, after excluding 43 due to
various issues, 13
were included in the meta-analysis. The mean sensitivity rate is at 62.83% for
all stages of
disease, somewhat higher from older relevant meta-analyses, while mean
specificity rate is at
85.26% which is consistent with what other researchers reported in the past.
Positive predictive
value is at 90.14%, correlating well with specificity values, as expected. CA
125 correlates with
disease stage, as mean control group value is at 14.05 U/ml, and mean case
group value is at
43.19 U/ml. Mean values for stage I-II are at 25.05 U/ml, while stage III-IV
are at 63.98 U/ml,
showing a significant statistical difference. CA 125 also shows a positive
correlation to the
presence of endometriomas as levels are significantly higher than in the
absence of it. Correlation
of other biomarkers to CA 125 for endometriosis diagnosis show conflicting
results, as some
suggest that a positive one exists while others suggest not.
CONCLUSIONS:Sensitivity rates vary significantly among different groups and
with a mean rate
of 62.83% for a cut-off limit of 35 U/ml, is not considered high enough to
allow the biomarker to
be used as a screening tool for the disease. Specificity rates are more
consistent and are high
enough (85.26%) to allow its’ use as a diagnostic tool. Positive predictive
value also correlates
well with specificity and may also be used for this. Positive correlation to
disease stage also
enables use as a diagnostic modality. Overall, further studies are needed in
order to assess the
sensitivity rates of the assay in order for serum CA 125 to be considered as a
single diagnostic marker for endometriosis
Keywords:
Endometriosis, CA 125, Biomarker
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
89
Number of pages:
63
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