Pr. Koninckx et al., DIAGNOSIS OF DEEP ENDOMETRIOSIS BY CLINICAL EXAMINATION DURING MENSTRUATION AND PLASMA CA-125 CONCENTRATION, Fertility and sterility, 65(2), 1996, pp. 280-287
Objectives: To evaluate a clinical examination during menstruation and
plasma CA-125 concentrations to diagnose deep endometriosis. Design:
Prospective study in 61 women scheduled for a laparoscopy, a retrospec
tive study in 140 women with deep endometriosis, and a clinical valida
tion study in 16 women with painful pelvic nodularities during menstru
ation. Setting: University Hospital Gasthuisberg, a tertiary referral
center. Results: In the retrospective study, deep endometriosis was de
tected by routine clinical examination in only 36% of women. Lesions i
nfiltrating deeper than 15 mm were detected in 50%. In the prospective
study pelvic nodularities were detected by routine clinical examinati
on in 4 women but were detected in 22 by clinical examination during m
enstruation. The latter was highly reliable to diagnose deep endometri
osis, cystic ovarian endometriosis, and cul-de-sac obliteration. CA-12
5 concentrations were higher during menstruation and correlated with d
eep endometriosis and with deep and cystic ovarian endometriosis. Nodu
larities at clinical examination or follicular phase CA-125 concentrat
ions >35 U/mL are useful to decide that a bowel preparation should be
given, achieving a sensitivity of 87% and a specificity of 83%. In the
clinical validation study, deep endometriosis was found in 14 of 16 w
omen. Conclusion: Clinical examination during menstruation can diagnos
e reliably deep endometriosis, cystic ovarian endometriosis, or cul-de
-sac adhesions. This test, preferentially combined with a follicular p
hase CA-125 assay, should be used to decide whether a preparation for
bowel surgery should be given.