DIAGNOSIS OF DEEP ENDOMETRIOSIS BY CLINICAL EXAMINATION DURING MENSTRUATION AND PLASMA CA-125 CONCENTRATION

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.