The value of CA-125, CA 19-9, interleukin-6, interleukin-8 and hsCRP in the diagnosis of endometri?osis

Objective: To develop a practical non-invasive test for the diagnosis of endometriosis by evaluating the serum levels of CA-125, CA 19-9, interleukin-6, interleukin-8 and hsCRP among the patients with endometriosis.Design: Prospective case-control study.Setting: Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology.Materials and Methods: The study was held between November 2010 and January 2012 and approved by the ethics committee of, Faculty of Medicine, Akdeniz University.A total of 164 women who underwent laparoscopy for indication of infertility were divided into two groups; control cases (86 cases) with no pathologic findings; and patients with endometriosis (78 cases). Patients with endometriosis were subdivided into stage 1-2 and stage 3-4.Blood samples were collected before the laparoscopy and stored at -80°C for subsequent analysis of CA-125, CA 19-9, IL-6, IL-8, and hsCRP. Analyses were performed by using the t test, receiver operatör characteristic and logictic regression analysis.Results: Serum levels of CA-125 and CA 19-9 were significantly increased in all women with endometriosis and in those with stage 3-4 endometriosis, compared with controls (p<0,05). A serum CA-125 thresold of 21,7 U/ml afforded a sensitivity of 70% and a specifity of 83% in the diagnosis of stage 3-4 endometriosis. Sensitivity and specifity for CA 19-9 in the diagnosis of stage 3-4 endometriosis, using 9,41 U/ml at the cut-off value, were 62% and 68%, recpectively.There was no statistically significant difference between cases with endometriosis and controls in the serum levels of IL-6, IL-8 and hsCRP (p>0,05). For discrimination of endometriosis patients serum IL-6 provided a sensitivty of 82% and a specifity of 48% at a cut-off value of 6,215 pg/ml.When combinations of markers were evaluated by using logistic regression analysis, a four-marker panel of CA-125, CA 19-9, IL-6 and hsCRP was found statistically significant in the diagnosis of patients with stage 3-4 endometriosis, during secretory phase.Conclusions: This study evaluates the use of each biomarker singly and in combination for the diagnosis of endometriosis. CA-125 and CA 19-9 are reliable non-invasive biomarkers for determining the severity of endometriosis. During the secretory phase the combination of CA-125, CA 19-9, IL-6 and hsCRP allows the diagnosis of patients with stage 3-4