Background: The aim of this study was to investigate the role of peripheral blood markers as additional diagnostic tools to transvaginal ultrasound (TVU) findings in the diagnosis of endometriosis.
Methods: This study included 40 patients undergoing laparoscopy for suspected endometriosis from January to December 2012. Preoperative levels of serum CA125, CA19-9, CEA and mRNA expression levels for survivin and VEGF were obtained. Real-time PCR was used to determine relative gene expression. A new diagnostic score was obtained by deploying the peripheral blood markers to the TVU findings. Statistical methods used were Chi-square, Fisher's, Student's t-test or the Mann - Whitney test.
Results: There was a statistically significant difference in serum CA125, survivin and VEGF levels in patients with endometriosis and those without endometriosis (p<0.001, p=0.025 and p=0.009, respectively). False negative TVU findings were noted in 3/13 patients (23.1%) with peritoneal endometriosis without ovaries involvement. High sensitivity (93.3%), specificity (90.0%), PPV (96.6%), NPV (81.8%) and accuracy (92.5%) were obtained for a diagnostic score based on TVU and significant peripheral blood markers (CA125, survivin and VEGF).
Conclusions: Determination of serum CA125, mRNA expression levels for survivin and VEGF along with TVU can contribute to higher accuracy of the noninvasive diagnostic tools for endometriosis.
Uvod: Cilj ovog istraživanja je da se ispita značaj određivanja koncentracija serumskih biomarkera (CA125, CA19-9, CEA i ekspresije iRNK za survivin i VEGF) zajedno sa transvaginalnim ultrazvučnim pregledom (TVU) prilikom dijagnostikovanja endometrioze.
Metode: Ova studija obuhvata 40 pacijentkinja kojima je zbog sumnje na postojanje endometrioze urađena dijagnostička laparoskopija sa patohistološkom analizom u jednogodišnjem periodu od januara 2012. do decembra 2013. Preoperativno su određivane koncentracije CA125, CA19-9, CEA kao i nivoi ekspresije iRNK za survivin i VEGF. Real-time PCR je korišćen za određivanje relativne ekspresije gena. Određivanjem vrednosti serumskih biomarkera zajedno sa TVU dobijen je novi dijagnostički skor. Statističke metode koje su korišćene su Hi kvadratni test, Fisherov, Studentov t test ili Mann-Whitney test.
Rezultati: Postoji statistički značajna razlika u serumskoj koncentraciji CA125, survivina i nivoa VEGF kod pacijentkinja sa endometriozom i onih bez endometrioze (p<0,001, p=0,025 i p=0,009). Lažno negativan nalaz TVU zabeležen je kod 3/13 pacijenata (23,1%) sa peritonealnom endometriozom. Visoka osetljivost (93,3%), specifičnost (90,0%), PPV (96,6%), NPV (81,8%) i tačnost (92,5%) postižu se određivanjem koncentracija serumskih biomarkera (CA125, survivin i VEGF) i TVU.
Zaključak: Određivanje serumskih koncentracija CA125, nivoa ekspresije iRNK za survivin i VEGF zajedno sa TVU od velikog je kliničkog značaja u neinvazivnoj dijagnostici endometrioze.
Keywords: CA125; VEGF; endometriosis; laparoscopy; survivin; transvaginal ultrasound.