EJMS

Abstract

Endometriosis is characterized by the presence and/or the growth of endometrial tissue (both glands and stroma) outside the uterine cavity that causes a chronic inflammation, inside or outside the pelvis. Endometriosis is a common estrogen-dependent disease of reproductive age that affects up to 15% of women. Endometriosis was associated with a significantly increased risk of clear-cell and endometrioid invasive ovarian cancer with an odds ratio ranging from 3.7 to 35.4. Misdiagnosed ovarian cancer has been found in women with suspected ovarian endometriosis. For this reason serum tumor markers are being increasingly used for the differential diagnosis of adnexal masses. Among these markers CA125, which is a membrane glycoprotein produced by tissues derived from coelomic epithelium that is expressed by most epithelial ovarian cancers. CA 125 is overexpressed in 80% of ovarian cancers. CA 125 is frequently elevated in benign gynecological conditions. In endometriosis, CA 125 was elevated in 67% of cases. Thus, CA125 has a limited role in the differential diagnosis between endometriosis and ovarian cancer due to the lack of specificity. Another marker is a Human epididymis protein 4, or HE4, was discovered by Kirchhoff et al in 1991 and belongs to the-four disulfide core‖ family of proteins, which typically function as proteinase inhibitors. In endometriosis, CA 125 was elevated in 67% of cases, compared with 3% for HE4. A combination of CA 125 and HE4 was found to be a better predictor of malignancy than either marker alone. And another marker is a CA72-4 is a high molecular weight mucin-like glycoprotein first described by Colcher in 1981. It has been reported that this glycoprotein was elevated in a variety of malignancies, including gastrointestinal malignancies, ovarian malignancies, endometrium malignancies, lung malignancies. The aim of this study is to evaluate the role of the HE4, CA125, CA72-4 biomarkers for differential diagnosis between ovarian endometrioma and epithelial ovarian cancer. The study included thirty five patient with ovarian endometrioma, thirty five patient with epithelial ovarian cancer and thirty five controls. All samples were assessed for these biomarkers, CA125, HE4 and CA72-4 levels determined using ELISA technique. The statistical analysis was done. And diagnostic performance of these biomarkers as following: CA125 has AUC of 0.986, significant difference <0.001, when cut off >85.4 it has sensitivity of 91.43, specificity of 91.43, PPV of 91.4 and NPP 91.4. HE4 has AUC of 0.984, significant difference <0.001, when cut off >42 it has sensitivity of 91.43, specificity of 100.0, PPV of 100.0 and NPP 92.1. CA72-4 has AUC of 0.653, significant difference 0.027, when cut off >5.3 it has sensitivity of 65.71, specificity of 60.0, PPV of 88.5 and NPP 72.7