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Daoud E, Archer DF, Parazzini F, Herranz-Blanco B. Validation of an In Vitro Diagnostic Test for Endometriosis: Impact of Confounding Medical Conditions and Lesion Location. Int J Mol Sci 2024; 25:7667. [PMID: 39062909 PMCID: PMC11277503 DOI: 10.3390/ijms25147667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
With the aim to shorten the time for diagnosis and accelerate access to correct management, a non-invasive diagnostic test for endometriosis was developed and validated. The IVD test combines an ELISA test kit to quantify CA125 and BDNF concentrations in serum and a data treatment algorithm hosted in medical software processing results from the ELISA test and responses to six clinical variables. Serum samples and clinical variables extracted from psychometric questionnaires from 77 patients were collected from the Oxford Endometriosis CaRe Centre biobank (UK). Case/control classification was performed based on laparoscopy and histological verification of the excised lesions. Biomarkers serum concentrations and clinical variables were introduced to the software, which generates the qualitative diagnostic result ("positive" or "negative"). This test allowed the detection of 32% of cases with superficial endometriosis, which is an added value given the limited efficacy of existing imaging techniques. Even in the presence of various confounding medical conditions, the test maintained a specificity of 100%, supporting its suitability for use in patients with underlying medical conditions.
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Affiliation(s)
| | - David F. Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23407, USA;
| | - Fabio Parazzini
- Department of Clinical Science and Community Medicine, University of Milan, 20122 Milan, Italy;
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Fujimoto M, Kobayashi Y, Kuraoka K, Yoshiyama T, Shigematu H. A case of ductal carcinoma in situ (DCIS) with markedly elevated CA15-3 levels requiring 2 years of diagnosis. Surg Case Rep 2023; 9:209. [PMID: 38036933 PMCID: PMC10689309 DOI: 10.1186/s40792-023-01792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND CA15-3 is often elevated in breast cancer recurrence and rarely in ductal carcinoma in situ (DCIS). We report a case of DCIS with elevated CA15-3 levels, which was diagnosed after over 2 years of follow-up. CASE PRESENTATION A 74-year-old woman presented with a left-sided breast mass and pain. Redness, swelling, and induration were observed in the left breast. Ultrasonography revealed a non-mass lesion in the left 3 o'clock position, skin thickening, and axillary lymphadenopathy. Serum CA15-3 levels were markedly high at 640 U/mL, suggesting inflammatory breast cancer. However, biopsies showed no malignancy. We diagnosed chronic mastitis with elevated CA15-3 levels and followed up with magnetic resonance imaging and a biopsy, as needed. Finally, DCIS was diagnosed 27 months after the first visit. She underwent a left mastectomy and a sentinel lymph node biopsy; DCIS had spread 6.5 cm and was immunohistochemically positive for CA15-3. No metastasis was found in the lymph nodes, but incidental Hodgkin lymphoma was observed. Postoperative normalization of CA15-3 levels indicated that she had DCIS with elevated CA15-3 levels. The patient underwent chemotherapy for Hodgkin lymphoma postoperatively, and there was no evidence of recurrence 1 year after surgery. CONCLUSION High CA15-3 levels can also be observed in DCIS, indicating that CA15-3 should not be used solely in breast cancer staging.
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Affiliation(s)
- Mutsumi Fujimoto
- Department of Breast Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan.
| | - Yoshie Kobayashi
- Department of Breast Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan
| | - Kazuya Kuraoka
- Department of Diagnostic Pathology, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan
| | - Tomoyuki Yoshiyama
- Department of Breast Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan
| | - Hideo Shigematu
- Department of Breast Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023, Japan
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Lazim N, Elias MH, Sutaji Z, Abdul Karim AK, Abu MA, Ugusman A, Syafruddin SE, Mokhtar MH, Ahmad MF. Expression of HOXA10 Gene in Women with Endometriosis: A Systematic Review. Int J Mol Sci 2023; 24:12869. [PMID: 37629050 PMCID: PMC10454210 DOI: 10.3390/ijms241612869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
The homeobox A10 (HOXA10) gene is known to be related to endometriosis; however, due to a lack of knowledge/evidence in the pathogenesis of endometriosis, the mechanisms that link HOXA10 to endometriosis still need to be clarified. This review addresses the difference in the expression of the HOXA10 gene in endometriotic women versus non-endometriotic women across populations by country and discusses its influences on women's fertility. An organized search of electronic databases was conducted in Scopus, ScienceDirect, PubMed, and Web of Science. The keywords used were (HOXA10 OR "homeobox A10" OR PL OR HOX1 OR HOX1H OR HOX1.8) AND ("gene expression") AND (endometriosis). The initial search resulted in 623 articles, 10 of which were included in this review. All ten papers included in this study were rated fair in terms of the quality of the studies conducted. The expression of the HOXA10 gene was found to be downregulated in most studies. However, one study provided evidence of the downregulation and upregulation of HOXA10 gene expression due to the localization of endometriotic lesions. Measuring the expression of the HOXA10 gene in women is clinically essential to predicting endometriosis, endometrial receptivity, and the development of pinopodes in the endometrium during the luteal phase.
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Affiliation(s)
- Nurunnajah Lazim
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.L.); (M.H.E.); (Z.S.); (M.A.A.); (A.K.A.K.)
| | - Marjanu Hikmah Elias
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.L.); (M.H.E.); (Z.S.); (M.A.A.); (A.K.A.K.)
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia
| | - Zulazmi Sutaji
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.L.); (M.H.E.); (Z.S.); (M.A.A.); (A.K.A.K.)
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia
| | - Abdul Kadir Abdul Karim
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.L.); (M.H.E.); (Z.S.); (M.A.A.); (A.K.A.K.)
| | - Mohammad Azrai Abu
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.L.); (M.H.E.); (Z.S.); (M.A.A.); (A.K.A.K.)
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (A.U.); (M.H.M.)
| | - Saiful Effendi Syafruddin
- Medical Molecular Biology Institute, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Mohd Helmy Mokhtar
- Department of Physiology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (A.U.); (M.H.M.)
| | - Mohd Faizal Ahmad
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.L.); (M.H.E.); (Z.S.); (M.A.A.); (A.K.A.K.)
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Fujiwara S. Clinical perspectives of rare ovarian tumors: clear cell ovarian cancer. Jpn J Clin Oncol 2023; 53:664-672. [PMID: 37288485 DOI: 10.1093/jjco/hyad057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023] Open
Abstract
Ovarian clear cell carcinoma (OCCC) is a rare and distinct histological type of epithelial ovarian carcinoma in terms of its histopathological, clinical and genetic features. Patients with OCCC are younger and diagnosed at earlier stages than those with the most common histological type-high-grade serous carcinoma. Endometriosis is considered a direct precursor of OCCC. Based on preclinical data, the most frequent gene alternations in OCCC are mutations of AT-rich interaction domain 1A and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha. The prognosis of patients with early-stage OCCC is favorable, whereas patients at an advanced stage or who have the recurrent disease have a dismal prognosis due to OCCC's resistance to standard platinum-based chemotherapy. Despite a lower rate of response due to its resistance to standard platinum-based chemotherapy, the treatment strategy for OCCC resembles that of high-grade serous carcinoma, which includes aggressive cytoreductive surgery and adjuvant platinum-based chemotherapy. Alternative treatment strategies, including biological agents based on molecular characteristics specific to OCCC, are urgently needed. Furthermore, due to its rarity, well-designed collaborative international clinical trials are needed to improve oncologic outcomes and the quality of life in patients with OCCC.
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Affiliation(s)
- Satoe Fujiwara
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Herranz-Blanco B, Daoud E, Viganò P, García-Velasco JA, Colli E. Development and Validation of an Endometriosis Diagnostic Method Based on Serum Biomarkers and Clinical Variables. Biomolecules 2023; 13:1052. [PMID: 37509088 PMCID: PMC10377646 DOI: 10.3390/biom13071052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Endometriosis affects more than 10% of women of reproductive age, significantly impacting their quality of life. Diagnosis typically takes 4 to 11 years from symptom onset. The gold standard for diagnosing this disease, laparoscopy, is invasive, contributing to this delay in diagnosis. Two studies were conducted to develop a diagnostic test based on the combination of serum biomarkers and clinical variables. Study 1, the development study, aimed to: (i) confirm the ability of CA125, BDNF and clinical variables to differentiate between cases and controls, and (ii) develop a diagnostic algorithm based on these results. Study 2 validated the clinical performance of the developed in vitro diagnostic (IVD) test in diagnosing endometriosis. Serum samples and clinical variables extracted from psychometric questionnaires were obtained from the Oxford Endometriosis CaRe Centre biobank (UK). Case/control classification was performed based on laparoscopy and histological verification of the excised lesions. Studies 1 and 2 included n = 204 and n = 79 patients, respectively. Study 1 found a statistically significant difference between cases and controls for levels of both biomarkers. Of the assessed clinical variables from the patients' medical histories, six were found to be significantly different between endometriosis cases and controls. CA125, BDNF and these six clinical variables were combined into a multivariable prediction model. In Study 2, the IVD test demonstrated sensitivity and specificity values of 46.2% (25.5-66.8%) and 100% (86.7-100%), respectively. Due to its high specificity, this IVD test is a simple and accurate rule-in test for early disease identification, even in the presence of non-specific symptoms.
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Affiliation(s)
| | | | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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Georgievska J, Tofoski G, Dimitrov G, Daneva-Markova A, Jovanovska V, Dabeski D, Jovcevski S, Dzikova E, Atanasova A. The role of some inflammatory markers, cytokins and tumor markers in diagnosis of endometriosis. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Endometriosis is a multifactorial disease which etiopathogenesis has not been elucidated. One of the theories of etiopathogenesis is the inflammatory theory. Aims of the study: To develop a practical non-invasive test for the diagnosis of endometriosis by examining some inflammatory markers and cytokines; to compare the highly sensitive C-reactive protein (hsCRP), cytokines (interleukin-6-IL-6 and tumor necrotizing factor alpha) and the tumor marker cancer antigen 125 (CA-125) among healthy patients and patients with endometriosis; to determine the sensitivity and specificity of each biomarker separately in the diagnosis of endometriosis and to determine their role in the diagnosis of endometriosis. Materials and methods: In a prospective study conducted at the University Clinic for Gynecology and Obstetrics, Ss. Cyril and Methodius University in Skopje, North Macedonia 138 patients were included of a reproductive age between 18-50 years (83 with diagnosis endometriosis operated laparoscopically or with laparotomy) and a control group of 55 healthy women, in a period between 01.09.2018 to 01.05.2021. Serum levels of IL-6, TNF-α, hs-CRP and tumor marker CA-125 were evaluated in both groups. Results: Serum levels of CA-125, IL-6 and TNF-α and hs-CRP were significantly higher in patients with endometriosis compared to the control group. The surface under the ROC curve (AUC) for IL-6, CA-125, hs-CRP, and TNF-α has shown that as individual markers they all have a discriminatory capacity to diagnose patients with endometriosis. Conclusions: Results obtained in our study showed statistically significantly higher serum concentrations of CA-125, IL-6 and TNF-α and hs-CRP in patients with endometriosis compared to the control group of patients. However, none of these biomarkers showed a high sensitivity for diagnosis of endometriosis. It is necessary to find a panel combination of biomarkers with a high sensitivity of about 100% that will enable early diagnosis of endometriosis.
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Miyagi E, Arakawa N, Sakamaki K, Yokota NR, Yamanaka T, Yamada Y, Yamaguchi S, Nagao S, Hirashima Y, Kasamatsu Y, Kato H, Mogami T, Miyagi Y, Kobayashi H. Validation of tissue factor pathway inhibitor 2 as a specific biomarker for preoperative prediction of clear cell carcinoma of the ovary. Int J Clin Oncol 2021; 26:1336-1344. [PMID: 34009487 PMCID: PMC8213588 DOI: 10.1007/s10147-021-01914-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tissue factor pathway inhibitor 2 (TFPI2) is a novel serum biomarker that discriminates ovarian clear cell carcinoma (CCC) from borderline ovarian tumors (BOTs) and non-clear cell epithelial ovarian cancers (EOCs). Here, we examined the performance of TFPI2 for preoperative diagnosis of CCC. METHODS Serum samples were obtained preoperatively from patients with ovarian masses, who needed surgical treatment at five hospitals in Japan. The diagnostic powers of TFPI2 and cancer antigen 125 (CA125) serum levels to discriminate CCC from BOTs, other EOCs, and benign lesions were compared. RESULTS A total of 351 patients including 69 CCCs were analyzed. Serum TFPI2 levels were significantly higher in CCC patients (mean ± SD, 508.2 ± 812.0 pg/mL) than in patients with benign lesions (154.7 ± 46.5), BOTs (181 ± 95.5) and other EOCs (265.4 ± 289.1). TFPI2 had a high diagnostic specificity for CCC (79.5%). In patients with benign ovarian endometriosis, no patient was positive for TFPI2, but 71.4% (15/21) were CA125 positive. TFPI2 showed good performance in discriminating stage II-IV CCC from BOTs and other EOCs (AUC 0.815 for TFPI2 versus 0.505 for CA125) or endometriosis (AUC 0.957 for TFPI2 versus 0.748 for CA125). The diagnostic sensitivity of TFPI2 to discriminate CCC from BOTs and other EOCs was improved from 43.5 to 71.0% when combined with CA125. CONCLUSIONS High specificity of TFPI2 for preoperative detection of CCC was verified with the defined cutoff level of TFPI2 in clinical practice. TFPI2 and CA125 may contribute substantially to precise prediction of intractable CCC.
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Affiliation(s)
- Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Noriaki Arakawa
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Japan.,Division of Medicinal Safety Science, National Institute of Health Sciences, Kawasaki, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics, Center for Novel and Explanatory Clinical Trials (Y-NEXT), Yokohama, Japan.,Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Naho Ruiz Yokota
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Center for Novel and Explanatory Clinical Trials (Y-NEXT), Yokohama, Japan
| | - Yuki Yamada
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | | | - Shoji Nagao
- Department of Gynecology, Hyogo Cancer Center, Hyogo, Japan
| | | | - Yuka Kasamatsu
- Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Tae Mogami
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.,Department of Gynecology, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
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Tang T, Lai H, Huang X, Gu L, Shi H. Application of serum markers in diagnosis and staging of ovarian endometriosis. J Obstet Gynaecol Res 2021; 47:1441-1450. [PMID: 33448139 DOI: 10.1111/jog.14654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 12/01/2020] [Accepted: 12/26/2020] [Indexed: 12/21/2022]
Abstract
AIMS Laparoscopic surgery is widely used for diagnosing ovarian endometriosis but it has medical risks. This study explored the application of blood indicators in diagnosis and staging of ovarian endometriosis, aiming to develop a noninvasive diagnostic method. METHODS A total of 190 ovarian endometriosis patients were included in observation group, among these participants, 77 patients among them were stages I-II, and the rest 113 patients were stages III-IV, and a total of 103 healthy women as control group. Serum biochemical indexes, tumor markers, and cytokines levels in two groups were used for the diagnosis and staging of the disease. Area under the receiver operating characteristic (ROC) curve (AUC) predicted the value of individual and joint tests for indicators. RESULTS Biochemical indexes, namely, alkaline phosphatase (ALP), total protein (TP), and glucose (Glu) could distinguish patients from normal women; and that ALP and Glu could indicate disease staging. In tumor markers, alpha fetoprotein (AFP), carcinoembryonic antigen (CA) 125, CA199 and human epididymis protein 4 (HE4) helped to diagnose endometriosis; CA125, HE4, and cytokeratin 19 fragment (CYFRA21-1) could differentiate stages. In cytokines, vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF)-α, interleukin (IL)-6, soluble fms-like tyrosine kinase receptor 1 (sflt-1), monocyte chemoattractant protein (MCP)-1 therefore, have values to diagnose endometriosis; VEGF, TNF-α, IL-6, and sflt-1 helped to differentiate disease staging. CONCLUSION Serological indicators in ovarian endometriosis patients were different from healthy women, which were of certain differential values in diagnosis and disease staging. The current study provided a novel strategy for endometriosis diagnosis.
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Affiliation(s)
- Ting Tang
- Department of Gynaecology, Ganzhou People's Hospital of Jiangxi Province, Ganzhou, China
| | - Huichao Lai
- Department of Gynaecology, Ganzhou People's Hospital of Jiangxi Province, Ganzhou, China
| | - Xuemei Huang
- Department of Gynaecology, Ganzhou People's Hospital of Jiangxi Province, Ganzhou, China
| | - Liqin Gu
- Department of Gynaecology, Ganzhou People's Hospital of Jiangxi Province, Ganzhou, China
| | - Haiying Shi
- Department of Assisted Reproduction, Ganzhou People's Hospital of Jiangxi Province, Ganzhou, China
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The Diagnostic Accuracy of Combined Enolase/Cr, CA125, and CA19-9 in the Detection of Endometriosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5208279. [PMID: 33062681 PMCID: PMC7545435 DOI: 10.1155/2020/5208279] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/03/2020] [Accepted: 07/28/2020] [Indexed: 01/01/2023]
Abstract
Background The present study was designed to verify the accuracy of the noninvasive biomarkers enolase/Cr, CA125, and CA19-9 as a clinical diagnostic tool for the detection of endometriosis. Methods A cross-sectional study was performed at Rasool-e-Akram Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2018. Eighty-six women were scheduled to undergo laparoscopy due to chronic pelvic pain, infertility, pelvic mass, and abnormal uterine bleeding. Serum and urine samples of all patients were collected preoperatively. Serum levels of CA125 and CA19-9, and urine levels of enolase-1 were measured. Serum levels of CA125 and CA19-9 were determined by the electrochemiluminescence method (ECL). Urinary enolase-1 was measured by the ELISA method. Result Serum levels of CA125 and CA19-9 were significantly higher in the endometriosis group than in controls (p < 0.001, p = 0.004, respectively). Levels of enolase I and enolase/Cr were higher in patients with endometriosis, but the differences were not statistically significant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined enolase/Cr, CA125, and CA19-9 were 65%, 66.6%, 71%, and 60.1%, respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of combined enolase/Cr, CA125, and CA19-9 was 1.94 and 0.52, respectively. The area under the ROC curve for enolase/Cr + CA125 + CA19 - 9 was 0.675 (95% confidence interval 0.573-0.710). Conclusion The present study revealed that concurrent measurement of enolase-1, CA125, and CA19-9 might be a valuable noninvasive test for the identification of endometriosis.
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10
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Sasamoto N, DePari M, Vitonis AF, Laufer MR, Missmer SA, Shafrir AL, Terry KL. Evaluation of CA125 in relation to pain symptoms among adolescents and young adult women with and without surgically-confirmed endometriosis. PLoS One 2020; 15:e0238043. [PMID: 32833998 PMCID: PMC7444809 DOI: 10.1371/journal.pone.0238043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is a painful gynecologic disease affecting one in ten reproductive aged women worldwide. Few studies have correlated this symptomatology with biomarker levels among women with and without endometriosis, and no studies correlating pain with biomarker levels have been performed in young patient populations. The purpose of this study was to examine whether CA125 correlates with different types and severity of pain among adolescents and young women with and without endometriosis and assess its performance as an endometriosis biomarker among those presenting with dysmenorrhea in this young population. Reproductive-aged women with laparoscopically-confirmed endometriosis (n = 282) and controls (n = 293) who participated in The Women's Health Study: From Adolescence to Adulthood (A2A), a cohort of adolescents and young women enrolled from 2012-2018, were included in this cross-sectional analysis. Plasma CA125 values were measured using WERF EPHect compliant blood samples collected at enrollment. Average CA125 were calculated by self-reported pain type (i.e. dysmenorrhea, non-cyclic/general pelvic pain, dyspareunia), severity, and frequency in endometriosis cases and controls. Median age at blood draw was 24 years in controls and 17 years in cases, with 68% and 89% non-Hispanic white, respectively. Most endometriosis cases (95%) were rASRM stage I/II. Average CA125 values were 12.5 U/mL in controls and 12.1 U/mL in cases adjusted for age. CA125 did not differ by pain type, its severity, or frequency in endometriosis cases or controls. Among participants who reported dysmenorrhea, CA125 did not discriminate endometriosis cases from controls using cutoff of 35 U/mL (AUC = 0.51, 95%CI = 0.50-0.53). Among adolescents and young adult women, CA125 did not correlate with pain type. CA125 did not efficiently discriminate endometriosis cases from controls even when accounting for pain symptomatology. Average CA125 values were low in adolescents and young women in both endometriosis cases and controls, suggesting cautious interpretation may be needed when measuring CA125 in this population.
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Affiliation(s)
- Naoko Sasamoto
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Mary DePari
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Allison F. Vitonis
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marc R. Laufer
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stacey A. Missmer
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
- Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amy L. Shafrir
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kathryn L. Terry
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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11
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Zhou CF, Liu MJ, Wang W, Wu S, Huang YX, Chen GB, Liu LM, Peng DX, Wang XF, Cai XZ, Li XX, Feng WQ, Ma Y. miR-205-5p inhibits human endometriosis progression by targeting ANGPT2 in endometrial stromal cells. Stem Cell Res Ther 2019; 10:287. [PMID: 31547870 PMCID: PMC6757391 DOI: 10.1186/s13287-019-1388-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/21/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND miRNA expression profiles in ectopic endometrium (EC) serving as pathophysiologic genetic fingerprints contribute to determining endometriosis progression; however, the underlying molecular mechanisms remain unknown. METHODS miRNA microarray analysis was used to determine the expression profiling of EC fresh tissues. qRT-PCR was performed to screen miR-205-5p expression in EC tissues. The roles of miR-205-5p and its candidate target gene, angiopoietin-2 (ANGPT2), in endometriosis progression were confirmed on the basis of both in vitro and in vivo systems. miR-205-5p and ANGPT2 expression were measured by in situ hybridization and immunochemistry, and their clinical significance was statistically analysed. RESULTS miR-205-5p was screened as a novel suppressor of endometriosis through primary ectopic endometrial stromal cell migration, invasion, and apoptosis assay in vitro, along with endometrial-like xenograft growth and apoptosis in vivo. In addition, ANGPT2 was identified as a direct target of miR-205-5p through bioinformatic target prediction and luciferase reporter assay. Re-expression and knockdown of ANGPT2 could respectively rescue and simulate the effects induced by miR-205-5p. Importantly, the miR-205-5p-ANGPT2 axis was found to activate the ERK/AKT pathway in endometriosis. Finally, miR-205-5p and ANGPT2 expression were closely correlated with the endometriosis severity. CONCLUSION The newly identified miR-205-5p-ANGPT2-AKT/ERK axis illustrates the molecular mechanism of endometriosis progression and may represent a novel diagnostic biomarker and therapeutic target for disease treatment.
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Affiliation(s)
- Chen-Fei Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Min-Juan Liu
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Sha Wu
- Department of Immunology/Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yu-Xin Huang
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Guo-Bin Chen
- Department of Obstetrics and Gynecology, Shenzhen Maternal and Child Healthcare Hospital of Southern Medical University, Shenzhen, 518028, China
| | - Li-Min Liu
- Department of Obstetrics and Gynecology, Shenzhen Maternal and Child Healthcare Hospital of Southern Medical University, Shenzhen, 518028, China
| | - Dong-Xian Peng
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Xue-Feng Wang
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Xu-Zi Cai
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Xiao-Xuan Li
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Wan-Qin Feng
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China
| | - Ying Ma
- Department of Obstetrics and Gynecology, Zhujiang Hospital of Southern Medical University, No.253, Middle Gongyeda Road, Haizhu District, Guangzhou, 510280, China.
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12
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Cho MC, Kim JH, Jung MH, Cho IA, Jo HC, Shin JK, Lee SA, Choi WJ, Lee JH. Analysis of vitamin D-binding protein (VDBP) gene polymorphisms in Korean women with and without endometriosis. Clin Exp Reprod Med 2019; 46:132-139. [PMID: 31405270 PMCID: PMC6736509 DOI: 10.5653/cerm.2019.00122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Vitamin D-binding protein (VDBP) mediates various biological processes in humans. The goal of this study was to investigate whether VDBP gene polymorphisms could predispose Korean women to endometriosis. METHODS We prospectively enrolled women with endometriosis (n = 16) and healthy controls (n = 16). Total serum 25-hydroxyl vitamin D (25(OH)D) concentrations were measured using an Elecsys vitamin D total kit. Levels of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using a vitamin D BP Quantikine ELISA kit. DNA was extracted using a DNeasy blood & tissue kit. Two singlenucleotide polymorphisms (SNPs; rs4588 and rs7041) in GC, the gene that codes for VDBP, were analyzed using a TaqMan SNP genotyping assay kit. The functional variant of VDBP was determined based on the results of the two SNPs. RESULTS Gravidity and parity were significantly lower in the endometriosis patients than in the control group, but serum CA-125 levels and the erythrocyte sedimentation rate were significantly higher. Total serum 25(OH)D levels in the endometriosis patients were significantly lower than in the control group. However, serum bioavailable 25(OH)D, free 25(OH)D, and VDBP levels did not differ significantly between the endometriosis and control groups. The genotypes and allele frequencies of GC were similar in both groups. CONCLUSION Korean women with endometriosis had lower total serum 25(OH)D concentrations than controls. Neither serum VDBP concentrations nor polymorphisms in the gene coding for VDBP were associated with endometriosis. Further studies are needed to investigate the pathophysiology and clinical implications of 25(OH)D and VDBP in endometriosis.
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Affiliation(s)
- Min-Chul Cho
- Department of Laboratory Medicine, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jin Hyun Kim
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - Myeong Hee Jung
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyen Chul Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Kyu Shin
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju, Korea
| | - Soon Ae Lee
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju, Korea
| | - Won Jun Choi
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jong Hak Lee
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju, Korea
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13
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Baek JC, Jo JY, Lee SM, Cho IA, Shin JK, Lee SA, Lee JH, Cho MC, Choi WJ. Differences in 25-hydroxy vitamin D and vitamin D-binding protein concentrations according to the severity of endometriosis. Clin Exp Reprod Med 2019; 46:125-131. [PMID: 31370113 PMCID: PMC6736508 DOI: 10.5653/cerm.2018.00416] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 05/10/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease. Methods Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed. Results Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12–3.63; p= 0.040). Conclusion These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.
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Affiliation(s)
- Jong Chul Baek
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Yoon Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea
| | - Seon Mi Lee
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jeong Kyu Shin
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Soon Ae Lee
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jong Hak Lee
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Min-Chul Cho
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Won Jun Choi
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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14
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Knific T, Vouk K, Vogler A, Osredkar J, Gstöttner M, Wenzl R, Rižner TL. Models including serum CA-125, BMI, cyst pathology, dysmenorrhea or dyspareunia for diagnosis of endometriosis. Biomark Med 2018; 12:737-747. [PMID: 29865858 DOI: 10.2217/bmm-2017-0426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate preoperative levels of CA-125 and HE4 in patients with endometriosis-like symptoms and to construct diagnostic models. PATIENTS Prospective case-control study included 124 endometriosis patients and 97 control patients. MATERIALS & METHODS Logistic regression was used to construct diagnostic models based on serum biomarker levels and clinical data. RESULTS A model with CA-125, BMI, information on cysts and dyspareunia had an area under the curve value of 0.836, sensitivity of 74.0% and specificity of 81.3%. The second model included CA-125, BMI, information on cysts and dysmenorrhea and had an area under the curve value of 0.819, sensitivity of 74.8% and specificity of 79.2%. CONCLUSION Constructed models have the potential for noninvasive diagnosis of endometriosis, and might be translated into clinical practice after additional validation.
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Affiliation(s)
- Tamara Knific
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Katja Vouk
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Andrej Vogler
- Department of Obstetrics & Gynaecology, University Medical Centre Ljubljana, Slovenia
| | - Joško Osredkar
- Clinical Institute of Clinical Chemistry & Biochemistry, University Medical Centre Ljubljana, Slovenia
| | - Manuela Gstöttner
- Department of Obstetrics & Gynaecology, Medical University Vienna, Austria
| | - René Wenzl
- Department of Obstetrics & Gynaecology, Medical University Vienna, Austria
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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15
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Lee JH, Song JY, Yi KW, Lee SR, Lee DY, Shin JH, Cho S, Seo SK, Kim SH. Effectiveness of Dienogest for Treatment of Recurrent Endometriosis: Multicenter Data. Reprod Sci 2018; 25:1515-1522. [DOI: 10.1177/1933719118779733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jae Hoon Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea
| | - SiHyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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16
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Dai Y, Li X, Shi J, Leng J. A review of the risk factors, genetics and treatment of endometriosis in Chinese women: a comparative update. Reprod Health 2018; 15:82. [PMID: 29783992 PMCID: PMC5963030 DOI: 10.1186/s12978-018-0506-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/11/2018] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is one of the major causes of economic burden and compromised quality of life in a very large percentage of Asian women. While it is perceived as a benign condition, recent research has shown that it may be a significant cause of infertility and metastatic cancer. It has also been associated with other diseases linked to the functioning of the immune system. Genetic as well as environmental factors are known to affect the manifestation and progression of endometriosis. This review aims to summarize recent research pertaining to the risk factors, diagnosis and treatment of endometriosis in Chinese women. It also provides an overview of identified genetic mutations and polymorphisms and their effects on the risk of developing endometriosis in the Chinese population. A comparison has been drawn between Asian and European-American female populations and the differences in risk factors and treatment responses have been summarized. Since traditional Chinese medicine (TCM) is often used to treat endometriosis, wherever possible, a comparison between efficacies of Western medicine and TCM in the Chinese population has also been provided. Although much progress has been made in the treatment and resolution of endometriosis, several gaps remain and this review also highlights possible areas of future research and advancement that can result in an improvement in patient outcomes and quality of life.
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Affiliation(s)
- Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
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17
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Chew KT, Zakaria IA, Abu MA, Ahmad MF, Hing EY, Abdul Ghani NA. Elevated serum CA 19-9 with adnexal mass: is it always an ovarian malignancy? Horm Mol Biol Clin Investig 2018; 34:/j/hmbci.ahead-of-print/hmbci-2018-0011/hmbci-2018-0011.xml. [PMID: 29584612 DOI: 10.1515/hmbci-2018-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
Endometriotic cysts a common benign gynaecological disease in women of reproductive age. We report an unusual case of ruptured endometrioma associated with increased CA 19-9. A 27-year-old woman presented with an acute abdomenal adnexal mass and elevated CA 19-9. The initial diagnosis of ovarian malignancy turned out to be a ruptured endometrioma, confirmed during surgery and in the histopathological report.
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Affiliation(s)
- Kah Teik Chew
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia, Phone: +603-91455956
| | - Izyan Atiqah Zakaria
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Muhammad Azrai Abu
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Mohd Faizal Ahmad
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Erica Yee Hing
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Nur Azurah Abdul Ghani
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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18
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Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma. Obstet Gynecol Sci 2017; 61:111-117. [PMID: 29372157 PMCID: PMC5780305 DOI: 10.5468/ogs.2018.61.1.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 12/20/2022] Open
Abstract
Objective Endometriosis is a common and recurring gynecologic disease which have afflicting females of reproductive age. We investigated the efficacy of long-term, post-operative use of dienogest for ovarian endometrioma. Methods We studied 203 patients who had undergone laparoscopic or robotic surgery for ovarian endometrioma, and were administrated dienogest 2 mg/day beginning in July of 2013, and continuing. We evaluated side effects of dienogest and ultrasonography was performed every 6 months to detect potential recurrence of endometrioma (2 cm) in these post-surgical patients. Results The follow-up observation periods were 30.2±20.9 months from surgery. The mean age was 34.1±7.2 years old. The mean diameter of pre-operative endometrioma was 5.6±3.0 cm2. One hundred eighty-two (89.7%) women received dienogest continuously for 12.0±7.1 months. Of the subjects, 21 (10.3%) patients discontinued dienogest at 2.4±1.0 months. The most common side effect when dienogest was discontinued was abnormal uterine bleeding. The occurrence rate of vaginal bleeding was 15.8%, a number which did not differ significantly in patients with/without post-operative gonadotropin releasing hormone agonist administration. The other side effects were gastrointestinal trouble including constipation, acne, headache, depression, hot flush, weight gain, and edema. However, no serious adverse events or side effects were documented and recurrent endometriomas were diagnosed in 3 patients (1.5%). Conclusion The data indicates that dienogest was both tolerable and safe for long-term use as prophylaxis in an effort to obviate the recurrence of ovarian endometrioma post-operatively, as well as potential need for surgical re-intervention.
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19
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Hirsch M, Duffy J, Davis CJ, Nieves Plana M, Khan KS. Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis. BJOG 2016; 123:1761-8. [PMID: 27173590 DOI: 10.1111/1471-0528.14055] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The development of a non-invasive and accurate diagnostic biomarker for endometriosis is urgently needed. OBJECTIVE Evaluate the diagnostic accuracy of serum cancer antigen 125 (CA 125) for endometriosis. SEARCH STRATEGY We searched EMBASE, MEDLINE, and Web of Science from inception to January 2016. SELECTION CRITERIA Diagnostic accuracy studies of serum CA 125 (index test) for histologically confirmed endometriosis (reference standard) were included. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, extracted study characteristics and data. Methodological quality was assessed using Quality Assessment of Comparative Diagnostic Accuracy Studies (QUADAS-2) checklist. MAIN RESULTS Twenty-two studies (16 cohort, six case-control), 3626 participants, were identified. Bivariate hierarchical models were used to pool accuracy data of 14 studies (2920 participants) using CA 125 ≥ 30 units/ml. Pooled specificity was 93% (95% CI 89-95%) and sensitivity 52% (95% CI 38-66%). CA 125 was significantly more sensitive for the diagnosis of moderate or severe endometriosis compared with minimal disease (63%, 95% CI 47-77% versus 24%, 95%CI 19-32%, P-value = 0.001). CONCLUSIONS CA 125 performs well as a rule-in test facilitating expedited diagnosis and ensuring investigation and treatment can be confidently tailored for the management of endometriosis. Unfortunately, a negative test, CA 125 < 30 units/ml, is unable to rule out endometriosis. TWEETABLE ABSTRACT Blood test CA 125: a rule-in test for the diagnosis of women presenting with symptoms of endometriosis.
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Affiliation(s)
- M Hirsch
- Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
| | - Jmn Duffy
- Balliol College, University of Oxford, Oxford, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - C J Davis
- Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - M Nieves Plana
- Madrid Cochrane Collaboration Centre, Francisco de Vitoria University, Madrid, Spain.,Clinical Biostatistics Unit, Ramon y Cajal Institute of Research (IRYCIS) and CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - K S Khan
- Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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20
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Dai X, Jin C, Hu Y, Zhang Q, Yan X, Zhu F, Lin F. High CA-125 and CA19-9 levels in spontaneous ruptured ovarian endometriomas. Clin Chim Acta 2015; 450:362-5. [PMID: 26403090 DOI: 10.1016/j.cca.2015.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/16/2015] [Accepted: 09/19/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate the clinical significance of serum CA-125 and CA19-9 in women with spontaneous ruptured ovarian endometriomas. METHODS From January 2006 to April 2015, a total of 1653 women were diagnosed with ovarian endometriomas, and 43 women were diagnosed with the spontaneous rupture of their ovarian endometrioma. In addition, 70 women diagnosed with unruptured ovarian endometriomas were chosen to serve as control subjects. Serum CA-125 and CA19-9 levels, together with the clinical materials, were collected. RESULTS Serum CA-125, CA19-9, and the combined biomarkers were shown to be obviously elevated in the spontaneous ruptured ovarian endometrioma group (p=0.001, p=0.001, p=0.001, respectively). The AUC value for the combined biomarkers was 0.992 (95% CI, 0.981-1.000), with a high sensitivity and specificity of nearly 100% and 93.6%, respectively. Moreover, the maximum diameter of the mass was significantly (p=0.001) increased in the ruptured group. CONCLUSIONS Serum CA-125 and CA19-9 were significantly increased in patients with spontaneous ruptured ovarian endometriomas. Moreover, the combined biomarkers were better than either CA-125 or CA19-9 alone in the diagnosis of a spontaneous rupture of the ovarian endometrioma.
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Affiliation(s)
- Xinyue Dai
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China
| | - Chu Jin
- The Department of Information and Engineering, Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China
| | - Yan Hu
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China
| | - Qian Zhang
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China
| | - Xiaojian Yan
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China
| | - Fangfang Zhu
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China
| | - Feng Lin
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China.
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