الفهرس 
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Abstract
Endometriosis, an estrogen dependent gynecologic
disorder, affects 10% to 15% women of reproductive age from
all ethnic and social groups. Endometriosis is defined as the
presence of endometrial-like tissue outside the uterine cavity.
The degree of endometriosis is staged according to the
classification system of the American Society of Reproductive
Medicine into minimal, mild, moderate, and severe disease
(Fassbender et al., 2013).
Endometriosis can be associated with infertility and/or
pain symptoms, including cyclic pelvic pain, dysmenorrhea,
dyspareunia, dysuria, and dyschezia (Sinaii et al., 2008).
Endometriosis-associated pain can be caused by peritoneal
inflammation, adhesion formation, and specific innervations of
endometriotic lesions and is correlated with the presence of
deep infiltrating disease (Fassbender et al., 2013).
Transvaginal ultrasound (TVU) is an adequate
diagnostic method to detect ovarian endometriotic cysts but
does not rule out peritoneal endometriosis, endometriosisassociated
adhesions, or some locations of deep infiltrating endometriosis (DIE) (Kennedy et al., 2005). Furthermore,
routine vaginal examination alone may be insufficient to detect
endometriosis before laparoscopy (Hudelist et al., 2011).
The gold standard for diagnosis of endometriosis is
laparoscopic inspection with histologic confirmation after
retrieval of lesions (Kennedy et al., 2005). However,
laparoscopy is a surgical procedure with rare but significant
potential risks for the patients (Slack et al., 2007).
The diagnosis of endometriosis is difficult because of
non-specific symptoms, late presentation and the use of
laparoscopy, which is limited by available funding, the
surgeon’s experience, and human error, including missing nonspecific
lesions. The development of a simple blood test as a
marker for screening patients at risk for endometriosis would
reduce the number of unnecessary interventions and would
therefore be very useful (Fassbender et al., 2013).
In an effort to find a less-invasive method for
diagnosing endometriosis, and based on the fact that
endometriosis induces a local, and likely also a systemic,
inflammatory process, numerous studies have focused on markers of inflammation in the peritoneal fluid and/or serum
of women who have the disease (Seeber et al., 2008).
A non-invasive test for endometriosis would be useful
for the early detection of endometriosis in symptomatic
women who have pelvic pain and/or subfertility with normal
ultrasound results. This would include nearly all cases of
minimal-to-mild endometriosis, some cases of moderate-tosevere
endometriosis without a clearly visible ovarian
endometrioma, and cases with pelvic adhesions and/or other
pelvic pathology that might benefit from surgery to improve
pelvic pain and/or subfertility (Fassbender et al., 2013).
As endometriosis can be progressive in up to 50% of
women, early noninvasive diagnosis has the potential to offer
early treatment and prevent progression (Fassbender et al.,
2013).
Early non-invasive diagnosis of minimal–mild
endometriosis in women who try to conceive should enable
gynaecologists to select these women for laparoscopic excision
of endometriosis which improves fertility and may prevent
progression of endometriosis to a moderate-to-severe stage
(Mihalyi et al., 2010). The most important goal of the test is that no women
with endometriosis or other significant pelvic pathology, who
might benefit from laparoscopic surgery, are missed
(D’Hooghe et al., 2006). To achieve this, a test with a high
sensitivity is needed (Fassbender et al., 2013).
The aim of the current study was to assess the validity
of serum and peritoneal CA125, CA19.9 and plasma cell-free
nuclear DNA (ccf nDNA) as biomarkers in early diagnosis of
pelvic endometriosis.
In the current study, all biomarkers showed high
significance in comparison between the endometriosis group
and the control group. ROC curve analysis was done and a cutoff
value was set for each marker at which the highest
sensitivity and specificity were figured out.
We concluded that, serum CA125, serum CA19-9,
peritoneal CA125, peritoneal CA19-9 and plasma cell free
nuclear DNA are highly reliable biomarkers for screening and
early diagnosis of endometriosis, but they can not be used to
discriminate between stage I and stage II.