The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis.

OBJECTIVE To assess the diagnostic performance of serum CA-125 measurement in the detection of endometriosis. DESIGN Meta-analysis. SETTING AND PATIENT(S) Twenty-three studies comparing serum CA-125 levels and laparoscopically confirmed endometriosis. INTERVENTION(S) Serum CA-125 measurement and laparoscopy. MAIN OUTCOME MEASURE(S) Sensitivity and specificity of serum CA-125 measurement in the diagnosis of endometriosis with laparoscopy as the reference standard. RESULT(S) The estimated summary receiver operating characteristic curves showed that the performance of serum CA-125 measurement in the diagnosis of endometriosis grade I/IV is limited, whereas its performance in the diagnosis of endometriosis grade III/IV is better. CONCLUSION(S) Despite its limited diagnostic performance, we believe that the routine use of serum CA-125 measurement in patients with infertility might be justified. In contrast to laparoscopy, serum CA-125 measurement is an inexpensive test that is not a burden for the patient. It could identify a subgroup of patients who are more likely to benefit from early laparoscopy. Studies reporting on the mutual dependence between serum CA-125 measurement and data from the history and physical examination are needed.