Diagnostic value of non-invasive markers in the diagnosis of endometriosis (original study)

Background. One of the key challenges in modern gynecology remains the diagnostic delay in endometriosis, which averages 7 to 12 years from the onset of first symptoms to the establishment of the diagnosis. This delay is primarily due to the polymorphism of clinical manifestations, insufficient awareness among primary care physicians, and the operator-dependent nature of imaging methods, particularly in deep infiltrating forms of the disease, where a high correlation between radiological descriptions and surgical findings is mainly achieved in specialized centers. Objective. To assess the significance of clinical predictors (dysmenorrhea, severe pain ≥7 on the visual analogue scale [VAS], dyspareunia, and reproductive disorders) and the laboratory marker CA-125 in identifying patients at risk for deep infiltrating endometriosis (DIE). Materials and Methods. A single-center study was conducted including 86 women of reproductive age (18—42 years) with a clinical suspicion of endometriosis. The diagnosis was confirmed surgically. Two groups were formed: patients with ovarian endometriosis combined with deep infiltrating endometriosis (n=23) and patients with ovarian endometriosis without deep forms (n=63). Results. In the overall cohort, dysmenorrhea was present in 81.3% of patients, severe pain ≥7 on the VAS in 46.5%, and dyspareunia in 38.3%. The mean serum CA-125 level was 55.2 U/ml. These features were more frequently observed in patients with deep infiltrating endometriosis, supporting their role as markers for referral to expert imaging modalities and specialized endometriosis centers. Conclusion. The integration of clinical predictors with CA-125 measurement represents a simple and practical tool for the early identification of patients at high risk of deep infiltrating endometriosis. This approach may help reduce diagnostic delays and ensure timely selection of optimal management strategies.