Comparative study between VEGF-A and CA-125 in diagnosis and follow-up of advanced endometriosis after conservative laparoscopic surgery

To evaluate the role of serum level of VEGF-A in comparison to CA-125 in diagnosis and follow-up of patients with advanced endometriosis after conservative laparoscopic surgery. A prospective randomized case-control study was performed on patients referred for laparoscopy complaining of unexplained primary infertility with or without chronic pelvic pain. Thirty patients with advanced endometriosis; stage III-IV were included (study group), another 30 women without endometriosis or any other medical conditions were settled as a control group. Pre-operative blood samples were collected from study and control cases. Post-operative blood samples were collected from 25 treated patients in the follicular phase of the third menstrual cycle; 5 cases were drop-outs. Serum level of cancer antigen-125 (CA-125) and vascular endothelial growth factor (VEGF-A) were assayed by using enzyme linked immunosorbent assay (ELISA) kit. There was a statistically significant difference in serum CA-125 and VEGF-A level in patients with advanced endometriosis before conservative laparoscopic surgery and those without endometriosis (p < 0.001) and after conservative laparoscopic surgery (p < 0.001). High sensitivity (93.3 \%), specificity (96.7 \%) and accuracy (95.0 \%) of VEGF-A assay than in CA-125 distinguishing between patients with endometriosis from those without endometriosis; CA-125 has 70.0 \%sensitivity, 90.0 \% specificity and 85.0 \% accuracy. Percentage of decrease of VEGF-A level after operation was higher than that of CA-125 (45.9 vs. 25.8 \%) p < 0.001, respectively. The use of VEGF-A for diagnosis of advanced endometriosis at cut-off 680 pg/ml and for follow-up is better than CA-125.