Il laboratorio nella patologia ginecologica

Laboratory role in gynecological diagnosis: fisiological and pathological conditions. Laboratory investigations play a fundamental role in assessing the pathophysiology of the reproductive system during all woman's life. To investigate the integrity of the hormonal status, the correct course of pregnancy, and fertility it is in fact necessary to analyze different blood analytes, particularly hormones and biomarkers. The evaluation of AMH and CA125 serum levels is essential in the diagnostic process and in the evaluation of treatment response of frequent and important gynecological disorders such as polycystic ovary syndrome and endometriosis. Determining serum markers is also a effective tool in the differential diagnosis of pelvic masses and in the early diagnosis of gynecological malignancies, especially for ovarian carcinoma, which is the one with the highest mortality rate among these. The most used and valid tumor markers are CA125 and HE4, currently approved by the FDA. CA125, the first to be used and recommended in the follow-up, unfortunately is affected by several physiopathological variables that limit its specificity in the early detection of ovarian carcinoma. HE4 has exhibited better diagnostic performance than CA125 in the differential and early diagnosis of ovarian cancer, and recent studies have also shown a pathogenetic, prognostic and monitoring role in this neoplasia. To date, the combined evaluation of HE4 and CA125 serum concentrations and the utilization of diagnostic algorithms can also provide important and valuable information for the differential diagnosis between ovarian and benign gynecological diseases. For the same purpose, new biological matrices and new molecular markers are presently being studied. We can therefore affirm that the laboratory represents one of the fundamental tools used in the management of gynecological patients, and a valid aid within a multidisciplinary team in the context of the correct setting of the diagnosis and therapeutic and monitoring programs.