Endometrial alterations in endometriosis: a systematic review of putative biomarkers
Abstract
BACKGROUND: Endometriosis is usually diagnosed by an invasive procedure such as a laparoscopy. Great interest therefore lies in the potential to identify biomarkers which may be surrogates of disease presence or activity, especially relating to the effects of therapy. We have reviewed the existing literature on endometrial differences in women with endometriosis, and assess their potential use as disease biomarkers. METHODS: We used QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria to conduct a systematic review of published papers over the past 25 years on the subject of endometrial differences in endometriosis. We searched for all studies assessing differences between eutopic endometrium of women with and without endometriosis. RESULTS: We identified 182 relevant articles that are summarized in the review. These studies assess over 200 potential biomarkers, including hormones and their receptors (n = 29), cytokines (n = 25), factors identified using proteomics (n = 8) and histological analysis (n = 10) of endometrial tissue. Sensitivity and specificity were reported or could be calculated for only 32 articles, and ranged from 0 to 100%. Of the nine highest quality studies, six identified putative biomarkers related to nerve fibre growth or cell cycle control, highlighting these areas as promising candidates for future biomarker research. CONCLUSIONS: This systematic review identified several reports of endometrial differences which have the potential to be biomarkers of endometriosis. However, larger studies in well-defined populations are clearly required to determine their true usefulness.
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Array-based global and targeted gene expression studies have identified genes and pathways that may be involved in disease pathogenesis and reveal potential candidates for the development of an endometrial-based biomarker.
“Both array-based global and targeted gene expression studies [113] have identified genes and pathways that may be involved in disease pathogenesis and reveal potential candidates for the development of an endometrial-based biomarker.”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [113]
A systematic review of over 200 potential endometrial biomarkers revealed sensitivity and specificity ranging from 0 to 100%, with sensitivity and specificity reported in only 32 articles.
“A systematic review of over 200 potential endometrial biomarkers, including hormones and their receptors (n = 29), cytokines (n = 25), factors identified through proteomics (n = 8), and histology (n = 10) revealed sensitivity and specificity (reported in only 32 articles) ranging from 0 to 100% [113].”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [113]
The adoption of validated, internationally agreed upon standard operating procedures (SOPs) for tissue sample collection, processing and storage, and standardized phenotypic and other patient data collection, are crucial to optimise sample quality, reduce variability, and enable cross-centre studies.
“The adoption of validated, internationally agreed upon standard operating procedures (SOPs) for tissue sample collection, processing and storage, and standardized phenotypic and other patient data collection, are crucial to optimise sample quality, reduce variability, and enable cross-centre studies [17, 113, 148].”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [113]
A recent systematic review of 182 relevant articles that assessed over 200 potential biomarkers identified several reports of endometrial differences which have the potential to be biomarkers for endometriosis.
“A recent systematic review of 182 relevant articles that assessed over 200 potential biomarkers identified several reports of endometrial differences which have the potential to be biomarkers for endometriosis.”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [18]
The authors of that systematic review concluded that larger studies in well-defined populations are required to determine the true usefulness of endometrial biomarkers.
“However, the authors concluded that larger studies in well-defined populations are required to determine their true usefulness.18”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [18]
One immediate consequence of reframing endometriosis as a neuropathic/inflammatory pain condition would be to reinforce the urgency of developing strategies for earlier diagnosis of endometriosis as well as treatment of its associated pain before that pain can become chronic and other painful co-morbid conditions arise.
“Thus, one immediate consequence of reframing endometriosis as a neuropathic/inflammatory pain condition would be to reinforce the urgency of developing strategies for earlier diagnosis of endometriosis [30], [31] as well as treatment of its associated pain (e.g., dysmenorrhea) before that pain can become chronic and other painful co-morbid conditions arise.”
From Sprouted Innervation into Uterine Transplants Contributes to the Development of Hyperalgesia in a Rat Model of Endometriosis (2012) · cites this paper as [31]
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ESHRE guideline: management of women with endometriosis
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Self-citationESHRE guideline: endometriosis
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“…measurement of biomarkers in endometrial tissue, blood, menstrual or uterine fluids to diagnose endometriosis (Mol et al. , 1998; May et al. , 2010; May et al. , 2011; Liu et al. , 2015; Cosar et al. , 2016; Gupta et al. , 2016; Hirsch et al. , 2016; Nisenblat et al. , 2016a; Vanhie et al. ,…”
Self-citationPathogenesis and pathophysiology of endometriosis
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Aberrant Endometrial DNA Methylome and Associated Gene Expression in Women with Endometriosis
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Noninvasive biomarkers of endometriosis: myth or reality?
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Estimating Omissions From Searches
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Biomarker development in endometriosis
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- Authors
- May, K. E., Villar, J., Kirtley, S., Kennedy, S. H., & Becker, C. M.
- Affiliations
- John Radcliffe Hospital (GB)
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06-13
- Volume
- 17
- Issue
- 5
- Pages
- 637-653
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- OpenAlex
- W2125052189
- Cited by
- 237
- References
- 194
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 14 · 2022: 16 · 2021: 11 · 2020: 19 · 2019: 19 · 2018: 12 · 2017: 24 · 2016: 22 · 2015: 24 · 2014: 22 · 2013: 21 · 2012: 13
- FWCI
- 2.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction Update (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometriosis, eutopic endometrium, biomarkers, diagnostic accuracy, hormone receptors, cytokines, proteomics, cell cycle regulation, endometrial histology
- MeSH terms
- Cell Adhesion, Cell Cycle, Endometriosis, Endometrium, Extracellular Matrix, Female, Humans, Neovascularization, Pathologic, Gonadal Steroid Hormones, Biomarkers, Cytokines, Apoptosis, Reactive Oxygen Species, Reactive Nitrogen Species, Intercellular Signaling Peptides and Proteins, Proteomics
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