Is the Detection of Endometrial Nerve Fibers Useful in the Diagnosis of Endometriosis?
Abstract
Laparoscopy is currently considered to be the gold standard investigation in patients suspected to have endometriosis, but this is an invasive and relatively costly procedure and there may be significant delays in diagnosis. As the eutopic endometrium is recognized to be abnormal in patients with endometriosis, it has been suggested that endometrial sampling could provide an indirect diagnostic approach. In particular, recent reports have suggested that the presence of nerve fibers within the endometrial functional layer could represent a specific and sensitive marker of concurrent peritoneal endometriosis. However, such studies have been performed in select patient groups and using novel sampling and analytic techniques that are not used routinely in clinical pathology laboratories. The present study was performed upon conventional endometrial biopsies from 68 patients who underwent laparoscopy for suspected endometriosis. The biopsies were stained immunohistochemically for the neural marker PGP 9.5 and examined in a blinded manner. Endometrial functional layer nerve fibers were identified in 15 (22%) biopsies overall including 9/47 (19%) cases with histologically confirmed peritoneal endometriosis and 6/21 (29% cases) without endometriosis. There was no correlation between the presence of functional layer nerve fibers and the presenting symptoms, endometrial histology, or current hormonal therapy. In our experience, endometrial functional layer nerve fibers assessment performed using standard immunohistochemical techniques on routine biopsy specimens proved neither sensitive nor specific for the diagnosis of endometriosis. Pathologists and gynecologists considering this diagnostic approach should carefully consider the methodological factors that may influence its reliability.
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The detection of nerve fibers in 29% of women without endometriosis raised concerns regarding the assay's specificity.
“Nonetheless, the detection of nerve fibers in 29% of women without endometriosis raised concerns regarding the assay's specificity [143].”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [143]
Functional endometrial layer nerve fibers assessed by PGP9.5 immunostaining were detected in 9 of 45 (22%) of histologically confirmed cases of endometriosis and in 6 of 21 (29%) of women without endometriosis.
“Functional endometrial layer nerve fibers assessed by PGP9.5 immunostaining were detected in 9 of 45 (22%) of histologically confirmed cases of endometriosis and in 6 of 21 (29%) of women without endometriosis.”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [143]
Adoption of this method in a clinical laboratory failed to recapitulate the accuracy of endometrial PGP9.5 immunohistochemistry in the diagnosis of women with endometriosis.
“However, the adoption of this method in a clinical laboratory failed to recapitulate the accuracy of endometrial PGP9.5 immunohistochemistry in the diagnosis of women with endometriosis [143].”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [143]
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- Authors
- Leslie, C., Ma, T., McElhinney, B., Leake, R., & Stewart, C. J. R.
- Affiliations
- The University of Western Australia (AU)
- Corresponding author
- Stewart, Colin J.R.
- Venue
- International Journal of Gynecological Pathology
- Published
- 2013-03
- Volume
- 32
- Issue
- 2
- Pages
- 149-155
- ISSN
- 0277-1691 (ISSN-L)
- OpenAlex
- W2009986152
- Cited by
- 23
- References
- 26
- Citations by year
- 2024: 1 · 2023: 1 · 2021: 2 · 2019: 1 · 2018: 5 · 2016: 4 · 2015: 2 · 2014: 3 · 2013: 4
- FWCI
- 5.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Gynecological Pathology (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, PGP 9.5, endometrial biopsy, peritoneal endometriosis, sensitivity and specificity, eutopic endometrium, immunohistochemistry, non-invasive diagnosis
- MeSH terms
- Adult, Biopsy, Endometriosis, Endometrium, Female, Humans, Immunohistochemistry, Middle Aged, Nerve Fibers, Laparoscopy, Peritoneum, Sensitivity and Specificity, Biomarkers, Ubiquitin Thiolesterase
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