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Endometrial Biopsy with Nerve Fiber Detection May Reliably Diagnose Endometriosis

by Laurie Barclay, MD,  Medscape Medical News,  Aug 19, 2009
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Endometrial biopsy with detection of nerve fibers may diagnose endometriosis with reliability close to the accuracy of laparoscopy performed by experienced gynecologic laparoscopists, according to the results of a study reported in the August 19 Online First issue of Human Reproduction. A second study in the same issue shows that combined analysis of neural markers antihuman protein gene product 9.5 (PGP9.5), antivasoactive intestinal peptide (VIP), and antisubstance P (SP) predicts the presence of minimal to mild endometriosis with 95% sensitivity, 100% specificity, and 97.5% accuracy.

Al-Jefout and Colleagues Study Results

"[Our] study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis," lead author Moamar Al-Jefout, from Mu'tah University in Karak, Jordan, and University of Sydney in Sydney, Australia, said in a news release.

"This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management."

For 99 consecutive women presenting with pelvic pain and/or infertility, the investigators compared endometrial biopsies vs immunohistochemical nerve fiber detection using protein gene product 9.5 as a marker with surgical diagnosis after diagnostic laparoscopy by experienced gynecologic laparoscopists.

There were 64 women with endometriosis diagnosed laparoscopically. In these women, mean nerve fiber density in the functional layer of the endometrial biopsy was 2.7 ± 3.5 nerve fibers per mm2, and only 1 woman had no detectable nerve fibers.

There were 6 women who had endometrial nerve fibers but no active endometriosis detected by laparoscopy. Of these, 3 had severe painful menses, dyspareunia, and infertility; one of the others had adhesions thought to be insufficient to meet criteria for endometriosis; and 1 had a previous history of endometriosis.

Specificity for endometriosis of endometrial biopsy with immunohistochemical nerve fiber detection was 83%, sensitivity was 98%, positive predictive value was 91%, and negative predictive value was 96%. Read more.


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