New test could diagnose endometriosis without surgery
A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published in Europe’s leading reproductive medicine journal Human Reproduction.
As you know, a laparoscopy is the current method used to accurately diagnose endometriosis, but it’s not ideal due to the lengthy waits many women face, and the complications that can go alongside surgery. Therefore, researchers have been looking for new ways of diagnosing endometriosis.
Researchers at the University of Sydney and Mu’tah University in Karak, Jordan, thought that the presence of nerve fibres in the womb lining might be a sign of endometriosis. In a study of 99 women, they took a small sample of tissue from the womb lining by inserting a flexible tube attached to a syringe through the vagina, and then tested the sample for nerve fibres. To check the results, all the women also had surgery to look for endometriosis.
Out of the 99 women in the study, 64 had endometriosis detected by surgery. Of these 64 women, 63 also had a positive result in the test looking for nerve fibres. So, the new test only missed one case of endometriosis in a group of 99 women.
Despite missing this one case, the researchers still think the new test is accurate enough to be useful. If the test comes out positive, there's a 91 percent chance that a woman has endometriosis. A negative result would miss endometriosis only four percent of the time.
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Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu’tah University, said: “This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. 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. It may be particularly helpful in cases of infertility.”
In contrast to a laparoscopy, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: “It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres.”
He continued: “Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated.”
In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. “The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility.”
The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. “Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist,” he said.
Caroline Overton, Endometriosis UK Trustee and Consultant Obstetrician & Gynaecologist at St Michael's Hospital, Bristol said: It would be a break-through to have a simple diagnostic test for endometriosis. The test is unable to distinguish between the severity of endometriosis and doesn't replace laparoscopy, but looks promising.
The new test is experimental, and isn't available yet. Dr. Al-Jefout said he expects the test to come into use in the next three to five years. So, in future, it may offer a simpler alternative to surgery as a way of diagnosing endometriosis.
Pdfs of the full research paper is available here
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Human Reproduction is a monthly journal of the European Society of Human Reproduction and Embryology (ESHRE), and is published by Oxford Journals, a division of Oxford University Press.
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