Is the Detection of Endometrial Nerve Fibers Useful in the Diagnosis of Endometriosis?

Connull Leslie, Tony Ma, Bernadette McElhinney, Robyn Leake, Colin J R Stewart
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2013 · vol. 32(2) , pp. 149–155 · doi:10.1097/pgp.0b013e31825b0585 · PMID:23370651 · W2009986152
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This study found that assessing endometrial nerve fibers using standard immunohistochemical techniques on routine biopsy specimens was neither sensitive nor specific for diagnosing endometriosis.

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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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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Endometrium Nerve Fibers Adult Biomarkers Biopsy Endometriosis Endometriosis Endometrium Endometrium Endometrium Female Humans Immunohistochemistry Laparoscopy Middle Aged Nerve Fibers Peritoneum Peritoneum Peritoneum

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