Can we accurately diagnose endometriosis without a diagnostic laparoscopy?

Abstract

Endometriosis is a progressive, estrogen-dependent, chronic inflammatory disease that affects approximately 6-10% of reproductive age women. Patients usually presents with symptoms, such as non-menstrual pelvic and abdominal pain, ovulatory pain, dyspareunia, dysmenorrhea, dyschezia, and/or changes to bowel or bladder function, which can be exacerbated during ovulation or menses. Endometriosis is a leading cause of unexplained infertility, accounting for up to 50-80% of cases. Currently, altered endometrial receptivity and progesterone resistance are some of the leading theories that could explain endometriosis-related implantation failure. In the endometrium, the B-cell chronic lymphocytic leukemia/lymphoma 6 (BCL-6) protein forms a complex that binds to and inactivates regulators of the progesterone pathway, leading to progesterone resistance, aberrant decidualization, implantation failure, and recurrent miscarriages in women diagnosed with endometriosis. Surgical diagnosis consisting of laparoscopy, with or without histologic confirmation, is still considered the gold standard for diagnosis of endometriosis. Development of noninvasive screening and diagnostic tests to accurately identify patients with endometriosis has become increasing popular. A screening test for endometriosis has been developed to detect endometrial BCL-6 overexpression in asymptomatic women with unexplained infertility or recurrent pregnancy loss. Positive endometrial BCL-6 testing has been associated with recurrent miscarriages and poor in vitro fertilization outcomes. When the underlying cause of endometrial inflammation secondary to endometriosis was treated, an improvement in subsequent live birth rates was seen. Endometrial BCL-6 testing has a high positive predictive value that could help physicians and patients undergoing infertility treatment to seek surgical evaluation for endometriosis, to improve their reproductive outcomes.

The size, number and bilaterality of endometriomas do not affect spontaneous conception chance following surgical removal

“…Laparoscopy is the gold standard for diagnosing endometriosis and also provides for an opportunity for treatment ( Nezhat et al ., 2022 ). The majority of women in both groups underwent laparoscopy, with the laparoscopic rate being significantly higher in women with successful spontaneous conception.…”

Does Quality of Care (QoC) Perception Influence the Quality of Life (QoL) in Women with Endometriosis? Results from an Italian Nationwide Survey during Covid Pandemic

“…Common symptoms include pelvic and abdominal non-menstrual pain, ovulatory pain, pain during urination, dyspareunia, and dyschezia. The symptomatology may present in a mild or severe form, with no correlation of symptom severity to the stage of endometriosis [3]. The underlying pathophysiology of endometriosis remains uncertain; numerous hypotheses have been formulated, but none can fully explain the various clinical presentations of the disease.…”

Comparison of Morphological and Digital-Assisted Analysis for BCL6 Endometrial Expression in Women with Endometriosis

“…Initially described as a proto-oncogene and transcriptional repressor implicated in the pathogenesis of B-cell lymphoma, BCL6 has recently been identified as a promising tissular biomarker which could be used to diagnose women affected by endometriosis [ 1 , 2 , 3 , 4 ]. The recent identification of actors acting in conjunction with BCL6, and the delineation of several target genes have helped to better determine its biological functions [ 5 ].…”

“…While alternative methods such as medical imaging, genetic tests, or biomarkers are aimed at alleviating invasive diagnosis, none of them can adequately substitute for surgery at present [ 23 , 24 , 25 , 26 , 27 ]. Recent studies have identified a promising tissular biomarker called B-cell lymphoma 6 (BCL6), which could be used to diagnose women affected by endometriosis [ 1 , 2 , 3 , 4 ].…”

“…All the previous studies describing BCL6 expression in the endometrium of women with or without proven endometriosis use HSCORE for the quantification of BCL6 staining [ 1 , 2 , 3 , 4 ]. Evans-Hoeker et al established an immunostaining cutoff to better discriminate normal versus elevated BCL6 expression [ 1 ].…”