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.

Update on Biomarkers for the Detection of Endometriosis

“…These results were confirmed in a study of 27 prospectively collected eutopic endometrial specimens using identical sampling and detection methods [ 142 ]. 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 ]. 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.…”

Endometrial Nerve Fibers Detection in Women with Different Gynecological Pathologies: A Cross Sectional Study

“…Leslie et al [18] found endometrial nerve fibers in conventional biopsy specimens of 19% of patients with and 29% of patients without endometriosis. In a group of 44 women with pelvic pain, endometrial fine nerve fibers were present in patients with and without endometriosis.…”

Diagnostic Value of Endometrial Nerve Endometrial Tissue of Patients with Endometriosis

“…Leslie et al [13] analyzed 68 endometrial samples before surgery. They found no correlation between the presence of functional layer nerve fibers and the presenting symptoms, endometrial histology, or current hormonal therapy.…”

“…[8][9][10][11][12][13][14][15][16] Progesterone treatment revealed a decrease in endometrial nerve fibers, but no clinical significance was identified. [17] As a result, further studies were recommended in recent publications for these patient groups.…”