Health
Searching for new diagnostic tools for early diagnosis of endometriosis
Endometriosis is a common and burdensome chronic disease affecting over 11% of reproductive-age women in the United States and 190 million women worldwide. Early diagnosis remains a major clinical and public health challenge. The average time to diagnosis of endometriosis is seven years after the onset of symptoms, such as premenstrual, menstrual, and postmenstrual abdominal pain and cramps.
Endometriosis occurs when tissue that normally lines the uterus migrates and grows elsewhere, most commonly in the ovaries, fallopian tubes, or other organs. These conditions can cause life-altering consequences, including chronic pain, infertility, and quality of life.
In a commentary published in Journal of Reproductive Medicine, Gynecology, and ObstetricsResearchers at Florida Atlantic University's Schmidt College of Medicine and collaborators conducted a PubMed search to identify promising approaches to early diagnosis of endometriosis.
“Currently, diagnosing endometriosis requires a thorough review of the patient's medical history and physical examination,” said Dr. Panagiota “Jota” Kitsantas, professor and chair of the Department of Population Health and Social Medicine at FAU Schmidt School of Medicine and lead and corresponding author. “The most commonly used and accurate diagnostic methods are pelvic exam, abdominal ultrasound, MRI, and laparoscopy. Laparoscopic surgery is considered the gold standard for diagnosing endometriosis by gynecologists, but it is expensive and carries potential risks of surgical complications. Moreover, the accuracy of laparoscopy may vary depending on the surgeon's experience and the stage of the disease.”
The authors state that an ideal test for early diagnosis of endometriosis would use symptom-based criteria to determine which patients should be tested, with optimal cut points set to maximize sensitivity and specificity. A test with high predictive value would accurately confirm endometriosis if positive and rule it out if negative. A less-than-ideal test may not provide a definitive result but may help reduce the number of patients who need to proceed to more invasive procedures such as laparoscopy.
Endometriosis is associated with hormonal imbalances that drive angiogenesis, apoptosis, immune responses, and inflammation. Diagnostic tools for endometriosis have been developed to detect biomarkers such as mRNA fragments in blood and saliva, but have proven to be inaccurate.
“Noninvasive methods such as MRI and transvaginal ultrasound are only effective in advanced stages of endometriosis,” said co-author Charles H. Hennekens, MD, the inaugural Sir Richard Doll Professor of Medicine and Preventive Medicine in the Department of Medicine and School of Population Health and Social Medicine and senior academic advisor at FAU's Schmidt School of Medicine. “Recent studies have focused on new noninvasive methods to detect myoelectric activity in the gastrointestinal tract as a potential diagnostic tool. Visceral electrography (EVG) can detect unique myoelectric patterns associated with endometriosis, but this approach is promising but unproven.”
Currently, there are no FDA-approved noninvasive tests for endometriosis, and further analytical studies leading to peer-reviewed publications are needed to refine these new technologies and establish effective diagnostic criteria.
“Early diagnosis of endometriosis remains a challenge, with a succession of promising approaches being attempted but thus far ultimately unsuccessful,” said Kitsantas. “Newer technologies such as EVG, once fully evaluated, may provide clinicians with the post-test certainty they need to move from symptom-based to diagnosis-based treatment.”
Co-authors are Katerina N. Benson, a pre-med student at FAU; Sadine Al-Farauki, a recent FAU graduate who will be attending Ross University School of Medicine; Michelle Keba Knecht, senior medical librarian at FAU's Schmidt School of Medicine; and Lee A. Learman, MD, professor and chair of the Department of Obstetrics and Gynecology at the Virginia Tech Carilion School of Medicine.
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