Seven Hormonal Biomarkers for Diagnosing Endometriosis

So, which one is the best biomarker?

Key Points

Highlight:

• According to Dr. Tian group from China, aromatase may be the best diagnostic biomarker for endometriosis.

Background:

• It is of great significance to correctly diagnose endometriosis.
• Laparoscopy with histology of excised endometriosis lesions remains the gold standard for diagnosis, but it also has numerous disadvantages.
• Recently, many studies have discovered several hormonal biomarkers.
• Despite good diagnostic value, no one has systemically compared the accuracy of different biomarkers.

Key points:

• To compare the diagnostic accuracy of different hormonal biomarkers and to find the most effective hormonal biomarker, Dr. Tian group performed a meta-analysis and adjusted indirect comparison of diagnostic test accuracy.
• In total 17 studies (involved 1279 participations) and 7 hormonal biomarkers were included.
• These hormonal biomarkers are aromatase, HCG/LH, estrogen receptor (ER)-a, ER-b, serum prolactin, estrogen sulfotransferase, and 7b-hydroxysteroid dehydrogenase type 2 (17bHSD2).
• Aromatase had a higher sensitivity, specificity, positive likelihood ratio, and diagnostic odds ratio.
• The specificities of aromatase and serum prolactin were comparable but sensitivity and positive likelihood ratio of aromatase is much higher than serum prolactin.

Conclusions:

• Aromatase is the best diagnostic test for endometriosis among 7 hormonal biomarkers.
• However, this result requires more research to further validation.

Lay Summary

Endometriosis is an inflammatory condition characterized by implantation and invasive growth of endometrial tissue outside the uterine cavity. Although it is benign, endometriosis has cancer-like features, a mutation profile similar to that of ovarian cancer, and increased ovarian cancer risk. Therefore, it is of great significance to correctly diagnose endometriosis.

Laparoscopy with histology of excised endometriosis lesions remains the gold standard for diagnosis, but it also has numerous disadvantages such as high cost, need for general anesthesia, and risk of postoperative adhesion formation. In the past few years, noninvasive (or minimally invasive) methods have been developed. Recently, many studies have discovered several hormonal biomarkers, including aromatase, luteinizing hormone (LH), human chorionic gonadotropin (HCG) and so on. According to these studies, the level of these hormones is clearly different in endometriotic lesions.

Despite good diagnostic value, no one has compared the accuracy of different biomarkers. Therefore, in this paper, Dr. Tian group from Lanzhou University in China performed a meta-analysis and adjusted indirect comparison of diagnostic test accuracy. The authors assessed the diagnostic accuracy of hormonal biomarkers for endometriosis and compared the diagnostic accuracy of different index tests. This study recently published in “The Journal of Minimally Invasive Gynecology”.

The authors conducted a systematic search using PubMed, EMBASE, Cochrane Library, and China Biomedical Literature to identify relevant studies from the first day of databases to August 2018. There are two main strengths of this review. First, they used indirect comparative meta-analysis for the first time to analyze the diagnostic accuracy of hormonal biomarkers. Second, in addition to conducting indirect comparisons between different competitive diagnostic tests, they also performed indirect comparisons of different sub-groups of each hormonal biomarker.

In total, 17 studies that overall involved 1279 participants and 7 hormonal biomarkers were included in this evaluation. Two independent reviewers screened for study eligibility and extracted data. The seven hormonal biomarkers are aromatase, HCG/LH, estrogen receptor (ER)-a, ER-b, serum prolactin, estrogen sulfotransferase, and 7b-hydroxysteroid dehydrogenase type 2 (17bHSD2). Compared to other hormonal biomarkers, aromatase had a higher sensitivity, specificity, positive likelihood ratio, and diagnostic odds ratio. The specificities of aromatase and serum prolactin were comparable. Based on the sensitivity and positive likelihood ratio, however, aromatase seems to be better than serum prolactin as a biomarker among the seven investigated.

In conclusion, the authors suggested that aromatase is the best diagnostic test for endometriosis among 7 hormonal biomarkers based on the systemic analysis. However, due to the moderate quality of the included studies and the limited sample size, this result requires more research to further validation.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30965114