Density of small diameter sensory nerve fibres in endometrium: a semi-invasive diagnostic test for minimal to mild endometriosis.
BACKGROUND
The aim of our study was to test the hypothesis that multiple-sensory small-diameter nerve fibres are present in a higher density in endometrium from patients with endometriosis when compared with women with a normal pelvis, enabling the development of a semi-invasive diagnostic test for minimal-mild endometriosis.


METHODS
Secretory phase endometrium samples (n = 40), obtained from women with laparoscopically/histologically confirmed minimal-mild endometriosis (n = 20) and from women with a normal pelvis (n = 20) were selected from the biobank at the Leuven University Fertility Centre. Immunohistochemistry was performed to localize neural markers for sensory C, Adelta, adrenergic and cholinergic nerve fibres in the functional layer of the endometrium. Sections were immunostained with anti-human protein gene product 9.5 (PGP9.5), anti-neurofilament protein, anti-substance P (SP), anti-vasoactive intestinal peptide (VIP), anti-neuropeptide Y and anti-calcitonine gene-related polypeptide. Statistical analysis was done using the Mann-Whitney U-test, receiver operator characteristic analysis, stepwise logistic regression and least-squares support vector machines.


RESULTS
The density of small nerve fibres was approximately 14 times higher in endometrium from patients with minimal-mild endometriosis (1.96 +/- 2.73) when compared with women with a normal pelvis (0.14 +/- 0.46, P < 0.0001).


CONCLUSIONS
The combined analysis of neural markers PGP9.5, VIP and SP could predict the presence of minimal-mild endometriosis with 95% sensitivity, 100% specificity and 97.5% accuracy. To confirm our findings, prospective studies are required.
Bokor
A
A
Experimental Laboratory for Gynaecology, Department of Obstetrics and Gynaecology, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Kyama
C M
CM
Vercruysse
L
L
Fassbender
A
A
Gevaert
O
O
Vodolazkaia
A
A
De Moor
B
B
Fülöp
V
V
D'Hooghe
T
T
D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D004715:Endometriosis / Q000175:diagnosis* / Q000473:pathology; D004717:Endometrium / Q000294:innervation* / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008183:Luteal Phase; D009412:Nerve Fibers / Q000473:pathology*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013373:Substance P / Q000378:metabolism; D014015:Tissue Banks; D043222:Ubiquitin Thiolesterase / Q000378:metabolism; D014660:Vasoactive Intestinal Peptide / Q000378:metabolism
D015415:Biomarkers; C482860:UCHL1 protein, human; D013373:Substance P; D014660:Vasoactive Intestinal Peptide; D043222:Ubiquitin Thiolesterase