Blood biomarkers for the non-invasive diagnosis of endometriosis

• Published in: Cochrane database of systematic reviews 2016-05, Vol.2016 (5), p.CD012179-CD012179
• Main Authors: Nisenblat, Vicki, Bossuyt, Patrick M M, Shaikh, Rabia, Farquhar, Cindy, Jordan, Vanessa, Scheffers, Carola S, Mol, Ben Willem J, Johnson, Neil, Hull, M Louise
• Format: Article
• Language: English
• Subjects: Adult; Autoantibodies - blood; Biomarkers - blood; CA-125 Antigen - blood; CA-19-9 Antigen - blood; Diagnosis; Endometriosis - diagnosis; Endometrium - immunology; EVALUATION OF DIAGNOSTIC TECHNIQUES IN THE INVESTIGATION OR ASSESSMENT OF THE SUBFERTILE COUPLE; Female; Humans; Interleukin-6 - blood; Ovarian Diseases - diagnosis; Pelvis; Peritoneal Diseases - diagnosis; Randomized Controlled Trials as Topic
• ISSN: 1469-493X
• DOI: 10.1002/14651858.cd012179

About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive or minimally invasive tests available in clinical practice to accurately diagnose endometriosis. Although other reviews have assessed the ability of blood tests to diagnose endometriosis, this is the first review to use Cochrane methods, providing an update on the rapidly expanding literature in this field. To evaluate blood biomarkers as replacement tests for diagnostic surgery and as triage tests to inform decisions on surgery for endometriosis. Specific objectives include:1. To provide summary estimates of the diagnostic accuracy of blood biomarkers for the diagnosis of peritoneal, ovarian and deep infiltrating pelvic endometriosis, compared to surgical diagnosis as a reference standard.2. To assess the diagnostic utility of biomarkers that could differentiate ovarian endometrioma from other ovarian masses. We did not restrict the searches to particular study designs, language or publication dates. We searched CENTRAL to July 2015, MEDLINE and EMBASE to May 2015, as well as these databases to 20 April 2015: CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, DARE and PubMed. We considered published, peer-reviewed, randomised controlled or cross-sectional studies of any size, including prospectively collected samples from any population of reproductive-aged women suspected of having one or more of the following target conditions: ovarian, peritoneal or deep infiltrating endometriosis (DIE). We included studies comparing the diagnostic test accuracy of one or more blood biomarkers with the findings of surgical visualisation of endometriotic lesions. Two authors independently collected and performed a quality assessment of data from each study. For each diagnostic test, we classified the data as positive or negative for the surgical detection of endometriosis, and we calculated sensitivity and specificity estimates. We used the bivariate model to obtain pooled estimates of sensitivity and specificity whenever sufficient datasets were available. The predetermined criteria for a clinically useful blood test to replace diagnostic surgery were a sensitivity of 0.94 and a specificity of 0.79 to detect endometriosis. We set the criteria for triage tests at a sensiti