Endometrial nerve fibers detection in patients with different gynecological pathologies: pilot study

Abstract

Endometriosis is a benign gynecologic disorder defined as the presence of endometrial glands and stroma outside of the normal location with these ectopic lesions commonly occupying the pelvic peritoneum. The exact prevalence of endometriosis is difficult to quantify, as women with the disease are often asymptomatic and imaging modalities have low sensitivities for diagnosis. It is commonly found on the pelvic peritoneum but may also be found on the ovaries, rectovaginal septum and ureter, and rarely in the bladder, pericardium, and pleura. The primary tool for diagnosis despite being invasive, costly and associated with 3% minor complications and 0.5% major complications is laparoscopy with or without biopsy for histological diagnosis, to some extent, the results of laparoscopy are operator dependent and there is a relatively poor correlation between visual assessment and the histological findings. Similarly, biopsy specimens from purported endometriotic lesions may prove nonspecific or they may show variant histological patterns that are difficult to interpret, leading to under diagnosis. Even though transvaginal ultrasound (TVU) can be helpful in the diagnosis of ovarian endometriomas, it has no value for peritoneal disease therefore, the 10th congress on endometriosis stated that one of the main priorities is to find a reliable non invasive diagnostic test to diagnose endometriosis. The concept of using endometrial biopsy was possible after reports of the novel finding of multiple small unmyelinated sensory C nerve fibers in the functional layer of eutopic endometrium in all women with endometriosis, although women without endometriosis did not have any nerve fibers in the functional layer. It is well recognized that nerve fibers are present in the peritoneal endometriotic lesions and might have a role in pain generation.