الفهرس 
PATHOPHYSIOLOGY OF ENDOMETRIOSISOnly 14 pages are availabe for public view
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Abstract
E
ndometriosis, an estrogen dependent gynecologic disorder, affects 10% to 15% women of reproductive age from all ethnic and social groups. Endometriosis is defined as the presence of endometrial-like tissue outside the uterine cavity. The degree of endometriosis is staged according to the classification system of the American Society of Reproductive Medicine into minimal, mild, moderate, and severe disease (Fassbender et al., 2013).
Endometriosis can be associated with infertility and/or pain symptoms, including cyclic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia (Sinaii et al., 2008). Endometriosis-associated pain can be caused by peritoneal inflammation, adhesion formation, and specific innervations of endometriotic lesions and is correlated with the presence of deep infiltrating disease (Fassbender et al., 2013).
Transvaginal ultrasound (TVU) is an adequate diagnostic method to detect ovarian endometriotic cysts but does not rule out peritoneal endometriosis, endometriosis-associated adhesions, or some locations of deep infiltrating endometriosis (DIE) (Kennedy et al., 2005). Furthermore, routine vaginal examination alone may be insufficient to detect endometriosis before laparoscopy (Hudelist et al., 2011).
The gold standard for diagnosis of endometriosis is laparoscopic inspection with histologic confirmation after retrieval of lesions (Kennedy et al., 2005). However, laparoscopy is a surgical procedure with rare but significant potential risks for the patients (Slack et al., 2007).
The diagnosis of endometriosis is difficult because of non-specific symptoms, late presentation and the use of laparoscopy, which is limited by available funding, the surgeon’s experience, and human error, including missing non-specific lesions. The development of a simple blood test as a marker for screening patients at risk for endometriosis would reduce the number of unnecessary interventions and would therefore be very useful (Fassbender et al., 2013).
In an effort to find a less-invasive method for diagnosing endometriosis, and based on the fact that endometriosis induces a local, and likely also a systemic, inflammatory process, numerous studies have focused on markers of inflammation in the peritoneal fluid and/or serum of women who have the disease (Seeber et al., 2008).
A non invasive test for endometriosis would be useful for the early detection of endometriosis in symptomatic women who have pelvic pain and/or subfertility with normal ultrasound results. This would include nearly all cases of minimal-to-mild endometriosis, some cases of moderate-to-severe endometriosis without a clearly visible ovarian endometrioma, and cases with pelvic adhesions and/or other pelvic pathology that might benefit from surgery to improve pelvic pain and/or subfertility (Fassbender et al., 2013).
As endometriosis can be progressive in up to 50% of women, early noninvasive diagnosis has the potential to offer early treatment and prevent progression (Fassbender et al., 2013).
Early non-invasive diagnosis of minimal–mild endometriosis in women who try to conceive should enable gynaecologists to select these women for laparoscopic excision of endometriosis which improves fertility and may prevent progression of endometriosis to a moderate-to-severe stage (Mihalyi et al., 2010).
The most important goal of the test is that no women with endometriosis or other significant pelvic pathology, who might benefit from laparoscopic surgery, are missed (D’Hooghe et al., 2006). To achieve this, a test with a high sensitivity is needed (Fassbender et al., 2013).
The aim of this study was to assess the validity of serum and peritoneal IL-6, IL-8 and plasma cell-free nuclear DNA (ccf nDNA) as biomarkers in diagnosis of stage I and stage II of pelvic endometriosis.
In the current study, among the cases with endometriosis (group I), there was a significant correlation between serum IL-6, peritoneal IL-6, serum IL-8, peritoneal IL-8 and plasma ccf DNA.
In the current study, peritoneal IL-6 and IL-8 were elevated which suggests the inflammatory process which accompanies endometriosis and opens the door to further studies to assess levels of peritoneal IL-6 and IL-8 in relation to different stages of endometriosis.
ROC curve analysis was done to determine the cutoff values to discriminate between cases and controls, as well as between cases with stage I and stage II endometriosis, with variable ranges of sensitivity and specificity.
It was concluded that, serum IL-6, peritoneal IL-6, serum IL-8, peritoneal IL-8 and plasma ccf DNA are highly reliable biomarkers for screening and early diagnosis of endometriosis, and can be used to discriminate between stage I and stage II.