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Aromatase P450 messenger RNA expression in eutopic endometrium is not a specific marker for pelvic endometriosis
Kavitha Dheenadayalu1, Ian Mak, Stephan Gordts
1Department of Obstetrics and Gynaecology, Ealing Hospital, London, United Kingdom.
Objective:
To determine whether expression of aromatase P450 mRNA in eutopic endometrium is predictive of the presence of pelvic endometriosis.
Design:
A prospective, multicenter, observational study.
Setting:
Four tertiary centers for reproductive medicine.
Patient(S):
Sixty subjects of reproductive age undergoing laparoscopy for subfertility exploration, pain assessment, or sterilization.
Intervention(S):
Endometrial biopsy at time of laparoscopy.
Main Outcome Measure(S):
The expression of aromatase P450 mRNA in endometrial specimens was determined by single-tube reverse transcription-polymerase chain reaction (RT-PCR). Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA was amplified in parallel to exclude amplification failure.
Result(S):
The RT-PCR amplification was successful in 56 of the 60 biopsies (93%). Pelvic endometriosis was diagnosed in 34 patients (61%) and was strongly associated with aromatase P450 mRNA expression in eutopic endometrium. As a diagnostic marker for endometriosis, aromatase P450 mRNA expression yielded a sensitivity of 82%, a specificity of 59%, a positive predictive value of 76%, and a negative predictive value of 67%. If additional uterine pathology was taken in account, the sensitivity increased to 84%, the specificity to 72%, the positive predictive value to 87%, but the negative predictive value remained unchanged (67%).
Conclusion(S):
Although endometrial aromatase P450 gene expression is highly predictive of the presence of pelvic disease, the relative high incidence of false-negative results and lack of specificity is likely to impair clinical application.