Seven Hormonal Biomarkers for Diagnosing Endometriosis: Meta-Analysis and Adjusted Indirect Comparison of Diagnostic Test Accuracy

Ya Gao; Minghui Shen; Xueni Ma; Jipin Li; Bo Wang; Jiancheng Wang; Jinhui Tian

doi:10.1016/j.jmig.2019.04.004

Seven Hormonal Biomarkers for Diagnosing Endometriosis: Meta-Analysis and Adjusted Indirect Comparison of Diagnostic Test Accuracy

J Minim Invasive Gynecol. 2019 Sep-Oct;26(6):1026-1035.e4. doi: 10.1016/j.jmig.2019.04.004. Epub 2019 Apr 6.

Authors

Ya Gao¹, Minghui Shen², Xueni Ma³, Jipin Li³, Bo Wang⁴, Jiancheng Wang⁵, Jinhui Tian⁶

Affiliations

¹ Evidence-Based Medicine Center (Drs. Gao and Tian), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
² Department of Clinical Laboratory (Dr. Shen), Second Hospital of Lanzhou University, Lanzhou, China.
³ The Second Clinical Medical College of Lanzhou University (Drs. Ma and Li), Lanzhou, China.
⁴ Department of Nursing (Dr. B. Wang), Rehabilitation Center Hospital of Gansu Province, Lanzhou, China.
⁵ Gansu Provincial Hospital (Dr. J. Wang), Lanzhou, China.
⁶ Evidence-Based Medicine Center (Drs. Gao and Tian), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. Electronic address: tianjh@lzu.edu.cn.

PMID: 30965114
DOI: 10.1016/j.jmig.2019.04.004

Abstract

Objective: To compare the diagnostic accuracy of different hormonal biomarkers and to find the most effective hormonal biomarker for the diagnosis of endometriosis.

Data sources: We conducted a systematic search using PubMed, EMBASE, Cochrane Library, and China Biomedical Literature to identify relevant studies from the first day of databases to August 2018.

Methods of study selection: Two independent reviewers screened for study eligibility and extracted data. Random controlled trials, cross-sectional studies, case-control studies, and cohort studies evaluating the diagnostic accuracy of hormonal markers for endometriosis were included.

Tabulation, integration, and results: We included 17 studies that involved 1279 participants and evaluated 7 hormonal biomarkers. The pooled sensitivity and specificity in endometriosis were .79 (.71, .86) and .89 (.82, .94) for aromatase, .30 (.18, .46) and .80 (.65, .90) for human chorionic gonadotropin/luteinizing hormone receptor, .75 (.66, .83) and .47 (.34, .60) for estrogen receptor (ER)-α, .65 (.56, .74) and .68 (.55, .80) for ER-β, .45 (.38-.52) and .92 (.85-.97) for serum prolactin, .69 (.51, .83) and .30 (.16, .49) for estrogen sulfotransferase, and .73 (.60-.84) and .48 (.33-.63) for 17β-hydroxysteroid dehydrogenase type 2 (17βHSD2). Compared with human chorionic gonadotropin/luteinizing hormone receptor, ER-α, ER-β, estrogen sulfotransferase, and 17βHSD2, aromatase had a higher sensitivity, specificity, positive likelihood ratio, and diagnostic odds ratio. The specificities of aromatase and serum prolactin were comparable, but the sensitivity, positive likelihood ratio, and positive likelihood ratio of serum prolactin were much lower than that of aromatase.

Conclusion: Aromatase may be an excellent diagnostic test for endometriosis. However, because of the moderate quality of the included studies and the limited sample size, this result requires more research to validate. (PROSPERO registration number: PROSPERO 2018 CRD42018105126.).

Keywords: Adjusted indirect comparison; Diagnostic test accuracy; Endometriosis; Hormonal biomarkers; Meta-analysis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Biomarkers / blood*
Case-Control Studies
Cross-Sectional Studies
Diagnostic Techniques, Endocrine / standards*
Diagnostic Techniques, Obstetrical and Gynecological / standards*
Diagnostic Tests, Routine / standards
Endometriosis / blood
Endometriosis / diagnosis*
Female
Hormones / blood
Humans
Predictive Value of Tests
Reproducibility of Results
Sensitivity and Specificity

Substances

Biomarkers
Hormones