Altanets O. Algorithm for the diagnosis of external genital endometriosis in women with infertility

Due to the generalization of the anamnestic data of 96 infertile women, the risk factors for the development of external genital endometriosis (EGE) are clarified. A statistically significant correlation was established between women belonging to a group of infertility associated with EGE and the age of menarche. Prolongation of the average duration of menstrual bleeding in a group of women with infertility associated with EGE has been proven. A certain associative relationship was revealed between belonging to a group of infertile women with EGE and diseases of the hepatobiliary system, as well as benign diseases of the mammary glands. In the dissertation, on the basis of a comprehensive immunohistochemical study (IHC), the commonality of trends in the indicators of eutopic and ectopic endometrium of infertile women with verified ЕGE is proved. Comparison of the IHC indicators of the eutopic endometrium of healthy and infertile women with ЕGE. The main and additional criteria of the conditionally named “abnormal” immunophenotype of eutopic endometrium in women with infertility associated with ЕGE defined. Major: ER in glands (100 <H-score <200 or H-score> 200), PGR in stroma (H-score <100), BCL-2 at 2 + / 3 + and MMP-9 at 2+ / 3 + glandular epithelium. Extra: Ki-67 in glands with a median of 41.5% with an interquartile range of 32.0-53.5. The effectiveness of using the “abnormal” immunophenotype as a diagnostic criterion for EGE at the preclinical stage was evaluated. According to the ROC analysis, sensitivity (72.2%; 95% CI 54.8 - 85.8), specificity (75.0%; 95% CI 55.1 - 89.3%), prognostic significance of the positive (78 8%; 95% CI 61.1 - 91.0) and negative results (67.7%; 95% CI 48.6 – 83.3) were determined. Also, the diagnostic accuracy of the proposed method was calculated. It was 73.4% (95% CI 60.9 - 83.7). Prognostic markers of asymptomatic external genital endometriosis in infertile women based on a mathematical model have been identified. They determined the expression levels of MMP-9 and ER in the glands of the eutopic endometrium. When comparing the effectiveness of using an "abnormal" immunophenotype as a diagnostic criterion for PGE in infertile women with a mathematical prediction model developed, they obtained better operating characteristics in favor of the latter: increasing the area under the diagnostic ROC curve from 0.736 to 0.875 (p = 0.020) by 0.139 (95% CI 0,022 – 0,257) and the transition of its qualitative assessments by the generally accepted approaches from "good" to "very good" diagnostic method. An algorithm for diagnosing external genital endometriosis in women with infertility has been developed, which allows to reduce the time to verify the diagnosis by timely laparoscopy.