A novel triad for the diagnosis of endometriosis, the short anogenital distance combines with high endometrial BCL2 and low endometrial FASL

Mohamed Ali Alabiad; Ibtesam Elhasadi; Raja Aljafil; Amany Mohamed Shalaby; Ahmed Baker A Alshaikh; Fawaz E Edris; Ahmed Ismail Heraiz; Mohammed Alorini; Adel Mohamed Aboregela; Asmaa Hussein Mohamed

doi:10.1002/ijgo.15412

A novel triad for the diagnosis of endometriosis, the short anogenital distance combines with high endometrial BCL2 and low endometrial FASL

Int J Gynaecol Obstet. 2024 Feb 15. doi: 10.1002/ijgo.15412. Online ahead of print.

Affiliations

¹ Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
² Pathology, Faculty of Medicine, University of Benghazi, Benghazi, Libya.
³ Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt.
⁴ Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka, Saudi Arabia.
⁵ Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
⁶ Assisted Conception Unit at the International Medical Center, Jeddah, Saudi Arabia.
⁷ Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
⁸ Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.
⁹ Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
¹⁰ Basic Medical Sciences Department, College of Medicine, Bisha University, Bisha, Saudi Arabia.

PMID: 38358296
DOI: 10.1002/ijgo.15412

Abstract

Objective: To investigate the anogenital distance from the upper verge of the anus to the posterior fourchette (AGD_AF ), FASL, and BCL2 combination as a reliable and non-invasive tool for the diagnosis of endometriosis.

Methods: This study included 100 women with endometriosis and 50 women without endometriosis as the control group. All cases underwent history taking, body mass index (BMI) measurement, AGD measurement, and FASL and BCL2 immunohistochemical staining of the eutopic endometrial tissue.

Results: This study included 150 women divided into endometriosis and control groups. Endometriosis cases significantly had shorter AGD_AF , 22.9 ± 2.6 mm, compared with the control group, 27.3 ± 3.5 mm (P < 0.001). Lower FASL and higher BCL2 expression were associated with endometriosis (P < 0.001). The combined measurement of AGD^AF (cut-off point 24.55 mm) with FASL and BCL2 was associated with endometriosis (P < 0.001). The combined diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of AGD_AF , FASL, and BCL2 were 83%, 78%, 87.3%, and 69.6%, respectively. The area under the curve was greater for AGD_AF , FASL, and BCL2 in combination than for individual measurements.

Conclusion: Combining short AGD_AF with high BCL2 and low FASL is a highly sensitive, non-invasive diagnostic tool for endometriosis.

Keywords: BCL2; FASL; anogenital distance; endometriosis.