Seven hormonal biomarkers for diagnosing endometriosis: a meta-analysis and adjusted indirect comparison of diagnostic test accuracy

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 0.79 (0.71,0.86) and 0.89 (0.82,0.94) for aromatase, 0.30 (0.18,0.46) and 0.80 (0.65,0.90) for HCG/LH receptor, 0.75 (0.66,0.83) and 0.47 (0.34,0.60) for ER-α, 0.65 (0.56,0.74) and 0.68 (0.55,0.80) for ER-β, 0.45 (0.38-0.52) and 0.92(0.85-0.97) for serum prolactin, 0.69 (0.51,0.83) and 0.30 (0.16,0.49) for estrogen sulfotransferase (EST), and 0.73 (0.60-0.84) and 0.48 (0.33-0.63) for 17βHSD2. Compared with HCG/LH receptor, ER-α, ER-β, EST 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, due to the moderate quality of the included studies and the limited sample size, this result requires more research to validate.