Dear Sirs:
We were delighted to see the advance in research outlined in the
article, “Density of small diameter sensory nerve fibres in endometrium: a
semi-invasive diagnostic test for minimal to mild endometriosis” [Bokor et
al., Hum. Reprod. Advance Access published August 18, 2009, DOI
10.1093/humrep/dep283]. Congratulations to the authors for their
progressive work.
It is most unfortunate, however, that this limited study – which, by
the authors' own admission requires additional investigation – is now
being propagated throughout the global media as a replacement for
laparoscopic intervention. Indeed, widespread headlines boldly declaring
"Pelvic test stops need for surgery!" have been running unbridled for
weeks in countless publications.
While fault for such misleading promulgation does not necessarily lie
at the feet of the authors, we would implore them nonetheless to make a
definitive statement against such claims. To that end, one test on a
highly limited number of subjects with known disease is in no way a
replacement for the gold standard diagnosis and treatment of
Endometriosis; simply, laparoscopic excision (or other surgical
intervention). One simply cannot, with any integrity, make claims
implying that surgical intervention is ready to be replaced at this level
of infancy in the study.
Endometrial nerve fibre samplings may be promising in terms of
prognosticative value, but let us not abandon the practice of what, to
date, constitutes accurate diagnostic intervention and treatment for
countless women and adolescents around the world. Endometriosis still
requires histological confirmation of ectopic glands and stroma - not
necessarily nerve fiber density. Moreover, were we to utilize such a
test, what then would be the treatment for these patients? Are the
authors implying that surgery should be obviated altogether and replaced
with the use of only medical suppression as treatment? What too, would be
the costs factored into use of such a test? There are far too many
unknowns to give license to the worldwide media to proclaim that there is
a new “test for Endometriosis”, one which precludes the need for any
surgery whatsoever, and to fail to mention that the work is extremely
preliminary in nature.
Worse still, some media has even reported erroneously on the test
specifics, claiming it was performed on a far greater number of samples
than is true, thereby lending far more credence to the validity of the
study then perhaps is deserved.
Indeed, any research into the realm of Endometriosis is promising and
a cause for celebration. However, when irresponsible reporting about work
that is merely laying the infrastructure for future studies is reported as
the holy grail, it underserves the entire global population of women and
girls suffering from this disease and detracts from the important work of
all those professionals who have dedicated their lives to diagnosing and
treating it effectively using currently available tools.
The superiority of laparoscopy has not been replaced as either a
diagnostic or treatment measure as yet, and we respectfully request that
future media outreach on this matter adequately conveys this fact.
Respectfully yours,
Heather C. Guidone
Director, Executive Board
Endometriosis Research Center
Conflict of Interest:
None declared
