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

Objective To investigate the anogenital distance from the upper verge of the anus to the posterior fourchette (AGDAF), 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.