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Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024; 311:e232191. [PMID: 38591980 PMCID: PMC11070694 DOI: 10.1148/radiol.232191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Endometriosis is a prevalent and potentially debilitating condition that mostly affects individuals of reproductive age, and often has a substantial diagnostic delay. US is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis. Other than the visualization of an endometrioma, sonologists frequently do not appreciate endometriosis on routine transvaginal US images. Given a substantial body of literature describing techniques to depict endometriosis at US, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis. The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus. This statement defines the targeted screening population, describes techniques for augmenting pelvic US, establishes direct and indirect observations for endometriosis at US, creates an observational grading and reporting system, and makes recommendations for additional imaging and patient management. The panel recommends transvaginal US of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis. These additional techniques can be performed in 5 minutes or less and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients.
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Affiliation(s)
| | | | - Luciana Chamié
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Shuchi Rodgers
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Rosanne M. Kho
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Mindy M. Horrow
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Phyllis Glanc
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Myra Feldman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Yvette Groszmann
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Zaraq Khan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Steven L. Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Liina Poder
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Tatnai L. Burnett
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Eric M. Hu
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Susan Egan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Wendaline VanBuren
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
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Peng J, Liu Q, Pu T, Zhang M, Zhang M, Du M, Li G, Zhang X, Xu C. Targeted Imaging of Endometriosis and Image-Guided Resection of Lesions Using Gonadotropin-Releasing Hormone Analogue-Modified Indocyanine Green. Mol Imaging 2023; 2023:6674054. [PMID: 38089464 PMCID: PMC10713253 DOI: 10.1155/2023/6674054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Objective In this study, we utilized gonadotropin-releasing hormone analogue-modified indocyanine green (GnRHa-ICG) to improve the accuracy of intraoperative recognition and resection of endometriotic lesions. Methods Gonadotropin-releasing hormone receptor (GnRHR) expression was detected in endometriosis tissues and cell lines via immunohistochemistry and western blotting. The in vitro binding capacities of GnRHa, GnRHa-ICG, and ICG were determined using fluorescence microscopy and flow cytometry. In vivo imaging was performed in mouse models of endometriosis using a near-infrared fluorescence (NIRF) imaging system and fluorescence navigation system. The ex vivo binding capacity was determined using confocal fluorescence microscopy. Results GnRHa-ICG exhibited a significantly stronger binding capacity to endometriotic cells and tissues than ICG. In mice with endometriosis, GnRHa-ICG specifically imaged endometriotic tissues (EMTs) after intraperitoneal administration, whereas ICG exhibited signals in the intestine. GnRHa-ICG showed the highest fluorescence signals in the EMTs at 2 h and a good signal-to-noise ratio at 48 h postadministration. Compared with traditional surgery under white light, targeted NIRF imaging-guided surgery completely resected endometriotic lesions with a sensitivity of 97.3% and specificity of 77.8%. No obvious toxicity was observed in routine blood tests, serum biochemicals, or histopathology in mice. Conclusions GnRHa-ICG specifically recognized and localized endometriotic lesions and guided complete resection of lesions with high accuracy.
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Affiliation(s)
- Jing Peng
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Qiyu Liu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Tao Pu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Mingxing Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Meng Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Ming Du
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Guiling Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Xiaoyan Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Congjian Xu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai 200032, China
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Ichikawa M, Shiraishi T, Okuda N, Nakao K, Shirai Y, Kaseki H, Akira S, Toyoshima M, Kuwabara Y, Suzuki S. Clinical Significance of a Pain Scoring System for Deep Endometriosis by Pelvic Examination: Pain Score. Diagnostics (Basel) 2023; 13:diagnostics13101774. [PMID: 37238258 DOI: 10.3390/diagnostics13101774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10-20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10-6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis.
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Affiliation(s)
- Masao Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Tatunori Shiraishi
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Naofumi Okuda
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Kimihiko Nakao
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Yuka Shirai
- Department of Obstetrics and Gynecology, Nippon Medical School, Chibe Hokuso Hospital, 1715 Kamagari, Inzai 270-1694, Chiba, Japan
| | - Hanako Kaseki
- Department of Obstetrics and Gynecology, Nippon Medical School, Chibe Hokuso Hospital, 1715 Kamagari, Inzai 270-1694, Chiba, Japan
| | - Shigeo Akira
- Meirikai Tokyo Yamato Hospital, 36-3 Honcho Itabashi, Tokyo 173-0001, Japan
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Yoshimitu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
- Department of Obstetrics and Gynecology, Nippon Medical School, Musashikosugi Hospital, 1-383 Kosugicho, Nakahara, Kawasaki 211-8533, Kanagawa, Japan
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Alcázar JL, Eguez PM, Forcada P, Ternero E, Martínez C, Pascual MÁ, Guerriero S. Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:477-486. [PMID: 35289968 PMCID: PMC9825886 DOI: 10.1002/uog.24900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis, using laparoscopy as the reference standard. METHODS A search for studies evaluating the role of the sliding sign in the assessment of pouch of Douglas obliteration and/or bowel involvement using laparoscopy as the reference standard published from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, The Cochrane Library, ClinicalTrials.gov and SCOPUS databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the studies. Analyses were performed using MIDAS and METANDI commands in STATA. RESULTS A total of 334 citations were identified. Eight studies were included in the analysis, resulting in 938 and 963 patients available for analysis of the diagnostic accuracy of the sliding sign for pouch of Douglas obliteration and bowel involvement, respectively. The mean prevalence of pouch of Douglas obliteration was 37% and the mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting pouch of Douglas obliteration were 88% (95% CI, 81-93%), 94% (95% CI, 91-96%), 15.3 (95% CI, 10.2-22.9), 0.12 (95% CI, 0.07-0.21) and 123 (95% CI, 62-244), respectively. The heterogeneity was moderate for sensitivity and low for specificity for detecting pouch of Douglas obliteration. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting bowel involvement were 81% (95% CI, 64-91%), 95% (95% CI, 91-97%), 16.0 (95% CI, 9.0-28.6), 0.20 (95% CI, 0.10-0.40) and 81 (95% CI, 34-191), respectively. The heterogeneity for the meta-analysis of diagnostic accuracy for bowel involvement was high. CONCLUSION The sliding sign on TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. L. Alcázar
- Department of Obstetrics and GynecologyClínica Universidad de NavarraPamplonaSpain
| | - P. M. Eguez
- Department of Obstetrics and GynecologyUniversity HospitalBadajozSpain
| | - P. Forcada
- Department of Obstetrics and GynecologyUniversity HospitalCastellónSpain
| | - E. Ternero
- Department of Obstetrics and GynecologyPuerta de Mar University HospitalCadizSpain
| | - C. Martínez
- Department of Obstetrics and GynecologyLa Fe University HospitalValenciaSpain
| | - M. Á. Pascual
- Department of Obstetrics, Gynecology, and ReproductionHospital Universitari DexeusBarcelonaSpain
| | - S. Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita e Diagnostica Ostetrico–GinecologicaAzienda Ospedaliero Universitaria–Policlinico Duilio Casula MonserratoMonserratoItaly
- Department of Obstetrics and GynecologyUniversity of CagliariCagliariItaly
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5
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Accuracy of transvaginal ultrasound and magnetic resonance imaging for diagnosis of deep endometriosis in bladder and ureter: a meta-analysis. J OBSTET GYNAECOL 2022; 42:2272-2281. [PMID: 35421318 DOI: 10.1080/01443615.2022.2040965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This meta-analysis aimed to determine the accuracy of transvaginal ultrasound (TVS) and pelvic magnetic resonance imaging (MRI) in diagnosing urinary tract endometriosis (UTE). A comprehensive search of the Pubmed and Embase was conducted between January 1989 and June 2020. Studies that described the accuracy of MRI or TVS for the diagnosis of UTE using surgical data as the reference standard were included. Of the 913 citations identified, 23 studies were analysed. For detection of endometriosis in bladder endometriosis (BE), the overall pooled sensitivities of TVS and MRI were 72% and 68% respectively, and their specificities were 99% and 100% respectively. For detection of endometriosis in the ureteral endometriosis (UE), the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%. In conclusion, both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective. Besides, pelvic MRI and TVS are more accurate for predicting UTE localised in the ureter than bladder, especially in terms of sensitivity.IMPACT STATEMENTWhat is already known on this subject? Previous studies have confirmed high diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) on bladder endometriosis (BE) respectively. However, high heterogeneity was found for both sensitivity and specificity and no meta-analysis has yet been performed to test the diagnostic value of TVS and MRI for ureteral endometriosis (UE).What the results of this study add? In this meta-analysis, we firstly confirmed high diagnostic value of TVS and MRI on UE respectively. For detection of UE, the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%.What the implications are of these findings for clinical practice and/or further research? Early preoperative diagnosis and accurate understanding of the widespread distribution of endometriosis are prerequisites for radical surgical in UTE. In the present study, we updated the previous results on the accuracy of TVS and MRI for the diagnosis of BE and firstly confirmed high diagnostic value of TVS and MRI on UE. Both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective.
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6
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Testini V, Eusebi L, Grechi G, Bartelli F, Guglielmi G. Imaging of Endometriosis: The Role of Ultrasound and Magnetic Resonance. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractEndometriosis is a chronic gynecological disease characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus. It causes pelvic pain, dysmenorrhea, dyspareunia, or infertility. Diagnosis requires a combination of clinical history, non-invasive and invasive techniques. The aim of the present review was to evaluate the contribution of imaging techniques, mainly transvaginal sonography and magnetic resonance imaging to diagnose different locations and for the most appropriate treatment planning. Endometriosis requires a multidisciplinary teamwork to manage these patients clinically and surgically.
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7
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Gerges B, Li W, Leonardi M, Mol BW, Condous G. Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:190-200. [PMID: 33038269 DOI: 10.1002/uog.23148] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To review the accuracy of different imaging modalities for the detection of rectosigmoid deep endometriosis (DE) in women with clinical suspicion of endometriosis, and to determine the optimal modality. METHODS A search was conducted using PubMed, MEDLINE, Scopus, EMBASE and Google Scholar to identify studies using imaging to evaluate women with suspected DE, published from inception to May 2020. Studies were considered eligible if they were prospective and used any imaging modality to assess preoperatively for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical diagnosis as the reference standard. Eligibility was restricted to studies including at least 10 affected and 10 unaffected women. The QUADAS-2 tool was used to assess the quality of the included studies. Mixed-effects diagnostic meta-analysis was used to determine the overall pooled sensitivity and specificity of each imaging modality for rectal/rectosigmoid DE, which were used to calculate the likelihood ratio of a positive (LR+) and negative (LR-) test and diagnostic odds ratio (DOR). RESULTS Of the 1979 records identified, 30 studies (3374 women) were included in the analysis. The overall pooled sensitivity and specificity, LR+, LR- and DOR for the detection of rectal/rectosigmoid DE using transvaginal sonography (TVS) were, respectively, 89% (95% CI, 83-92%), 97% (95% CI, 95-98%), 30.8 (95% CI, 17.6-54.1), 0.12 (95% CI, 0.08-0.17) and 264 (95% CI, 113-614). For magnetic resonance imaging (MRI), the respective values were 86% (95% CI, 79-91%), 96% (95% CI, 94-97%), 21.0 (95% CI, 13.4-33.1), 0.15 (95% CI, 0.09-0.23) and 144 (95% CI, 70-297). For computed tomography, the respective values were 93% (95% CI, 84-97%), 95% (95% CI, 81-99%), 20.3 (95% CI, 4.3-94.9), 0.07 (95% CI, 0.03-0.19) and 280 (95% CI, 28-2826). For rectal endoscopic sonography (RES), the respective values were 92% (95% CI, 87-95%), 98% (95% CI, 96-99%), 37.1 (95% CI, 21.1-65.4), 0.08 (95% CI, 0.05-0.14) and 455 (95% CI, 196-1054). There was significant heterogeneity and the studies were considered methodologically poor according to the QUADAS-2 tool. CONCLUSIONS The sensitivity of TVS for the detection of rectal/rectosigmoid DE seems to be slightly better than that of MRI, although RES was superior to both. The specificity of both TVS and MRI was excellent. As TVS is simpler, faster and more readily available than the other methods, we believe that it should be the first-line diagnostic tool for women with suspected DE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Gerges
- Sydney Medical School Nepean, University of Sydney Nepean Hospital, Kingswood, NSW, Australia
- Sydney West Advanced Pelvic Surgery (SWAPS), Blacktown Hospital, Blacktown, NSW, Australia
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - M Leonardi
- Sydney Medical School Nepean, University of Sydney Nepean Hospital, Kingswood, NSW, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - G Condous
- Sydney Medical School Nepean, University of Sydney Nepean Hospital, Kingswood, NSW, Australia
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8
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Abstract
Minimally invasive surgery continues to transform the field of gynecological surgery and is now the standard of care for the surgical treatment of many diseases in gynecology. Owing to minimally invasive surgery's clear advantages, new advances in technology are being employed rapidly and enabling even the most complicated procedures to be performed less invasively. We examine recent literature on minimally invasive surgical innovations, advances, and common practices in benign gynecology that, from our point of view, made an impact on the way laparoscopic surgery is performed and managed in the last decade.
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Affiliation(s)
- Lior Levy
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
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9
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Bordonné C, Puntonet J, Maitrot-Mantelet L, Bourdon M, Marcellin L, Dion E, Plu-Bureau G, Santulli P, Chapron C. Imaging for evaluation of endometriosis and adenomyosis. Minerva Obstet Gynecol 2021; 73:290-303. [PMID: 34008384 DOI: 10.23736/s2724-606x.21.04710-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endometriosis and adenomyosis are two frequent diseases that impair women's quality of life by causing pain and infertility. Both endometriosis and adenomyosis are heterogeneous diseases that manifest as different forms. Adenomyosis may be described as diffuse adenomyosis, focal adenomyosis especially of the outer myometrium and cystic adenomyoma. Endometriosis has three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). These two diseases are closely linked, and it is now clear that adenomyosis can either arise on its own or coexist with endometriosis. There is a strong clinical relationship between endometriosis and adenomyosis according to their respective phenotypes. Various classifications are available to describe both diseases. Transvaginal ultrasonography (TVUS) and/or pelvic magnetic resonance imaging (MRI) are the first examination performed when endometriosis or adenomyosis are suspected. These two imaging techniques, used in a combination manner, allow accurate description of both endometriosis and adenomyosis, to assess the diagnosis and to improve clinical and surgical care. In this review, we described the different imaging aspects of endometriosis and adenomyosis to help the less experienced radiologist or gynecologist in the diagnosis and evaluation of those diseases.
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Affiliation(s)
- Corinne Bordonné
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France - .,Faculty of Medicine, University of Paris, Paris, France -
| | - Julien Puntonet
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Lorraine Maitrot-Mantelet
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Mathilde Bourdon
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Louis Marcellin
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Elisabeth Dion
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Geneviève Plu-Bureau
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Pietro Santulli
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Charles Chapron
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
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10
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Burghaus S, Beckmann MW. [Endometriosis: gynecological diagnosis and treatment : What should pain management specialists know?]. Schmerz 2021; 35:172-178. [PMID: 33730222 DOI: 10.1007/s00482-021-00541-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endometriosis is one of the most common diseases in women of reproductive age. Despite characteristic symptoms such as dysmenorrhea, chronic abdominal pain, dysuria, dyschezia and dyspareunia, the average latency until diagnosis is around 10 years. In addition to the individual limitations, the disease also has economic and health policy relevance. The complaints are followed by reductions in working hours, cyclically recurring short-term sick leave or presenteeism with reduced performance. OBJECTIVE An overview of the main recommendations of the S2k guideline on the diagnosis and treatment of endometriosis. MATERIAL AND METHODS For the S2k guideline "Diagnostics and therapy of endometriosis", a systematic literature search was conducted in PubMed and Cochrane according to a defined algorithm and over a period of more than 5 years, from 01.01.2014 to 31.12.2018. For the evaluation, 322 publications, including systematic reviews, meta-analyses and randomized controlled trials were considered and these were assessed by 41 mandate holders and representatives from 25 Association of the Scientific Medical Societies in Germany (AWMF) and non-AWMF professional societies, organizations, associations and working groups of the German Society for Gynecology and Obstetrics (DGGG), as well as two patient target groups. RESULTS In a structured consensus process, 48 recommendations and 27 statements were formulated, which are presented in extracts in this paper. DISCUSSION Interdisciplinary cooperation is essential in the treatment of patients with (suspected) endometriosis. This team should include all necessary disciplines in a cross-sectoral network. This is most likely to be achieved in a certified structure.
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Affiliation(s)
- Stefanie Burghaus
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Universitätsstr. 21-23, 91054, Erlangen, Deutschland.
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Universitätsstr. 21-23, 91054, Erlangen, Deutschland
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11
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Scioscia M, Zanetti I, Raspanti X, Spoto E, Portuese A, Noventa M, Pontrelli G, Greco P, Virgilio BA. Ultrasound Differential Diagnosis in Deep Infiltrating Endometriosis of the Urinary Tract. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2261-2275. [PMID: 32385923 DOI: 10.1002/jum.15322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
Endometriosis of the urinary tract is a rare condition that may lead to severe complications. At present, the major challenge appears to be the ultrasound differential diagnosis with diseases that can afflict the ureter and the bladder. Preoperative scan findings were compared with surgical and histologic records. Twenty-three cases were selected as being of interest, as they were referred for suspected endometriosis, whereas second-level ultrasound revealed a different disease in some cases. This case series aims to help in becoming familiar with the possible differential diagnosis of lesions of the urinary tract that resemble endometriosis.
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Affiliation(s)
- Marco Scioscia
- Departments of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Italy
- Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Isabella Zanetti
- Departments of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Italy
- Department of Morphology, Surgery, and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, Sant'Anna University Hospital, Cona, Italy
| | - Xenia Raspanti
- Department of Radiology, Policlinico Hospital, Abano Terme, Italy
| | - Elide Spoto
- Department of Radiology, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Marco Noventa
- Departments of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Italy
| | - Giovanni Pontrelli
- Departments of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Italy
- Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Pantaleo Greco
- Department of Morphology, Surgery, and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, Sant'Anna University Hospital, Cona, Italy
| | - Bruna Anna Virgilio
- Departments of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Italy
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12
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Scioscia M, Virgilio BA, Laganà AS, Bernardini T, Fattizzi N, Neri M, Guerriero S. Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge. Diagnostics (Basel) 2020; 10:E848. [PMID: 33092074 PMCID: PMC7589178 DOI: 10.3390/diagnostics10100848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/22/2022] Open
Abstract
Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions' appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Bruna A. Virgilio
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, VA, Italy
| | - Tommaso Bernardini
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Nicola Fattizzi
- Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; (M.S.); (B.A.V.); (T.B.); (N.F.)
| | - Manuela Neri
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (M.N.); (S.G.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Stefano Guerriero
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (M.N.); (S.G.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
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13
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Abstract
Endovaginal sonographic imaging has been shown to reliably identify pelvic endometriosis, but most United States imaging practices do not adequately assess locations and features of endometriosis beyond ovarian endometrioma. In this article, we propose a protocol for sonographer-acquired images and maneuvers to be interpreted subsequently by sonologists (radiologists or gynecologists). The purpose is to improve the sensitivity of endovaginal sonography for the detection of endometriosis in imaging practices that involve the non-physician sonographer as part of their workflow.
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14
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Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care. Abdom Radiol (NY) 2020; 45:1608-1622. [PMID: 31446452 DOI: 10.1007/s00261-019-02182-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a chronic, multifocal disease, which can lead to pain or subfertility. Treatments are tailored toward the therapeutic goals of the individual patient; either to improve a specific pain symptom or optimize fertility. Management of endometriosis is complex, and best implemented by a comprehensive, multidisciplinary team of physicians and health care providers. The role of the radiologist in the management of endometriosis is becoming increasingly important as more centers move toward utilizing female pelvic MR studies to diagnose, delineate or follow endometriosis lesions. The radiologist must communicate pertinent, actionable findings from these studies in a manner that is clear and concise. Structured radiologic reports (SRR) add value in that they provide organized, clear, and comprehensive information from imaging studies, ensuring reports include essential items required for decision-making. In this paper, we review our MR imaging protocol and present the structured radiologic report implemented at our institution by our multidisciplinary endometriosis care team. Imaging features of endometriosis at each site specified in the structured report are summarized. The importance of each element included in the structured report from a management perspective is highlighted.
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15
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Diagnosing endometriosis before laparoscopy: radiologic tools to evaluate the disease. Curr Opin Obstet Gynecol 2020; 32:292-297. [DOI: 10.1097/gco.0000000000000638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Venkatesh S, Anjali M, Vasudeva A, Kumar P. Sliding Sign and Gel Sonovaginography: A Sneak Peek Prior to Laparoscopy in Patients with Endometriosis. J Hum Reprod Sci 2020; 13:26-30. [PMID: 32577065 PMCID: PMC7295256 DOI: 10.4103/jhrs.jhrs_169_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
Context: The rising incidence of endometriosis may be due to improvisation in the diagnostic techniques. Transvaginal sonography has proven to be very useful in the diagnosis of complexity of the disease and in turn to predict the intraoperative findings on laparoscopy. Aims: The aim was to study the use of sliding sign for detecting the status of the pouch of Douglas (POD) and to check for the presence of bowel and nonbowel deep infiltrating endometriosis (DIE) by gel sonovaginography. Settings and Design: This is a prospective observational study carried out patient division of Department of OBG in Kasturba Hospital Manipal. Methods: The study was carried out over a period of 2 years and included 136 women. After written informed consent, a detailed history and clinical examination was done. A detailed transvaginal sonography was done for each of the patients by a single observer on the Philips HD11XE machine two-dimensional transvaginal probe which included gel sonovaginography and real-time dynamic test called sliding sign. Statistical Analysis: Chi-square test was used in this study. Results: Sliding sign is highly specific, sensitive, and accurate for the detection of POD obliteration. It is 96.6% sensitive and 89.5% specific. It is 94.1% accurate and 94.5% positively predictive for the same. Transvaginal sonography is >92% specific for the detection of bowel and nonbowel DIE. The accuracy is over 91%. The negative predictability is 93.6% and 94.6%, respectively. Conclusions: Sliding sign is a useful, easy-to-perform, reproducible, and noninvasive modality for assessing the status of POD. Gel sonovaginography is also useful in accurately detecting the presence of deep infiltrating endometriotic deposits.
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Affiliation(s)
- Spoorthy Venkatesh
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
| | - M Anjali
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
| | - Akhila Vasudeva
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
| | - Pratap Kumar
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
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Guerriero S, Ajossa S, Pascual MA, Rodriguez I, Piras A, Perniciano M, Saba L, Paoletti AM, Mais V, Alcazar JL. Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:269-273. [PMID: 30977185 DOI: 10.1002/uog.20289] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the use of ultrasound (US) soft markers as a first-line imaging tool to raise suspicion of rectosigmoid (RS) involvement in women suspected of having deep endometriosis. METHODS We included in this prospective observational study all patients with clinical suspicion of deep endometriosis who underwent diagnostic transvaginal US evaluation at our unit from January 2016 to February 2017. Several US soft markers were evaluated for prediction of RS involvement (presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesion of the ovary to the uterus (reduced ovarian mobility), presence of 'kissing ovaries' (KO) and absence of the 'sliding sign'), using as the gold standard expert US examination for the presence of RS endometriosis. RESULTS Included were 333 patients with clinical suspicion of deep endometriosis. Of these, 106 had an US diagnosis of RS endometriosis by an expert. The only significant variables found in the prediction model were absence of the sliding sign (odds ratio (OR), 13.95; 95% CI, 7.7-25.3), presence of KO (OR, 22.5; 95% CI, 4.1-124.0) and the interaction between these two variables (OR, 0.03; 95% CI, 0.004-0.28). Regarding their interaction, RS endometriosis was present when KO was absent and the sliding sign was present in 10% (19/190) of cases, when both KO and the sliding sign were present in 71.4% (5/7) of cases, when both KO and the sliding sign were absent in 60.8% (76/125) of cases and when KO was present and the sliding sign was absent in 54.5% (6/11) of cases. Thus, when the sliding sign was absent and/or KO was present, transvaginal US showed a specificity of 75% (95% CI, 69-80%) and a sensitivity of 82% (95% CI, 73-88%). CONCLUSIONS US findings of absence of the sliding sign and/or presence of KO in patients with clinical suspicion of endometriosis should raise suspicion of RS involvement and indicate referral for expert US examination, with a low rate of false-negative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Guerriero
- Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, Monserrato, Italy
| | - S Ajossa
- Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain
| | - I Rodriguez
- Unidad Epidemiología y Estadística, Departamento de Obstetricia, Ginecología y Reproducción, Hospital Universitario Dexeus, Barcelona, Spain
| | - A Piras
- Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - M Perniciano
- Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - A M Paoletti
- Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - V Mais
- Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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18
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Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis. Diagnostics (Basel) 2019; 9:diagnostics9040225. [PMID: 31861142 PMCID: PMC6963762 DOI: 10.3390/diagnostics9040225] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/01/2019] [Accepted: 12/10/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES A meta-analysis, with a head-to-head approach, was carried out to compare the three most common techniques for a deep pelvic endometriosis (DPE) diagnosis. We focused on: transvaginal-sonography (TVS), magnetic-resonance imaging (MRI), and rectal-endoscopy-sonography (RES). METHODS Electronic databases were searched from their inception until December 2018. All prospective and well-defined retrospective studies carried out in tertiary referral centers were considered. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesizing Evidence from Diagnostic Accuracy Tests (SEDATE) guidelines. We considered only papers in which at least two imaging modalities were compared in the same set of patients (head-to-head approach). Meta-analysis of diagnostic test accuracy (DTA) was performed separately for each location of interest. Bivariate or univariate approach has been applied when appropriate. We analyze the DTA of TVS vs. MRI, TVS vs. RES, and MRI vs. RES. RESULTS Our meta-analysis (17 studies included) showed high-to-moderate DTA of TVS for all endometriosis locations (apart from recto-vaginal septum (RVS)) that were not statistically different from MRI and RES for those localized in the posterior compartment. RES results were more accurate than MRI for RS lesions but less accurate than TVS for other pelvic locations, except for RVS. CONCLUSIONS All approaches provide good accuracy with specific strong points. Ultrasonography demonstrated a diagnostic accuracy not inferior to MRI and RES; therefore, it must be considered the primary approach for DPE diagnosis. MRI has to be considered as a valuable approach in settings where highly skilled sonographers are not available. Keypoints: (1) We confirmed the non-inferiority of TVS compared to MRI and RES for the diagnosis of specific pelvic anatomic location of endometriosis lesions. (2) Ultrasonography could be considered the primary approach for DPE diagnosis (less invasive than RES and less expensive than MRI). (3) MRI has to be considered as a valuable approach in settings where skilled sonographers are not available.
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Sonographic Differential Diagnosis in Deep Infiltrating Endometriosis: The Bowel. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5958402. [PMID: 31781626 PMCID: PMC6855068 DOI: 10.1155/2019/5958402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022]
Abstract
Up to one-third of fertile-age women with severe endometriosis suffer from colonic involvement. Transvaginal ultrasonography has become a first-line diagnostic tool for the study of the pelvis and more specifically for the diagnosis of pelvic endometriosis. Accuracy of pelvic ultrasound for deep endometriosis increases with operator experience, but the difficulties in the differential diagnosis with diseases that can afflict the bowel tract remain a challenge. We reviewed noteworthy cases referred for secondary level diagnosis suspected of bowel endometriosis in which the subsequent ultrasound led to an alternative diagnosis. This case series aims to highlight awareness for both experts and less-experienced operators the possible differential diagnoses of bowel lesions that initially resemble endometriosis.
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20
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A Practical Guide to the Clinical Evaluation of Endometriosis-Associated Pelvic Pain. J Minim Invasive Gynecol 2019; 27:270-279. [PMID: 31669551 DOI: 10.1016/j.jmig.2019.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
Endometriosis-associated pain (EAP) has a significant impact on the quality of life of those affected and their families. Recognizing that endometriosis is a chronic condition associated with an impairment in function and negative social impact, there is a shift toward reducing diagnostic delays and initiating timely management. This article provides a comprehensive and practical approach to the clinical diagnosis of EAP, which can subsequently facilitate prompt and directed treatment. The key components of the history, physical examination, and high-quality imaging to evaluate suspected EAP and related pain conditions are presented. Currently, biomarkers have limited utility in the diagnosis of endometriosis, but research in this area continues; development of a reliable noninvasive test for endometriosis may further improve early identification of this condition.
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21
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Bekhouche A, Pottier E, Wahab CA, Milon A, Kermarrec É, Bazot M, Thomassin-Naggara I. Recommandations récentes de la Haute Autorité de santé et de l’European Society of Urogenital Radiology sur l’imagerie de l’endométriose. IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Oliveira JGAD, Bonfada V, Zanella JDFP, Coser J. Transvaginal ultrasound in deep endometriosis: pictorial essay. Radiol Bras 2019; 52:337-341. [PMID: 31656353 PMCID: PMC6808616 DOI: 10.1590/0100-3984.2018.0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Endometriosis is characterized by the presence of endometrial tissue outside the
uterus. When endometrial implants penetrate more than 5 mm into the peritoneum,
the condition is referred to as deep pelvic endometriosis. Although laparoscopy
is the gold standard test to establish a diagnosis of deep endometriosis,
transvaginal ultrasound represents an alternative that can contribute to
detection of the disease, because it is an accessible, low-cost, noninvasive
examination that allows preoperative planning in cases requiring surgical
treatment. However, in clinical practice, transvaginal ultrasound is still not
widely used as the first-line examination in suspected cases of endometriosis.
This essay describes the findings of deep endometriosis on transvaginal
ultrasound, in order to disseminate knowledge of the utility of the technique
for the diagnosis of this disease.
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Guerriero S, Pascual MA, Ajossa S, Rodriguez I, Zajicek M, Rolla M, Rams Llop N, Yulzari V, Bardin R, Buonomo F, Comparetto O, Perniciano M, Saba L, Mais V, Alcazar JL. Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:262-269. [PMID: 30426587 DOI: 10.1002/uog.20176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE). METHODS Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE. RESULTS The trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE. CONCLUSIONS The suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - I Rodriguez
- Unidad Epidemiología y Estadística, Departamento de Obstetricia, Ginecología y Reproducción, Hospital Universitario Quirón Dexeus, Barcelona, Spain
| | - M Zajicek
- Obstetrics and Gynecology Ultrasound Unit at the Chaim Sheba Medical Center, Tel-Hashomer, Israel affiliated to Tel-Aviv University, Israel
| | - M Rolla
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - N Rams Llop
- Secció d'Ecografia Servei de Ginecologia i Obstetricia Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Yulzari
- Ob/Gyn Ultrasonic Imaging Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - R Bardin
- Hellen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - F Buonomo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - O Comparetto
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - M Perniciano
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - V Mais
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Lete I. Endometriosis: Diagnosis and treatment. Med Clin (Barc) 2019; 152:508-512. [PMID: 30803797 DOI: 10.1016/j.medcli.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Iñaki Lete
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Universitario Araba, Vitoria, España; Universidad del País Vasco, Vitoria, España; Instituto de Investigación Bioaraba, Vitoria, España.
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25
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Accuracy of Physical Examination, Transvaginal Sonography, Magnetic Resonance Imaging, and Rectal Endoscopic Sonography for Preoperative Evaluation of Rectovaginal Endometriosis. Ultrasound Q 2019; 35:54-60. [PMID: 30789487 DOI: 10.1097/ruq.0000000000000428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to compare the effectiveness of physical examination, transvaginal sonography, magnetic resonance imaging, and rectal endoscopic sonography for the identification of rectovaginal endometriosis and potential rectal infiltration. Women with suspected rectovaginal endometriosis underwent physical examination, transvaginal sonography, magnetic resonance imaging, and rectal endoscopic sonography. Evaluation was performed for the presence of rectovaginal endometriotic foci and rectal infiltration. The findings obtained with these methods were compared with those of surgical and histopathological examination. Sensitivity, specificity, positive predictive values, and negative predictive values were evaluated for each method. Rectovaginal endometriosis was histologically confirmed in 21 (72.4%) of 29 women. With respect to diagnosis of rectovaginal endometriosis, the sensitivity, specificity, and accuracy of physical examination were 95.2%, 62.5%, and 86.2%; those of transvaginal sonography were 42.9%, 87.5%, and 55.2%; those of magnetic resonance imaging were 90.5%, 87.5%, and 89.7%; and those of rectal endoscopic sonography were 81.0%, 75.0%, and 79.3%, respectively. With respect to identification of rectal infiltration, the sensitivity, specificity, and accuracy of transvaginal sonography were 26.7%, 85.7%, and 55.2%; those of magnetic resonance imaging were 73.3%, 92.9%, and 82.8%; and those of rectal endoscopic sonography were 86.7%, 85.7%, and 86.2%, respectively. Magnetic resonance imaging combined with physical examination seem to be the main approach for the presurgical assessment of rectovaginal endometriosis. Rectal endoscopic sonography is a worthwhile method for the diagnosis of rectal infiltration.
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Espada M, Alvarez-Moreno E, Jimenez de la Pena M, Munoz Capio V, Reid S, Condous G. Imaging techniques in endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518773215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common gynecological condition affecting up to 15% of the general female population. Here, we present a systematic review of imaging techniques of endometriosis. The aim of this review is to determine the most accurate site-specific preoperative diagnostic tools in order to map, locate, evaluate the extension, and stage the disease. There are important reasons to stage endometriosis: to create a common language, to enable specificity of diagnosis, standardize comparisons, and to facilitate research applications. The requirements of an ideal endometriosis classification system are that it be empirically and scientifically based, be of general consensus, have unambiguous definition of terms, be comprehensive in all cases, have a simple translation from anatomic features to verbal description, reflect disease, predict fertility, predict pain relief, be useful to guide treatment, indicate risk of recurrence, identify clinical situations in which it does not apply, be simple to calculate, and be easy to communicate to women. An extensive search of papers regarding imaging techniques in endometriosis was performed in Pubmed from January 1992 to February 2018, including original peer-reviewed papers, reviews, and international guidelines.
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Affiliation(s)
- Mercedes Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | | | | | | | - Shannon Reid
- Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
- OMNI Ultrasound & Gynaecological Care, Centre for Women’s Ultrasound and Early Pregnancy, Sydney, NSW, Australia
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Giampaolino P, Della Corte L, Saccone G, Vitagliano A, Bifulco G, Calagna G, Carugno J, Di Spiezio Sardo A. Role of Ovarian Suspension in Preventing Postsurgical Ovarian Adhesions in Patients with Stage III-IV Pelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2018; 26:53-62. [PMID: 30092363 DOI: 10.1016/j.jmig.2018.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Endometriosis is a benign complex gynecologic condition with high morbidity that affects women of reproductive age. Pelvic adhesion formation represents a serious clinical challenge in the management of patients with endometriosis. Several interventions aimed at reducing postoperative ovarian adhesion formation have been proposed in recent years. Here we summarize the published evidence on the efficacy of ovarian suspension in preventing postoperative ovarian adhesion formation in women undergoing laparoscopic surgery for stage III-IV endometriosis. The research was conducted using electronic databases. A review of the abstracts of all references retrieved from the search was conducted. Selection criteria for the systematic review included all randomized controlled trials (RCTs) and nonrandomized studies (NRSs) of premenopausal women diagnosed with stage III-IV pelvic endometriosis who underwent ovarian suspension or no ovarian suspension (control group). The RCTs were eligible for meta-analysis. Eight studies, 2 RCTs and 6 NRSs, were included in the systematic review. In all 8 studies, ovarian suspension was performed during surgery for stage III-IV endometriosis. The site of the suspension was the anterior abdominal wall in 76.8% of the cases. Five studies reported the use of polypropylene as suture for the suspension. Removal of the suspension suture in the postoperative period was reported in 6 studies. Pooled data from a meta-analysis of the RCTs show that women who underwent ovarian suspension had a significantly lower incidence of postoperative adhesion formation, particularly of moderate to severe adhesions. Ovarian suspension may reduce the rate and severity of postoperative adhesions formation in women undergoing laparoscopy for the treatment of stage III-IV endometriosis; however, RCTs with larger sample sizes are needed.
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Affiliation(s)
- Pierluigi Giampaolino
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Amerigo Vitagliano
- Department of Woman's and Child's Health, University of Padua, Padua, Italy (Dr Vitagliano)
| | - Giuseppe Bifulco
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gloria Calagna
- Department of Obstetrics and Gynecology, "Villa Sofia Cervello" University of Palermo, Palermo, Italy (Dr Calagna)
| | - Jose Carugno
- UHealth Obstetrics & Gynecology, Miller School of Medicine, University of Miami, Miami, Florida (Dr Carugno)
| | - Attilio Di Spiezio Sardo
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy.
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Abstract
Endometriosis is a common inflammatory disease characterized by the presence of tissue outside the uterus that resembles endometrium, mainly on pelvic organs and tissues. It affects ~5-10% of women in their reproductive years - translating to 176 million women worldwide - and is associated with pelvic pain and infertility. Diagnosis is reliably established only through surgical visualization with histological verification, although ovarian endometrioma and deep nodular forms of disease can be detected through ultrasonography and MRI. Retrograde menstruation is regarded as an important origin of the endometrial deposits, but other factors are involved, including a favourable endocrine and metabolic environment, epithelial-mesenchymal transition and altered immunity and inflammatory responses in genetically susceptible women. Current treatments are dictated by the primary indication (infertility or pelvic pain) and are limited to surgery and hormonal treatments and analgesics with many adverse effects that rarely provide long-term relief. Endometriosis substantially affects the quality of life of women and their families and imposes costs on society similar to those of other chronic conditions such as type 2 diabetes mellitus, Crohn's disease and rheumatoid arthritis. Future research must focus on understanding the pathogenesis, identifying disease subtypes, developing non-invasive diagnostic methods and targeting non-hormonal treatments that are acceptable to women who wish to conceive.
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Guerriero S, Alcázar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Mais V, Piras B, Schirru F, Benedetto MG, Saba L. Deep Infiltrating Endometriosis: Comparison Between 2-Dimensional Ultrasonography (US), 3-Dimensional US, and Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1511-1521. [PMID: 29193230 DOI: 10.1002/jum.14496] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasonography (US) in comparison with magnetic resonance imaging (MRI) for identification of deep infiltrating endometriosis. METHODS In this prospective observational study, 159 premenopausal women who underwent surgery for a clinical suspicion of deep infiltrating endometriosis were prospectively enrolled. All women underwent 2DUS, 3DUS, and MRI. The following 3 locations of deep endometriosis were considered: (1) intestinal; (2) other posterior lesions (retrocervical septum, rectovaginal septum, uterosacral ligaments, and vaginal fornix); and (3) anterior. The sensitivity, specificity, positive predictive value, and negative predictive value of 2D and 3D transvaginal US in comparison with MRI were determined. RESULTS Intestinal deep infiltrating endometriosis was identified by 2DUS in 56 of 66 patients, by 3DUS in 59 of 66, and by MRI in 61 of 66. A receiver operating characteristic curve analysis showed optimal results for 2DUS, 3DUS, and MRI (areas under the curve, 0.86, 0.915, and 0.935, respectively) with a statistically significant difference between 2DUS and MRI (P = .0103), even when the 95% confidence interval showed an overlap. Other posterior deep infiltrating endometriosis was identified by 2DUS in 55 of 75 patients, by 3DUS in 65 of 75, and by MRI in 66 of 75. A receiver operating characteristic curve analysis showed very good results for 2DUS, 3DUS, and MRI (areas under the curve, 0.801, 0.838, and 0.857) with no statistically significant differences. In the 12 women with deep infiltrating endometriosis in the anterior location, the nodules were correctly identified by 2DUS in 3 of 12 patients, by 3DUS in 5 of 12, and by MRI in 6 of 12. CONCLUSIONS Our results seem to suggest that there is a statistically significant difference between 2DUS and MRI for the intestinal location of deep infiltrating endometriosis, whereas no differences were found among the techniques for the other locations.
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Affiliation(s)
- Stefano Guerriero
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Maria Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Silvia Ajossa
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Maura Perniciano
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Alba Piras
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Valerio Mais
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Bruno Piras
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Federica Schirru
- Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Melis Gian Benedetto
- Department of Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy
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Guerriero S, Saba L, Pascual MA, Ajossa S, Rodriguez I, Mais V, Alcazar JL. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:586-595. [PMID: 29154402 DOI: 10.1002/uog.18961] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To perform a systematic review of studies comparing the accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in diagnosing deep infiltrating endometriosis (DIE) including only studies in which patients underwent both techniques. METHODS An extensive search was carried out in PubMed/MEDLINE and Web of Science for papers from January 1989 to October 2016 comparing TVS and MRI in DIE. Studies were considered eligible for inclusion if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE and using surgical data as a reference standard. Quality was assessed using the QUADAS-2 tool. A random-effects model was used to determine pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR). RESULTS Of 375 citations identified, six studies (n = 424) were considered eligible. For MRI in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.78-0.90), specificity was 0.95 (95% CI, 0.83-0.99), LR+ was 18.4 (95% CI, 4.7-72.4), LR- was 0.16 (95% CI, 0.11-0.24) and DOR was 116 (95% CI, 23-585). For TVS in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.68-0.94), specificity was 0.96 (95% CI, 0.85-0.99), LR+ was 20.4 (95% CI, 4.7-88.5), LR- was 0.16 (95% CI, 0.07-0.38) and DOR was 127 (95% CI, 14-1126). For MRI in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.66 (95% CI, 0.51-0.79), specificity was 0.97 (95% CI, 0.89-0.99), LR+ was 22.5 (95% CI, 6.7-76.2), LR- was 0.38 (95% CI, 0.23-0.52) and DOR was 65 (95% CI, 21-204). For TVS in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.59 (95% CI, 0.26-0.86), specificity was 0.97 (95% CI, 0.94-0.99), LR+ was 23.5 (95% CI, 9.1-60.5), LR- was 0.42 (95% CI, 0.18-0.97) and DOR was 56 (95% CI, 11-275). For MRI in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.70 (95% CI, 0.55-0.82), specificity was 0.93 (95% CI, 0.87-0.97), LR+ was 10.4 (95% CI, 5.1-21.2), LR- was 0.32 (95% CI, 0.20-0.51) and DOR was 32 (95% CI, 12-85). For TVS in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.67 (95% CI, 0.55-0.77), specificity was 0.86 (95% CI, 0.73-0.93), LR+ was 4.8 (95% CI, 2.6-9.0), LR- was 0.38 (95% CI, 0.29-0.50) and DOR was 12 (95% CI, 7-24). Confidence intervals of pooled sensitivities, specificities and DOR were wide for both techniques in all the locations considered. Heterogeneity was moderate or high for sensitivity and specificity for both TVS and MRI in most locations assessed. According to QUADAS-2, the quality of the included studies was considered good for most domains. CONCLUSION The diagnostic performance of TVS and MRI is similar for detecting DIE involving rectosigmoid, uterosacral ligaments and rectovaginal septum. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - I Rodriguez
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - V Mais
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Szubert M, Ziętara M, Suzin J. Conservative treatment of deep infiltrating endometriosis: review of existing options. Gynecol Endocrinol 2018; 34:10-14. [PMID: 28952821 DOI: 10.1080/09513590.2017.1381837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Endometriosis with its estimated incidence rate of ∼7-10% of women of reproductive age is a disease with the wide spectrum of symptoms depending on form and localization of endometrial foci. One clinical form of endometriosis is deep infiltrating endometriosis (DIE), most difficult to manage and generating a lot of direct and indirect treatment costs. We search the literature from PubMed database to establish the role of conservative treatment of DIE. Randomised controlled trials are lacking but in experts opinion hormonal treatment should be the first-line treatment in DIE. After evaluation of pain or other symptoms, second-line therapy with GnRH analogs or danazol should be offered or minimally invasive surgery. Consensus is not made whether surgery is the best therapeutic treatment for affected patients. Strong depending on surgeon's experience conservative surgery should be offered if the total excision of DIE foci is possible, which is essential for a successful outcome. If available treatment options do not release pain associated with DIE, experimental treatment in clinical trials should be discussed with patients.
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Affiliation(s)
- Maria Szubert
- a Clinic of Operative and Oncologic Gynecology, First Department of Gynecology and Obstetrics , Medical University of Lodz, M. Pirogow's Teaching Hospital , Lodz , Poland
| | - Magdalena Ziętara
- b Students' Scientific Society at the First Department of Gynecology and Obstetrics , Medical University of Lodz , Lodz , Poland
| | - Jacek Suzin
- a Clinic of Operative and Oncologic Gynecology, First Department of Gynecology and Obstetrics , Medical University of Lodz, M. Pirogow's Teaching Hospital , Lodz , Poland
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Vitagliano A, Noventa M, Di Spiezio Sardo A, Saccone G, Gizzo S, Borgato S, Vitale SG, Laganà AS, Nardelli GB, Litta PS, Saccardi C. Uterine fibroid size modifications during pregnancy and puerperium: evidence from the first systematic review of literature. Arch Gynecol Obstet 2017; 297:823-835. [DOI: 10.1007/s00404-017-4621-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
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Bazot M, Bharwani N, Huchon C, Kinkel-Trugli K, Cunha TM, Guerra A, Manganaro L, Bunesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall A. Recommandations de la Société européenne d’imagerie génito-urinaire : IRM de l’endométriose pelvienne. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bazot M, Daraï E. Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertil Steril 2017; 108:886-894. [DOI: 10.1016/j.fertnstert.2017.10.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022]
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Young SW, Dahiya N, Patel MD, Abrao MS, Magrina JF, Temkit M, Kho RM. Initial Accuracy of and Learning Curve for Transvaginal Ultrasound with Bowel Preparation for Deep Endometriosis in a US Tertiary Care Center. J Minim Invasive Gynecol 2017; 24:1170-1176. [DOI: 10.1016/j.jmig.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/21/2017] [Accepted: 07/02/2017] [Indexed: 02/03/2023]
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Gerges B, Lu C, Reid S, Chou D, Chang T, Condous G. Sonographic evaluation of immobility of normal and endometriotic ovary in detection of deep endometriosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:793-798. [PMID: 27281370 DOI: 10.1002/uog.15990] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/23/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To examine the association between ovarian immobility and presence of endometriomas and assess the diagnostic accuracy of transvaginal sonographic (TVS) ovarian immobility in the detection of deep infiltrating endometriosis (DIE). METHODS This was a multicenter prospective observational study of women presenting with chronic pelvic pain from January 2009 to March 2015. Women with or without history of endometriosis who were scheduled to undergo laparoscopic surgery for endometriosis gave a detailed history and underwent specialized TVS in a tertiary referral unit prior to laparoscopy. During TVS, ovarian mobility and the presence of endometriomas were assessed. The relationship between TVS ovarian mobility, with or without endometriomas, and DIE was correlated with the gold standard, diagnosis of endometriosis at laparoscopy. RESULTS Included in the analysis were 265 women with preoperative TVS and laparoscopic outcomes. Ovarian immobility on TVS was significantly associated with presence of endometriomas at surgery, with a prevalence of 12.2%, 10.8% and 52.7% for fixation of the left ovary only, the right ovary only and bilateral ovaries, respectively, compared with 4.2%, 3.7% and 7.3% for normal ovaries. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and positive and negative likelihood ratios of TVS ovarian immobility for diagnosis at surgery of immobility of ovaries with endometriomas in the left ovary only were 44.4%, 92.3%, 44.4%, 92.3%, 5.8, 0.6, in the right ovary only were 50.0%, 98.5%, 80.0%, 94.2%, 33.0, 0.5 and bilaterally were 74.4%, 68.6%, 72.5%, 70.6%, 2.4, 0.4, while those for diagnosis of immobility of normal ovaries were 25.0%, 87.9%, 8.3%, 96.4%, 2.1, 0.9 for left ovary only, 14.3%, 92.9%, 7.1%, 96.6%, 2.0, 0.9 for right ovary only and 35.7%, 97.2%, 50.0%, 95.0%, 12.6, 0.7 bilaterally, respectively (P < 0.05 except for normal left and right ovaries with P = 0.2 and 0.4, respectively). The sensitivity, specificity, PPV and NPV for performance of ovarian immobility in the prediction of DIE for all women were 58.3%, 74.1%, 60.6%, 72.2% and in the prediction of need for bowel surgery were 78.2%, 71.1%, 41.3%, 92.6%, respectively. CONCLUSIONS There is a significant association between ovarian immobility and the presence of endometriomas. Ovarian immobility as a sonographic 'soft marker' of DIE performs better in the presence of endometriomas compared with in normal ovaries. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Gerges
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - C Lu
- Department of Computer Sciences, University of Wales, Aberystwyth, UK
| | - S Reid
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - D Chou
- Sydney Women's Endosurgery Centre (SWEC), Hurstville, NSW, Australia
| | - T Chang
- Nureva Women's Specialist Health, Campbelltown, NSW, Australia
- Laparoscopic Surgery for General Gynaecologist (LaSGeG), Sydney, NSW, Australia
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
- Laparoscopic Surgery for General Gynaecologist (LaSGeG), Sydney, NSW, Australia
- OMNI Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy, St Leonards, NSW, Australia
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Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 2016; 27:2765-2775. [PMID: 27921160 PMCID: PMC5486785 DOI: 10.1007/s00330-016-4673-z] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/05/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
Abstract Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. Key Points • This report provides guidelines for MRI in endometriosis. • Minimal and optimal MRI acquisition protocols are provided. • Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Bazot
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France.
| | - N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, 3rd Floor Queen Elizabeth the Queen Mother Building, Praed Street, London, W2 1NY, UK
| | - C Huchon
- Department of Obtetrics and Gynaecology, CHI Poissy Saint-Germain en Laye,Versailles University France, 10 rue du champ Gaillard, 78300, Poissy, France
| | - K Kinkel
- Institut de radiologie, Clinique des Grangettes, 7, chemin des Grangettes, CH 1224, Chêne-Bougeries, Switzerland
| | - T M Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - A Guerra
- Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | - L Manganaro
- Department of Radiological Sciences, Sapienza University of Rome, Vle. Regina Elena 324, 00162, Rome, Italy
| | - L Buñesch
- Department of Radiology (Urogenital Section), Hospital Clínic Barcelona, Villarroel, 170, Barcelona, 08036, Spain
| | - A Kido
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - K Togashi
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France
| | - A G Rockall
- Department of Radiology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
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Abstract
Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers.
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Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016; 106:1552-1571.e2. [DOI: 10.1016/j.fertnstert.2016.10.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
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Deep infiltrating endometriosis: Should rectal and vaginal opacification be systematically used in MR imaging? ACTA ACUST UNITED AC 2016; 44:322-8. [DOI: 10.1016/j.gyobfe.2016.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022]
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Saccardi C, Gizzo S, Vitagliano A, Noventa M, Micaglio M, Parotto M, Fiorese M, Litta P. Peri-incisional and intraperitoneal ropivacaine administration: a new effective tool in pain control after laparoscopic surgery in gynecology: a randomized controlled clinical trial. Surg Endosc 2016; 30:5310-5318. [DOI: 10.1007/s00464-016-4881-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/14/2016] [Indexed: 01/10/2023]
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Backonja U, Buck Louis GM, Lauver DR. Overall Adiposity, Adipose Tissue Distribution, and Endometriosis: A Systematic Review. Nurs Res 2016; 65:151-66. [PMID: 26938364 PMCID: PMC4780367 DOI: 10.1097/nnr.0000000000000146] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endometriosis has been associated with a lean body habitus. However, we do not understand whether endometriosis is also associated with other characteristics of adiposity, including adipose tissue distribution and amount of visceral adipose tissue (VAT; adipose tissue lining inner organs). Having these understandings may provide insights on how endometriosis develops-some of the physiological actions of adipose tissue differ depending on tissue amount and location and are related to proposed mechanisms of endometriosis development. OBJECTIVES The aim of this study was to review the literature regarding overall adiposity, adipose tissue distribution and/or VAT, and endometriosis. METHODS We reviewed and synthesized studies indexed in PubMed and/or Web of Science. We included studies that had one or more measures of overall adiposity, adipose tissue distribution, and/or VAT and women with and without endometriosis for comparison. We summarized the findings and commented on the methods used and potential sources of bias. RESULTS Of 366 identified publications, 19 (5.2%) were eligible. Two additional publications were identified from reference lists. Current research included measures of overall adiposity (e.g., body figure drawings) or adipose tissue distribution (e.g., waist-to-hip ratio), but not VAT. The weight of evidence indicated that endometriosis was associated with low overall adiposity and with a preponderance of adipose tissue distributed below the waist (peripheral). DISCUSSION Endometriosis may be associated with being lean or having peripherally distributed adipose tissue. Well-designed studies with various sampling frameworks and precise measures of adiposity and endometriosis are needed to confirm associations between adiposity measures and endometriosis and delineate potential etiological mechanisms underlying endometriosis.
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Affiliation(s)
- Uba Backonja
- Uba Backonja, PhD, RN, is National Library of Medicine Biomedical Informatics Postdoctoral Fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle. Germaine M. Buck Louis, PhD, MS, is Director and Senior Investigator, Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland. Diane R. Lauver, PhD, RN, FAAN, is Professor, School of Nursing, University of Wisconsin-Madison
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Perlman S, Kjer JJ. Ovarian damage due to cyst removal: a comparison of endometriomas and dermoid cysts. Acta Obstet Gynecol Scand 2015; 95:285-90. [PMID: 26669273 DOI: 10.1111/aogs.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/28/2015] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Surgical treatment of endometriomas and potential damage to the ovary have been debated. Studies have described the inconsistent risk of unintended removal of ovarian tissue when a cystectomy of an endometrioma is performed. We evaluated the risk of inadvertently removed ovarian tissue during surgery by comparing specimens of endometriomas and dermoid cysts removed laparoscopically. MATERIAL AND METHODS The material included 326 women in a retrospective cohort study at Rigshospitalet, University hospital in Copenhagen, Denmark from 2011 to 2013. Surgery was performed laparoscopically for 393 benign cysts with a diagnosis of either endometrioma (n = 294) or dermoid cyst (n = 99). The microscopic existence of ovarian tissue in the cystectomy specimens were compared and correlation between CA 125 and size of cysts was examined. RESULTS In total, 80.3% endometrioma cystectomies disclosed ovarian stroma compared with 17.2% of the resected dermoid cysts (p < 0.001). The difference was found despite skilled laparoscopic surgeons performing the procedure in the endometriosis cohort. A significant positive correlation between the size of endometriomas and the value of CA 125 was found (p < 0.009). CONCLUSION The risk of removal of ovarian tissue during laparoscopic surgery is significantly higher for endometriomas than for dermoid cysts.
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Affiliation(s)
- Signe Perlman
- Department of Gynecology 4232, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Kjer
- Department of Gynecology 4232, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
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Ghirardello A, Gizzo S, Noventa M, Quaranta M, Vitagliano A, Gallo N, Pantano G, Beggio M, Cosma C, Gangemi M, Plebani M, Doria A. Acute immunomodulatory changes during controlled ovarian stimulation: evidence from the first trial investigating the short-term effects of estradiol on biomarkers and B cells involved in autoimmunity. J Assist Reprod Genet 2015; 32:1765-72. [PMID: 26466939 DOI: 10.1007/s10815-015-0588-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/28/2015] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of the present study was to evaluate the in vivo immunomodulatory effects of an acute short-term estradiol (E(2)) increase on serum levels of B cell-activating factor (BAFF), immunoglobulins (Ig), anti-nuclear antibodies (ANA), and the peripheral B cell phenotype. METHODS We conducted, at the Infertility Center of the University of Padua, a prospective case-control study on a cohort of infertile normo-responder women (group-A, 63 patients) undergoing controlled ovarian stimulation (COS) compared with an age-matched cohort of normo-ovulatory healthy women (group-B, 39 patients). Three serial blood sample assays were conducted in both groups, at T0, hypothalamic suppression; T1, ovulation induction; and T2, βhCG test in group A, and at T0, 2nd day; T1, 14th day; and T2, 21st day of cycle in group B, and serum levels of E(2) and BAFF, BAFF/E(2) ratio, circulating IgM, IgG, and IgA, ANA titer, and peripheral B cell phenotype were measured. We compared group-A versus group-B in terms of absolute and E(2) normalized values of BAFF at baseline (T0) to verify for possible differences between healthy and infertile women, at T1 to verify for possible differences occurring after spontaneous ovulation versus COS, and at T2 to evaluate differences in serum BAFF levels between pregnant versus non-pregnant patients (considering only group-A) and between non-pregnant women after spontaneous versus COS cycles (group-B versus group-A). In group-A, we also evaluated IgM, IgG, IgA levels, ANA titer, and peripheral B cell phenotype at T0 versus T1 versus T2. RESULTS With the exception of E(2) levels at T1 (as expected), no significant differences were found between the two groups for all outcome measures. In group-A, BAFF at T0 positively correlated with IgM levels; marginal zone CD19+/CD27+/IgD+ memory B cell compartment tended to be expanded at T1 when compared with T0. CONCLUSIONS Despite several mechanistic and clinical studies supporting a stimulatory role of E(2) on autoimmunity, the acute increase of E(2) during COS for infertility treatment does not seem to have a major impact on the immune system.
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Affiliation(s)
- Anna Ghirardello
- Division of Rheumatology, Department of Medicine, University of Padua, Padua, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, Gynaecologic and Obstetric Unit, University of Padua, Padua, Italy. .,Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128, Padova, Italy.
| | - Marco Noventa
- Department of Woman and Child Health, Gynaecologic and Obstetric Unit, University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, Gynaecologic and Obstetric Unit, University of Padua, Padua, Italy
| | - Nicoletta Gallo
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Giorgia Pantano
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Marianna Beggio
- Division of Rheumatology, Department of Medicine, University of Padua, Padua, Italy
| | - Chiara Cosma
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Michele Gangemi
- Department of Woman and Child Health, Gynaecologic and Obstetric Unit, University of Padua, Padua, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padua, Padua, Italy
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Gizzo S, Vitagliano A, Noventa M, Litta P, Saccardi C, Quaranta M. Surgery, endometriosis-related infertility and negative impact on ovarian reserve: “which came first, the hen or the egg?” An unresolved dilemma. Arch Gynecol Obstet 2015; 292:709-11. [DOI: 10.1007/s00404-015-3792-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/10/2015] [Indexed: 01/31/2023]
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