Preoperative assessment and diagnosis of endometriosis: are we any closer?

Relationship between triglyceride-glucose index and endometriosis: a cross-sectional analysis

BACKGROUND

The link between insulin resistance and endometriosis is not well established. The triglyceride-glucose (TyG) index serves as a straightforward and economical indicator of insulin resistance. This study examines the link between the TyG index and the prevalence of endometriosis in a U.S.

COHORT

METHODS

This cross-sectional study analyzed data from the NHANES conducted between 1999 and 2006. Reproductive health was assessed through questionnaires, and the TyG index was derived from fasting triglyceride and glucose measurements. Weighted logistic regression models were used to analyze the relationship between the TyG index and endometriosis. Restricted cubic spline (RCS) curves explored the linear relationship, while stratified and sensitivity analyses assessed potential interactions and the robustness of the findings.

RESULTS

The study included 2,346 women, with 176 diagnosed with endometriosis and 2,170 without. Women with endometriosis exhibited an elevated TyG index compared to those without the condition. The weighted logistic regression analysis revealed that the TyG index is an independent risk factor for endometriosis (OR = 1.58, 95% CI 1.17-2.14, p = 0.004). RCS analysis indicated a significant positive linear association between the TyG index and endometriosis, with a turning point at 8.51. Subgroup analysis indicated a stronger association in certain populations. The post-propensity score matching analysis confirmed the robustness of these findings.

CONCLUSION

In the U.S. population, a higher TyG index is positively and linearly associated with endometriosis prevalence. Effective management of blood glucose and lipid levels may reduce the prevalence of endometriosis.

The Potential of Non-Invasive Biomarkers for Early Diagnosis of Asymptomatic Patients with Endometriosis

Endometriosis is a disease that affects women of reproductive age and has a significantly negative impact on their well-being. The main symptoms are dysmenorrhoea, chronic pelvic pain and infertility. In many patients the diagnostic process is very long and can take up to 8-12 years. Laparoscopy, an invasive method, is still necessary to confirm the diagnosis. Therefore, development of more effective diagnostic markers appears to be of the utmost importance for early diagnosis of endometriosis and provision of appropriate treatment. From a clinical point of view, detection of early-stage endometriosis in asymptomatic patients is an ideal situation since early diagnosis of endometriosis may delay the onset of symptoms as well as prevent progression and complications. In the meantime, Cancer Antigen 125 (CA-125) is still the most frequently studied and used marker. Other glycoproteins, growth factors and immune markers seem to play an important role. However, the search for an ideal endometriosis marker is still underway. Further studies into the pathogenesis of endometriosis will help to identify biomarkers or sets of biomarkers with the potential to improve and speed up the diagnostic process in a non-invasive way.

IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography

OBJECTIVE

To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center.

METHODS

This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs.

RESULTS

Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE.

CONCLUSIONS

Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Novel MYH8 mutations in 152 Han Chinese samples with ovarian endometriosis

Endometriosis is a common gynecological disease affecting up to 10% of women at reproductive age. Prior combined studies implied that MYH8 mutations might exist in endometriosis. Here, 152 Han Chinese samples with ovarian endometriosis were analyzed for the presence of MYH8 mutations. Two heterozygous missense mutations in the MYH8 gene, c.1441A > C (p.I481L) and c.4057G > A (p.E1353K), were identified in our samples. These mutations were neither found in public databases nor detected in our 485 Han Chinese control women without endometriosis. The p.I481L-mutated sample belonged to 34-year-old, who had slightly elevated serum CA 125 (42.09 U/mL); while the sample with p.E1353K mutation belonged to 25 years old, who had a markedly increased serum CA125 (89.86 U/mL). The evolutionary conservation analysis results suggested that these MYH8 mutations caused highly conserved amino acid substitutions among vertebrate species. Both the mutations were predicted to be 'disease causing' by MutationTaster and SIFT programs. In addition, no association was observed between MYH8 mutations and the available clinical data. In summary, the present study identified two novel potential pathogenic mutations in the MYH8 gene in samples with ovarian endometriosis for the first time, implying that MYH8 mutations might play a positive role in the pathogenesis of endometriosis.

Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis

BACKGROUND

The development of a non-invasive and accurate diagnostic biomarker for endometriosis is urgently needed.

OBJECTIVE

Evaluate the diagnostic accuracy of serum cancer antigen 125 (CA 125) for endometriosis.

SEARCH STRATEGY

We searched EMBASE, MEDLINE, and Web of Science from inception to January 2016.

SELECTION CRITERIA

Diagnostic accuracy studies of serum CA 125 (index test) for histologically confirmed endometriosis (reference standard) were included.

DATA COLLECTION AND ANALYSIS

Two authors independently selected trials, extracted study characteristics and data. Methodological quality was assessed using Quality Assessment of Comparative Diagnostic Accuracy Studies (QUADAS-2) checklist.

MAIN RESULTS

Twenty-two studies (16 cohort, six case-control), 3626 participants, were identified. Bivariate hierarchical models were used to pool accuracy data of 14 studies (2920 participants) using CA 125 ≥ 30 units/ml. Pooled specificity was 93% (95% CI 89-95%) and sensitivity 52% (95% CI 38-66%). CA 125 was significantly more sensitive for the diagnosis of moderate or severe endometriosis compared with minimal disease (63%, 95% CI 47-77% versus 24%, 95%CI 19-32%, P-value = 0.001).

CONCLUSIONS

CA 125 performs well as a rule-in test facilitating expedited diagnosis and ensuring investigation and treatment can be confidently tailored for the management of endometriosis. Unfortunately, a negative test, CA 125 < 30 units/ml, is unable to rule out endometriosis.

TWEETABLE ABSTRACT

Blood test CA 125: a rule-in test for the diagnosis of women presenting with symptoms of endometriosis.