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Psilopatis I, Burghaus S, Au K, Hofbeck L, Windischbauer L, Lotz L, Beckmann MW. The Hallmarks of Endometriosis. Geburtshilfe Frauenheilkd 2024; 84:555-563. [PMID: 38884026 PMCID: PMC11175833 DOI: 10.1055/a-2306-8759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/14/2024] [Indexed: 06/18/2024] Open
Abstract
A heuristic tool called "the hallmarks of cancer" helps to reduce the enormous complexity of cancer phenotypes and genotypes to a preliminary set of guiding principles. Other aspects of cancer have surfaced as possible improvements in our understanding of the disease's mechanisms. Endometriosis is a gynecological disease condition negatively impacting the quality of life of many women. To date, there is no curative treatment for endometriosis. Therapy is aimed at treating the symptoms using hormone therapy, pain therapy and complementary therapy. Chronic pain and overlapping pain syndromes and illnesses can also be treated with multimodal pain therapy and psychosomatic therapy. Endometriosis is, however, a chronic and complex entity which, in this regard, resembles cancer. The present work investigates the hallmarks of endometriosis with a view to summarizing the current research status and paving new ways for future research projects.
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Affiliation(s)
- Iason Psilopatis
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stefanie Burghaus
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Au
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Louisa Hofbeck
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lisa Windischbauer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Jianu EM, Pop RM, Gherman LM, Ranga F, Levai AM, Rus V, Bolboacă SD, Ștefan RA, Onofrei MM, Nati ID, Stoia IA, Ștefan PA, Mihu C, Mihu CM. The Effect of Rubus idaeus Polyphenols Extract in Induced Endometriosis in Rats. Molecules 2024; 29:778. [PMID: 38398530 PMCID: PMC10893551 DOI: 10.3390/molecules29040778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Endometriosis is a common gynecological condition with a complex physio-pathological background. This study aimed to assess the role of Rubus idaeus leaf extract (RiDE) as a potential therapeutic agent in reducing the size of the endometriotic lesions and modulate the plasma expression of MMP-2, MMP-9, and TGF-β1. The endometriotic lesions were induced in a rat model by the autologous transplant of endometrium. Thirty-six female rats, Wistar breed, with induced endometriosis, were divided into four groups and underwent treatment for 28 days. The CTRL group received 0.5 mL/day of the vehicle; the DG group received 1 mg/kg b.w./day dienogest; the RiDG group received 0.25 mL/kg b.w./day RiDE and the D+RiDG group received 1 mg/kg b.w./day dienogest and 0.25 mL/kg b.w./day RiDE, respectively. Rats' weight, endometriotic lesion diameter and grade, and plasma levels of MMP-2, MMP-9, and TGF-β1 were assessed before and after treatment. The administration of RiDE in association with dienogest vs. dienogest determined a lower weight gain and a reduction in diameter of the endometriotic lesions. RiDE administration restored MMP2 and MMP9 plasma levels to initial conditions. Rubus idaeus extract may help in reducing dienogest-associated weight gain, lower the size of endometriotic lesions, and have anti-inflammatory effects through MMP2 and MMP9 reduction.
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Affiliation(s)
- Elena-Mihaela Jianu
- Histology, Department of Morphofunctional Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania; (E.-M.J.); (R.-A.Ș.); (M.M.O.); (C.M.M.)
| | - Raluca Maria Pop
- Pharmacology, Toxicology and Clinical Pharmacology, Department of Morphofunctional Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania;
| | - Luciana Mădălina Gherman
- Experimental Centre, “Iuliu Haţieganu” University of Medicine and Pharmacy, Louis Pasteur, No 6, 400349 Cluj-Napoca, Romania
| | - Floricuța Ranga
- Food Science and Technology, Department of Food Science, University of Agricultural Science and Veterinary Medicine, Calea Mănăștur, No 3-5, 400372 Cluj-Napoca, Romania;
| | - Antonia-Mihaela Levai
- Obstetrics and Gynecology, Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania; (A.-M.L.); (I.-D.N.)
| | - Vasile Rus
- Department of Cell Biology, Histology and Embryology, University of Agricultural Sciences and Veterinary Medicine, Calea Mănăștur, No 3-5, 400372 Cluj-Napoca, Romania;
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Louis Pasteur, No 6, 400349 Cluj-Napoca, Romania;
| | - Roxana-Adelina Ștefan
- Histology, Department of Morphofunctional Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania; (E.-M.J.); (R.-A.Ș.); (M.M.O.); (C.M.M.)
| | - Mădălin Mihai Onofrei
- Histology, Department of Morphofunctional Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania; (E.-M.J.); (R.-A.Ș.); (M.M.O.); (C.M.M.)
| | - Ionel-Daniel Nati
- Obstetrics and Gynecology, Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania; (A.-M.L.); (I.-D.N.)
| | - Ioana Alexandra Stoia
- Obstetrics and Gynaecology Department County Emergency Hospital, Clinicilor, No 3-5, 400006 Cluj-Napoca, Romania;
| | - Paul-Andrei Ștefan
- Anatomy and Embryology, Department of Morphological Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania;
| | - Carina Mihu
- Pharmacology, Toxicology and Clinical Pharmacology, Department of Morphofunctional Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania;
| | - Carmen Mihaela Mihu
- Histology, Department of Morphofunctional Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș, No 8, 400012 Cluj-Napoca, Romania; (E.-M.J.); (R.-A.Ș.); (M.M.O.); (C.M.M.)
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Schliep KC, Ghabayen L, Shaaban M, Hughes FR, Pollack AZ, Stanford JB, Brady KA, Kiser A, Peterson CM. Examining the co-occurrence of endometriosis and polycystic ovarian syndrome. AJOG GLOBAL REPORTS 2023; 3:100259. [PMID: 37663310 PMCID: PMC10472311 DOI: 10.1016/j.xagr.2023.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Polycystic ovarian syndrome and endometriosis are 2 of the most common reproductive disorders among women but are thought to be unrelated. OBJECTIVE This study aimed to examine the overlap and common symptoms of polycystic ovarian syndrome and endometriosis. STUDY DESIGN The study population included the Endometriosis, Natural History, Diagnosis, and Outcomes Study (2007-2009) operative cohort: 473 women, aged 18 to 44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of 14 surgical centers located in Salt Lake City, Utah, or San Francisco, California, in addition to a population cohort composed of 127 women from the surgical centers' catchment areas. Age and site-adjusted multinomial regression models were used to estimate adjusted prevalence ratios and 95% confidence intervals of reproductive history characteristics among women with endometriosis only, women with polycystic ovarian syndrome only, and women with both endometriosis and polycystic ovarian syndrome. RESULTS Among the operative cohort, 35% had endometriosis only, 9% had polycystic ovarian syndrome only, and 5% had endometriosis and polycystic ovarian syndrome. Among the population cohort, 10% had endometriosis only, 8% had polycystic ovarian syndrome only, and 2% had endometriosis and polycystic ovarian syndrome. In the operative cohort, a history of subfertility was associated with a higher adjusted probability of having both conditions (adjusted prevalence ratio, 10.33; 95% confidence interval, 3.94-27.08), followed by having endometriosis only (adjusted prevalence ratio, 2.45; 95% confidence interval, 1.56-3.84) or polycystic ovarian syndrome only (adjusted prevalence ratio, 1.15; 95% confidence interval, 0.51-2.61), than having neither condition. In addition, experiencing chronic pelvic pain within the past 12 months was associated with a higher probability of having both conditions (adjusted prevalence ratio, 2.53; 95% confidence interval, 1.07-6.00) than having neither condition. CONCLUSION Among a cohort of women undergoing gynecologic laparoscopy or laparotomy, our study found that nearly 1 in 20 women had both an incident endometriosis diagnosis and symptoms consistent with polycystic ovarian syndrome. Among a population cohort of women not seeking gynecologic care, polycystic ovarian syndrome and endometriosis overlap prevalence was approximately 1 in 50 women.
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Affiliation(s)
- Karen C. Schliep
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT (Dr Schliep, Mses Ghabayen, Shaaban, and Hughes, and Dr Stanford)
| | - Lina Ghabayen
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT (Dr Schliep, Mses Ghabayen, Shaaban, and Hughes, and Dr Stanford)
| | - May Shaaban
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT (Dr Schliep, Mses Ghabayen, Shaaban, and Hughes, and Dr Stanford)
| | - Felicity R. Hughes
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT (Dr Schliep, Mses Ghabayen, Shaaban, and Hughes, and Dr Stanford)
| | - Anna Z. Pollack
- College of Health and Human Services, George Mason University, Fairfax, VA (Dr Pollack)
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT (Dr Schliep, Mses Ghabayen, Shaaban, and Hughes, and Dr Stanford)
| | - Kristy Allen Brady
- Department of Internal Medicine, University of Utah, Salt Lake City, UT (Dr Allen Brady)
| | - Amber Kiser
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT (Ms Kiser)
| | - C. Matthew Peterson
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT (Dr Peterson)
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Walker ZW, Gargiulo AR. The 2021 AAGL Endometriosis Classification Is a Fundamental Patient-centered Step Forward. J Minim Invasive Gynecol 2023; 30:339-341. [PMID: 36893897 DOI: 10.1016/j.jmig.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Zachary W Walker
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts (all authors)
| | - Antonio R Gargiulo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts (all authors).
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Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features. J Clin Med 2023; 12:jcm12041678. [PMID: 36836214 PMCID: PMC9962715 DOI: 10.3390/jcm12041678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The early diagnosis of endometriosis in adolescents is not developed. OBJECTIVE We aim to conduct clinical, imaging, laparoscopic and histological analyses of peritoneal endometriosis (PE) in adolescents in order to improve early diagnosis. METHODS In total, 134 girls (from menarche to 17 years old) were included in a case-control study: 90 with laparoscopically (LS) confirmed PE, 44 healthy controls underwent full examination and LS was analyzed in the PE group. RESULTS Patients with PE were characterized with heredity for endometriosis, persistent dysmenorrhea, decreased daily activity, gastrointestinal symptoms, higher LH, estradiol, prolactin and Ca-125 (<0.05 for each). Ultrasound detected PE in 3.3% and MRI in 78.9%. The most essential MRI signs are as follows: hypointense foci, the heterogeneity of the pelvic tissue (paraovarian, parametrial and rectouterine pouch) and sacro-uterine ligaments lesions (<0.05 for each). Adolescents with PE mostly exhibit initial rASRM stages. Red implants correlated with the rASRM score, and sheer implants correlated with pain (VAS score) (<0.05). In 32.2%, foci consisted of fibrous, adipose and muscle tissue; black lesions were more likely to be histologically verified (0.001). CONCLUSION Adolescents exhibit mostly initial PE stages, which are associated with greater pain. Persistent dysmenorrhea and detected MRI parameters predict the laparoscopic confirmation of initial PE in adolescents in 84.3% (OR 15.4; <0.01), justifying the early surgical diagnostics and shortening the time delay and suffering of the young patients.
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Mirzaei N, Jahanian Sadatmahalleh S, Rouholamin S, Nasiri M. A randomized trial assessing the efficacy of Silymarin on endometrioma-related manifestations. Sci Rep 2022; 12:17549. [PMID: 36266431 PMCID: PMC9584967 DOI: 10.1038/s41598-022-22073-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/10/2022] [Indexed: 01/13/2023] Open
Abstract
To study the effect of silymarin on the Interleukin-6 (IL-6) level, size of endometrioma lesion, pain, sexual function, and Quality of Life (QoL) in women diagnosed with endometriosis. This randomized, double-blind placebo-controlled clinical trial was performed on 70 women with endometriosis which was divided into two groups of intervention and control. The intervention was 140 mg silymarin (or matching placebo) administered twice daily for 12 weeks. The volume of endometrioma lesions, the level of IL-6 concentration in serum, pain, sexual function, and QoL were analyzed before and after the intervention. The means of endometrioma volume (P = 0.04), IL-6 (P = 0.002), and pain (P < 0.001) were reduced significantly in the silymarin group after intervention. However, the QoL and female sexual function did not improve substantially in the two groups (P > 0.05). Silymarin significantly reduced interleukin-6 levels, sizes of endometrioma lesions, and pain-related symptoms. The trial has been registered in the Iranian Registry of Clinical Trials (IRCT20150905023897N5) on 4th February 2020 (04/02/2020) ( https://en.irct.ir/trial/42215 ) and the date of initial participant enrollment was 2nd March 2020 (02/03/2020).
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Affiliation(s)
- Negin Mirzaei
- grid.412266.50000 0001 1781 3962Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal Al-Ahmad Highway, Nasr Bridge, Tehran, 14115-111 Iran
| | - Shahideh Jahanian Sadatmahalleh
- grid.412266.50000 0001 1781 3962Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal Al-Ahmad Highway, Nasr Bridge, Tehran, 14115-111 Iran
| | - Safoura Rouholamin
- grid.411036.10000 0001 1498 685XDepartment of Obstetrics and Gynecology, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Hezar-Jerib Ave., Isfahan, 81746 73461 Iran
| | - Malihe Nasiri
- grid.411600.2Department of Basic Sciences, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Misal M, Girardo M, Behbehani S, Bindra V, Hoffman MR, Lim WH, Martin C, Mehta SK, Nensi A, Soares T, Taylor D, Wagner S, Wright KN, Wasson MN. Evaluating surgical complexity of endoscopic hysterectomy: an interrater and intrarater agreement study of novel scoring tool. J Minim Invasive Gynecol 2022; 29:683-690. [DOI: 10.1016/j.jmig.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification. J Minim Invasive Gynecol 2021; 28:1822-1848. [PMID: 34690085 DOI: 10.1016/j.jmig.2021.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In the field of endometriosis, several classification, staging and reporting systems have been developed. Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? DATA SOURCES A systematic PUBMED literature search was performed. Data were extracted and summarized. METHODS OF STUDY SELECTION na TABULATION, INTEGRATION AND RESULTS: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. CONCLUSION Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated for the purpose for which they were developed. The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.
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Affiliation(s)
- Nathalie Vermeulen
- ESHRE, Central office (Dr. Vermeulen), Meerstraat 60, Grimbergen, BE 1852, Belgium
| | - Mauricio S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia (Dr. Abrao), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Jon I Einarsson
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery (Dr. Einarsson), Boston, MA, USA
| | - Andrew W Horne
- University of Edinburgh, MRC Centre for Reproductive Health (Dr. Horne), QMRI, 49 Little France Crescent, Edinburgh, UK EH16 4TJ
| | - Neil P Johnson
- Repromed Auckland, 105 Remuera Road, Remuera, Auckland (Dr. Johnson), New Zealand 1050
| | - Ted T M Lee
- Magee Womens Hospital of UPMC, Department of Obstetrics, Gynecology and Reproductive Sciences (Dr. Lee), Pittsburgh, PA, USA
| | - Stacey Missmer
- Michigan State University College of Human Medicine, Department of Obstetrics, Gynecology and Reproductive Biology (Dr. Missmer), East Lansing, MI, USA; Harvard University T H Chan School of Public Health, Department of Epidemiology, Boston, MA, USA; World Endometriosis Research Foundation, WERF, London, UK
| | - John Petrozza
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology (Dr. Petrozza), Boston, MA, USA
| | - Carla Tomassetti
- University Hospital Leuven, Department of Obstetrics and Gynaecology, Leuven University Fertility Centre (Dr. Tomassetti), Leuven, Belgium
| | - Krina T Zondervan
- University of Oxford, Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health (Dr. Zondervan), Oxford, Oxfordshire, UK; University of Oxford, Wellcome Centre for Human Genetics, Oxford, Oxfordshire, UK
| | - Grigoris Grimbizis
- Medical School, Aristotle University of Thessaloniki (Dr. Grimbizis), 1st Dept Obstet Gynecol, Tsimiski 51 Street, Thessaloniki, Greece 54623
| | - Rudy Leon De Wilde
- Carl von Ossietzky Universitat Oldenburg, University Hospital for Gynecology (Dr. De Wilde), Oldenburg, Germany.
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification . Hum Reprod Open 2021; 2021:hoab025. [PMID: 34693032 PMCID: PMC8530712 DOI: 10.1093/hropen/hoab025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/11/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? SUMMARY ANSWER Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. WHAT IS KNOWN ALREADY In the field of endometriosis, several classification, staging and reporting systems have been developed. PARTICIPANTS/MATERIALS, SETTING, METHODS A systematic PUBMED literature search was performed. Data were extracted and summarized. MAIN RESULTS AND THE ROLE OF CHANCE Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. LARGE SCALE DATA NA. LIMITATIONS, REASONS FOR CAUTION The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. WIDER IMPLICATIONS OF THE FINDINGS It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working toward a universally accepted endometriosis classification. STUDY FUNDING/COMPETING INTEREST(S) The meetings and activities of the working group were funded by the American Association of Gynecologic Laparoscopists, European Society for Gynecological Endoscopy, European Society of Human Reproduction and Embryology and World Endometriosis Society. A.W.H. reports grant funding from the MRC, NIHR, CSO, Wellbeing of Women, Roche Diagnostics, Astra Zeneca, Ferring, Charles Wolfson Charitable Trust, Standard Life, Consultancy fees from Roche Diagnostics, AbbVie, Nordic Pharma and Ferring, outside the submitted work. In addition, A.W.H. has a patent Serum biomarker for endometriosis pending. N.P.J. reports personal fees from Abbott, Guerbet, Myovant Sciences, Vifor Pharma, Roche Diagnostics, outside the submitted work; he is also President of the World Endometriosis Society and chair of the trust board. S.M. reports grants and personal fees from AbbVie, and personal fees from Roche outside the submitted work. C.T. reports grants, non-financial support and other from Merck SA, non-financial support and other from Gedeon Richter, non-financial support from Ferring Pharmaceuticals, outside the submitted work and without private revenue. K.T.Z. reports grants from Bayer Healthcare, MDNA Life Sciences, Roche Diagnostics Inc, Volition Rx, outside the submitted work; she is also a Board member (Secretary) of the World Endometriosis Society and World Endometriosis Research Foundation, Research Advisory Board member of Wellbeing of Women, UK (research charity), and Chair, Research Directions Working Group, World Endometriosis Society. The other authors had nothing to disclose. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
| | | | - Mauricio S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew W Horne
- University of Edinburgh, MRC Centre for Reproductive Health, QMRI, Edinburgh, UK
| | | | - Ted T M Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Stacey Missmer
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, East Lansing, MI, USA.,Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA.,World Endometriosis Research Foundation, WERF, London, UK
| | - John Petrozza
- Department of Obstetrics and Gynecology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford Endometriosis CaRe Centre, Oxford, Oxfordshire, UK.,University of Oxford, Wellcome Centre for Human Genetics, Oxford, UK
| | - Grigoris Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rudy Leon De Wilde
- Carl von Ossietzky Universitat Oldenburg, University Hospital for Gynecology, Oldenburg, Germany
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Facts Views Vis Obgyn 2021; 13:305-330. [PMID: 34672508 PMCID: PMC9148706 DOI: 10.52054/fvvo.13.3.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In the field of endometriosis, several classification, staging and reporting systems have been developed. However, endometriosis classification, staging and reporting systems that have been published and validated for use in clinical practice have not been systematically reviewed up to now. Objectives The aim of the current review is to provide a historical overview of these different systems based on an assessment of published studies. Materials and Methods A systematic Pubmed literature search was performed. Data were extracted and summarised. Results Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific and different purposes. There is still no international agreement on how to describe the disease. Studies evaluating different systems are summarised showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the Enzian system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusions Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. What is new? This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.
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Burghaus S, Schäfer SD, Beckmann MW, Brandes I, Brünahl C, Chvatal R, Drahoňovský J, Dudek W, Ebert AD, Fahlbusch C, Fehm T, Fehr PM, Hack CC, Häuser W, Hancke K, Heinecke V, Horn LC, Houbois C, Klapp C, Kramer H, Krentel H, Langrehr J, Matuschewski H, Mayer I, Mechsner S, Müller A, Müller A, Müller M, Oppelt P, Papathemelis T, Renner SP, Schmidt D, Schüring A, Schweppe KW, Seeber B, Siedentopf F, Sirbu H, Soeffge D, Weidner K, Zraik I, Ulrich UA. Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020). Geburtshilfe Frauenheilkd 2021; 81:422-446. [PMID: 33867562 DOI: 10.1055/a-1380-3693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 01/16/2023] Open
Abstract
Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature. Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG. Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed.
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Affiliation(s)
| | - Sebastian D Schäfer
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster, Germany
| | | | - Iris Brandes
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christian Brünahl
- Institut für Psychosomatische Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Wojciech Dudek
- Thoraxchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas D Ebert
- Praxis für Frauengesundheit, Gynäkologie & Geburtshilfe, Berlin, Germany
| | | | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Winfried Häuser
- Klinik für Innere Medizin 1 (Gastroenterologie, Hepatologie, Onkologie, Stoffwechsel- und Infektionskrankheiten, Psychosomatik), Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | | | | | | | - Christian Houbois
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Germany
| | - Christine Klapp
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. Hamburg, Charité - Universitätsmedizin Berlin Klinik für Geburtsmedizin, Berlin, Germany
| | - Heike Kramer
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. Hamburg, Spardorf, Germany
| | - Harald Krentel
- Klinik für Frauenheilkunde, Geburtshilfe, Gynäkologische Onkologie und Senologie, Ev. Krankenhaus BETHESDA, Duisburg, Germany
| | - Jan Langrehr
- Allgemein-, Gefäß- und Viszeralchirurgie, Martin Luther Krankenhaus, Berlin, Germany
| | | | - Ines Mayer
- EVA - Endometriose Vereinigung Austria e. V., Wien, Austria
| | - Sylvia Mechsner
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Armelle Müller
- EVA - Endometriose Vereinigung Austria e. V., Wien, Austria
| | - Michael Müller
- Universitätsklinik für Frauenheilkunde, Universitätsspital Bern, Bern, Switzerland
| | - Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Linz, Austria
| | | | - Stefan P Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Kliniken Böblingen, Böblingen, Germany
| | - Dietmar Schmidt
- MVZ für Histologie, Zytologie und molekulare Diagnostik, Trier, Germany
| | | | | | - Beata Seeber
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Department Frauenheilkunde, Innsbruck, Austria
| | | | - Horia Sirbu
- Thoraxchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniela Soeffge
- Endometriose-Vereinigung Deutschland e. V., Leipzig, Germany
| | - Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Isabella Zraik
- Urologie, KEM
- Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Uwe Andreas Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin Luther Krankenhaus, Berlin, Germany
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12
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Leonardi M, Espada M, Condous G. Closing the communication loop between gynecological surgeons, diagnostic imaging experts and pathologists in endometriosis: building bridges between specialties. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:523-525. [PMID: 33491846 DOI: 10.1002/uog.23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/02/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Leonardi
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - M Espada
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - G Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
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13
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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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14
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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:diagnostics10100848. [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
- Correspondence:
| | - 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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Malvezzi H, Marengo EB, Podgaec S, Piccinato CDA. Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology. J Transl Med 2020; 18:311. [PMID: 32787880 PMCID: PMC7425005 DOI: 10.1186/s12967-020-02471-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a chronic inflammatory hormone-dependent condition associated with pelvic pain and infertility, characterized by the growth of ectopic endometrium outside the uterus. Given its still unknown etiology, treatments usually aim at diminishing pain and/or achieving pregnancy. Despite some progress in defining mode-of-action for drug development, the lack of reliable animal models indicates that novel approaches are required. The difficulties inherent to modeling endometriosis are related to its multifactorial nature, a condition that hinders the recreation of its pathology and the identification of clinically relevant metrics to assess drug efficacy. In this review, we report and comment endometriosis models and how they have led to new therapies. We envision a roadmap for endometriosis research, integrating Artificial Intelligence, three-dimensional cultures and organ-on-chip models as ways to achieve better understanding of physiopathological features and better tailored effective treatments.
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Affiliation(s)
- Helena Malvezzi
- Hospital Israelita Albert Einstein, São Paulo, SP 05652-900 Brazil
| | - Eliana Blini Marengo
- Instituto Butanta- EstabilidadeBiotech Quality Control, São Paulo, SP 05503-900 Brazil
| | - Sérgio Podgaec
- Hospital Israelita Albert Einstein, São Paulo, SP 05652-900 Brazil
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16
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Byun J, Peterson CM, Backonja U, Taylor RN, Stanford JB, Allen-Brady KL, Smith KR, Louis GMB, Schliep KC. Adiposity and Endometriosis Severity and Typology. J Minim Invasive Gynecol 2020; 27:1516-1523. [PMID: 31927045 DOI: 10.1016/j.jmig.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE Prior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN Cross-sectional study among women with no prior diagnosis of endometriosis. SETTING Fourteen clinical centers in Salt Lake City, UT, and San Francisco, CA. PATIENTS A total of 495 women (of which 473 were analyzed), aged 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS Gynecologic laparoscopy/laparotomy regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS Participants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I-IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators. CONCLUSION Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.
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Affiliation(s)
- Jiyoung Byun
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep)
| | - C Matthew Peterson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility (Drs. Peterson and Taylor), University of Utah, Salt Lake City, Utah
| | - Uba Backonja
- Department of Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma (Dr. Backonja); Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle (Dr. Backonja), Washington
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility (Drs. Peterson and Taylor), University of Utah, Salt Lake City, Utah
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep)
| | - Kristina L Allen-Brady
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep); Department of Internal Medicine, Genetic Epidemiology (Dr. Allen-Brady)
| | - Ken R Smith
- Department of Family and Consumer Studies and Population Sciences/Huntsman Cancer Institute (Dr. Smith), University of Utah, Salt Lake City, Utah
| | - Germaine M Buck Louis
- Dean's Office, College of Health and Human Services, George Mason University, Fairfax, Virginia (Dr. Buck Louis)
| | - Karen C Schliep
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep).
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17
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Tomassetti C, Bafort C, Meuleman C, Welkenhuysen M, Fieuws S, D'Hooghe T. Reproducibility of the Endometriosis Fertility Index: a prospective inter-/intra-rater agreement study. BJOG 2019; 127:107-114. [PMID: 31319445 DOI: 10.1111/1471-0528.15880] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the reproducibility of the Endometriosis Fertility Index (EFI). DESIGN Single-cohort prospective observational study. SETTING University hospital. POPULATION Women undergoing laparoscopic resection of any rASRM-stage endometriosis. METHODS Details of pre- and peroperative findings were collected into a coded research file. EFI scoring was performed en-bloc by three different raters (expert-1 [C.T.], expert-2 [C.M.], junior [C.B.]). Required sample size: 71. Definitions used for agreement: clinical (scores within same range: 0-4, 5-6, 7-10) and numerical (difference ≤1 EFI point). MAIN OUTCOME MEASURES Primary outcome: rate of clinical agreement between two experts. SECONDARY OUTCOMES expert numerical agreement, clinical and numerical agreement between expert-1 and junior, and within expert-1 (intra-observer), agreement of rASRM score and -stage. RESULTS A near 'inter-expert' clinical agreement rate (1.000, 95% CI 0.956-1.000; P = 0.0149) was observed. The numerical agreement between two experts was also high (0.988, 95% CI 0.934-1.000); similarly, high agreement rates were observed for both 'junior-expert' comparisons (clinical 0 .963, 95% CI 0.897-0.992; numerical 0.988, 95% CI 0.934-1.000) and 'intra-expert' comparisons (clinical 0.988, 95% CI 0.934-1.000; numerical 1.000, 95% CI 0.956-1.000). Reasons for disagreements were different scoring of the least-function score and disagreements in rASRM scores. The reproducibility of the rASRM score was clearly inferior to that of the EFI for all comparisons. CONCLUSION The EFI can be reproduced reliably by different raters, further supporting its use in daily clinical practice as the principal clinical tool for postoperative fertility counselling/management of women with endometriosis. TWEETABLE ABSTRACT A study confirming the high reproducibility of the EFI substantiates its use in daily clinical practice.
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Affiliation(s)
- C Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - C Bafort
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - C Meuleman
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - M Welkenhuysen
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - S Fieuws
- Department of Public Health, Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - T D'Hooghe
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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18
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Pantou A, Simopoulou M, Sfakianoudis K, Giannelou P, Rapani A, Maziotis E, Grigoriadis S, Tsioulou P, Syrkos S, Souretis K, Koutsilieris M, Pantos K. The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization. J Clin Med 2019; 8:E548. [PMID: 31013645 PMCID: PMC6517944 DOI: 10.3390/jcm8040548] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022] Open
Abstract
The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients' diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.
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Affiliation(s)
- Agni Pantou
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Konstantinos Sfakianoudis
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Petroula Tsioulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Stephen Syrkos
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
| | - Kyriakos Souretis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, 16-20, Windsor Walk, London SE5 8BB, UK.
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
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Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019; 220:354.e1-354.e12. [PMID: 30625295 DOI: 10.1016/j.ajog.2018.12.039] [Citation(s) in RCA: 304] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 01/02/2023]
Abstract
Endometriosis can have a profound impact on women's lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. Inherent challenges include a gold standard based on an invasive surgical procedure (laparoscopy) and diverse symptomatology, contributing to the well-established delay of 4-11 years from first symptom onset to surgical diagnosis. We believe that remedying the diagnostic delay requires increased patient education and timely referral to a women's healthcare provider and a shift in physician approach to the disorder. Endometriosis should be approached as a chronic, systemic, inflammatory, and heterogeneous disease that presents with symptoms of pelvic pain and/or infertility, rather than focusing primarily on surgical findings and pelvic lesions. Using this approach, symptoms, signs, and clinical findings of endometriosis are anticipated to become the main drivers of clinical diagnosis and earlier intervention. Combining these factors into a practical algorithm is expected to simplify endometriosis diagnosis and make the process accessible to more clinicians and patients, culminating in earlier effective management. The time has come to bridge disparities and to minimize delays in endometriosis diagnosis and treatment for the benefit of women worldwide.
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Hemmert R, Schliep KC, Willis S, Peterson CM, Louis GB, Allen-Brady K, Simonsen SE, Stanford JB, Byun J, Smith KR. Modifiable life style factors and risk for incident endometriosis. Paediatr Perinat Epidemiol 2019; 33:19-25. [PMID: 30307628 PMCID: PMC6353682 DOI: 10.1111/ppe.12516] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Caffeine, alcohol, smoking and physical activity are known to alter sex steroid synthesis, which may affect hormone-dependent gynaecologic disease risk, such as endometriosis; however, few studies have assessed life style factors prior to endometriosis diagnosis. METHODS Four hundred and seventy three women, ages 18-44 years, underwent laparoscopy or laparotomy, regardless of clinical indication, at 14 clinic sites, 2007-2009. Women with prior surgically confirmed endometriosis were excluded. Life style factors were assessed prior to surgery. Adjusted risk ratios (RR) of endometriosis by caffeine, alcohol, smoking (serum cotinine), and physical activity were estimated, adjusting for age, marital status, education, race/ethnicity, age at menarche, gravidity, BMI, study site, and other life style factors. RESULTS There were no associations between women with endometriosis and alcohol consumption (RR 0.9, 95% CI 0.7, 1.3), caffeine consumption (RR 1.1, 95% CI 0.8, 1.5), or smoking (serum cotinine <10 vs ≥10 ng/mL; RR 1.0, 95% CI 0.7, 1.6). Similar null findings were found between endometriosis and weekly occurrences of physical activity and total walking, moderate, and vigorous activity; a modest trend was found between total daily sitting time and increased endometriosis risk. CONCLUSIONS This study, which is unique in its capture of life style exposures prior to incident endometriosis diagnosis, largely found no association between alcohol, caffeine, smoking, and physical activity and risk of endometriosis.
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Affiliation(s)
- Rachael Hemmert
- Division of Public Health, Department of Family and Preventive Medicine, Universityof Utah, Salt Lake City, UT
| | - Karen C. Schliep
- Division of Public Health, Department of Family and Preventive Medicine, Universityof Utah, Salt Lake City, UT
| | - Sydney Willis
- Division of Public Health, Department of Family and Preventive Medicine, Universityof Utah, Salt Lake City, UT
| | - C. Matthew Peterson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Germaine Buck Louis
- Dean’s Office, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Kristina Allen-Brady
- Genetic Epidemiology, Department of Internal Medicine, University of Utah; Salt Lake City, UT
| | | | - Joseph B. Stanford
- Division of Public Health, Department of Family and Preventive Medicine, Universityof Utah, Salt Lake City, UT
| | - Jiyoung Byun
- Division of Public Health, Department of Family and Preventive Medicine, Universityof Utah, Salt Lake City, UT
| | - Ken R. Smith
- Department of Family and Consumer Studies and Population Sciences/Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Chen Z, Hwang BS. A Bayesian semiparametric approach to correlated ROC surfaces with stochastic order constraints. Biometrics 2018; 75:539-550. [PMID: 30390405 DOI: 10.1111/biom.12997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
In application of diagnostic accuracy, it is possible that a priori information may exist regarding the test score distributions, either between different disease populations for a single test or between multiple correlated tests. Few have considered constrained diagnostic accuracy analysis when the true disease status is binary; almost none when the disease status is ordinal. Motivated by a study on diagnosing endometriosis, we propose an approach to estimating diagnostic accuracy measures that can incorporate different stochastic order constraints on the test scores when an ordinal true disease status is in consideration. We show that the Dirichlet process mixture provides a convenient framework to both flexibly model the test score distributions and embed the a priori ordering constraints. We also utilize the Dirichlet process mixture to model the correlation between multiple tests. In taking a Bayesian perspective to inference, we develop an efficient Markov chain Monte Carlo algorithm to sample from the posterior distribution and provide posterior estimates of the receiver operating characteristic surfaces and the associated summary measures. The proposed approach is evaluated with extensive simulation studies, and is demonstrated with an application to the endometriosis study.
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Affiliation(s)
- Zhen Chen
- Biostatistics and Bioinformatics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892
| | - Beom Seuk Hwang
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
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Assessing the completeness and correctness of the registration of malignant mesothelioma in Belgium. Lung Cancer 2018; 122:38-43. [DOI: 10.1016/j.lungcan.2018.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/19/2018] [Accepted: 05/20/2018] [Indexed: 11/21/2022]
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Taylor HS, Adamson GD, Diamond MP, Goldstein SR, Horne AW, Missmer SA, Snabes MC, Surrey E, Taylor RN. An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis. Int J Gynaecol Obstet 2018; 142:131-142. [DOI: 10.1002/ijgo.12521] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/19/2018] [Accepted: 05/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Hugh S. Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale School of Medicine; New Haven; CT USA
| | | | - Michael P. Diamond
- Department of Obstetrics and Gynecology; Augusta University; Augusta GA USA
| | - Steven R. Goldstein
- Department of Obstetrics and Gynecology; New York University Langone Medical Center; New York NY USA
| | - Andrew W. Horne
- Medical Research Council Centre for Reproductive Health; University of Edinburgh; Edinburgh UK
| | - Stacey A. Missmer
- Department of Epidemiology; Harvard TH Chan School of Public Health; Boston MA USA
- Department of Obstetrics, Gynecology and Reproductive Biology; Michigan State University; Grand Rapids MI USA
| | | | - Eric Surrey
- Colorado Center for Reproductive Medicine; Lone Tree; CO USA
| | - Robert N. Taylor
- Department of Obstetrics and Gynecology; Wake Forest School of Medicine; Winston-Salem NC USA
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Buck Louis GM, Backonja U, Schliep KC, Sun L, Peterson CM, Chen Z. Women's Reproductive History Before the Diagnosis of Incident Endometriosis. J Womens Health (Larchmt) 2016; 25:1021-1029. [PMID: 27379997 PMCID: PMC5111831 DOI: 10.1089/jwh.2015.5712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Endometriosis is a gynecologic disease reported to be associated with infertility and, possibly, adverse pregnancy outcomes. While considerable research focuses on pregnancy outcomes following diagnosis and/or treatment, few data actually describe women's reproductive history before diagnosis for a more complete understanding of endometriosis and reproduction. MATERIALS AND METHODS The study sample comprised 473 women (aged 18-44 years) undergoing laparoscopies or laparotomies, irrespective of surgical indication at 14 clinical sites, during the period 2007-2009. Upon enrollment and before surgery, women were queried about pregnancy intentions and the time required to become pregnant for planned pregnancies. Endometriosis was defined as surgically visualized disease. Using discrete time survival analysis, we estimated fecundability odds ratios (FORs) and 95% confidence intervals (CIs) to assess time to pregnancy (TTP) after adjusting for potential confounders (age, body composition, cigarette smoking, site). Generalized estimating equations accounted for multiple pregnancy attempts per woman. FORs <1.0 denote a longer TTP or diminished fecundity. RESULTS Approximately 66% and 69% of women with and without endometriosis, respectively, reported having a planned pregnancy before surgery, respectively. After adjustment, an endometriosis diagnosis was associated with ≈29% reduction in fecundity or a longer TTP across all pregnancy-trying attempts (adjusted FOR = 0.71; 95% CI 0.46-1.10). While FORs were consistently <1.0, irrespective of endometriosis staging, CIs included 1. CONCLUSIONS Women with endometriosis had a longer TTP than unaffected women, irrespective of disease severity, although the findings did not achieve significance. Prior reproductive history may be informative for predicting fecundity and pregnancy outcomes following diagnosis/treatment.
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Affiliation(s)
- Germaine M. Buck Louis
- Division of Intramural Population Health, Eunice Kennedy ShriverNational Institute of Child Health and Human Development, Rockville, Maryland
| | - Uba Backonja
- Division of Intramural Population Health, Eunice Kennedy ShriverNational Institute of Child Health and Human Development, Rockville, Maryland
- Division of Biomedical and Health Informatics, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Karen C. Schliep
- Epidemiology Branch, Division of Intramural Population Health, Eunice Kennedy ShriverNational Institute of Child Health and Human Development, Rockville, Maryland
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Liping Sun
- Glotech Corporation, Rockville, Maryland
| | - C. Matthew Peterson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health, Eunice Kennedy ShriverNational Institute of Child Health and Human Development, Rockville, Maryland
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