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Haddad RF, de Azevedo BC, de Mattos LA, Podgaec S. Nodular image in the appendix observed on ultrasound: endometriosis or neuroendocrine neoplasia? REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo1. [PMID: 38765516 PMCID: PMC11075395 DOI: 10.61622/rbgo/2024ao01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/21/2023] [Indexed: 05/22/2024] Open
Abstract
Objective To evaluate the association between clinical and imaging with surgical and pathological findings in patients with suspected neuroendocrine tumor of appendix and/or appendix endometriosis. Methods Retrospective descriptive study conducted at the Teaching and Research Institute of Hospital Israelita Albert Einstein, in which medical records and databases of patients with suspected neuroendocrine tumor of appendix and/or endometriosis of appendix were analyzed by imaging. Results Twenty-eight patients were included, all of which had some type of appendix alteration on the ultrasound examination. The pathological outcome of the appendix found 25 (89.3%) lesions compatible with endometriosis and three (10.7%) neuroendocrine tumors. The clinical findings of imaging and surgery were compared with the result of pathological anatomy by means of relative frequency. Conclusion It was possible to observe a higher prevalence of appendix endometriosis when the patient presented more intense pain symptoms. The image observed on ultrasound obtained a high positive predictive value for appendicular endometriosis.
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Affiliation(s)
- Raphael Federicci Haddad
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Bruna Cestari de Azevedo
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Leandro Accardo de Mattos
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Sergio Podgaec
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Universidade de São PauloFaculdade de MedicinaDepartamento de Obstetrícia e GinecologiaSão PauloSPBrazilDepartamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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2
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Intestinal Endometriosis Leading to Recurrent Hematochezia. ACG Case Rep J 2022; 9:e00872. [PMID: 36237283 PMCID: PMC9553394 DOI: 10.14309/crj.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Endometriosis occurs when endometrial tissue existing outside of the endometrial cavity has an inflammatory response, which can lead to swelling and scarring, generally in the abdominopelvic cavity. It commonly presents in reproductive-age women and very infrequently presents in postmenopausal women. We report a case of a 51-year-old woman who underwent a hysterectomy a decade before presentation with new-onset intermittent proctalgia and hematochezia. Her colonoscopy showed a sigmoid polyp, which was confirmed to be endometriosis on histopathology. This case highlights intestinal endometriosis as a rare differential to be considered in women, regardless of age, with abnormal rectal bleeding.
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Transvaginal Ultrasound vs. Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12071767. [PMID: 35885670 PMCID: PMC9315729 DOI: 10.3390/diagnostics12071767] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Endometriosis is a widespread gynecological condition that causes chronic pelvic discomfort, dysmenorrhea, infertility, and impaired quality of life in women of reproductive age. Clinical examination, transvaginal ultrasonography (TVS), and magnetic resonance imaging (MRI) are significant preoperative non-invasive diagnosis procedures for the accurate assessment of endometriosis. Although TVS is used as the primary line for diagnosis, MRI is commonly utilized to achieve a better anatomical overview of the entire pelvic organs. The aim of this systematic review article is to thoroughly summarize the research on various endometriosis diagnosis methods that are less invasive. (2) Methods: To find relevant studies, we examined electronic databases, such as MEDLINE/PubMed, Cochrane, and Google Scholar, choosing 70 papers as references. (3) Results: The findings indicate that various approaches can contribute to diagnosis in different ways, depending on the type of endometriosis. For patients suspected of having deep pelvic endometriosis, transvaginal sonography should be the first line of diagnosis. Endometriosis cysts are better diagnosed with TVS, whereas torus, uterosacral ligaments, intestine, and bladder endometriosis lesions are best diagnosed using MRI. When it comes to detecting intestine or rectal nodules, as well as rectovaginal septum nodules, MRI should be the imaging tool of choice. (4) Conclusions: When diagnosing DE (deep infiltrative endometriosis), the examiner’s experience is the most important criterion to consider. In the diagnosis of endometriosis, expert-guided TVS is more accurate than routine pelvic ultrasound, especially in the deep infiltrative form. For optimal treatment and surgical planning, accurate preoperative deep infiltrative endometriosis diagnosis is essential, especially because it requires a multidisciplinary approach.
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4
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Monnaka VU, Hernandes C, Heller D, Podgaec S. Overview of miRNAs for the non-invasive diagnosis of endometriosis: evidence, challenges and strategies. A systematic review. EINSTEIN-SAO PAULO 2021; 19:eRW5704. [PMID: 33909757 PMCID: PMC8054530 DOI: 10.31744/einstein_journal/2021rw5704] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the evidence on miRNAs as biomarkers for the diagnosis of endometriosis, as well as to provide insights into the challenges and strategies associated with the use of these molecules as accessible tools in clinical practice. METHODS Systematic review conducted on PubMed®, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE® and Web of Science databases using the search terms endometriosis (all fields) AND miRNA (all fields), evaluating all publication up to May 2019. RESULTS Most miRNAs found to be dysregulated in this study were harvested from tissue samples, which precludes their use as a non-invasive diagnostic test. However, differential expression of 62 miRNAs was reported in samples that may be used for non-invasive diagnosis of endometriosis, such as blood, serum and plasma. CONCLUSION Despite the identification of several candidates, studies are investigatory in nature and have been conducted with small number of samples. Also, no particular miRNA has been validated for diagnostic purposes so far. Studies based primarily on biological samples and applicable to translational research are warranted. Large databases comprising information on sample type and the use of saliva and vaginal fluid for miRNAs identification may prove essential to overcome current barriers to diagnosis of endometriosis.
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Affiliation(s)
- Vitor Ulisses Monnaka
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Camila Hernandes
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Debora Heller
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Sérgio Podgaec
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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5
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Marlin N, Rivas C, Allotey J, Dodds J, Horne A, Ball E. Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e20986. [PMID: 33818394 PMCID: PMC8056291 DOI: 10.2196/20986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Endometriosis is a chronic inflammatory condition affecting 6%-10% of women of reproductive age and is defined by the presence of endometrial-like tissue outside the uterus (lesions), commonly affecting the pelvis and ovaries. It is associated with debilitating pelvic pain, infertility, and fatigue and often has devastating effects on the quality of life (QoL). Although it is as common as back pain, it is poorly understood, and treatment and diagnosis are often delayed, leading to unnecessary suffering. Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. OBJECTIVE This study aims to determine which women with confirmed endometriosis benefit from surgical improvement in pain and QoL and whether these women could be identified from clinical symptoms measured before laparoscopy. METHODS First, we will carry out a systematic search and review and, if appropriate, meta-analysis of observational cohort and case-control studies reporting one or more risk factors for endometriosis and postsurgical treatment success. We will search PubMed, Embase, and Cochrane databases from inception without language restrictions and supplement the reference lists by manual searches. Second, we will develop separate clinical prediction models for women with confirmed and suspected diagnoses of endometriosis. A total of three suitable databases have been identified for development and external validation (the MEDAL [ISRCTN13028601] and LUNA [ISRCTN41196151] studies, and the BSGE database), and access has been guaranteed. The models will be developed using a linear regression approach that links candidate factors to outcomes. Third, we will hold 2 stakeholder co-design workshops involving eight clinicians and eight women with endometriosis separately and then bring all 16 participants together. Participants will discuss the implementation, delivery, usefulness, and sustainability of the prediction models. Clinicians will also focus on the ease of use and access to clinical prediction tools. RESULTS This project was funded in March 2018 and approved by the Institutional Research Ethics Board in December 2019. At the time of writing, this study was in the data analysis phase, and the results are expected to be available in April 2021. CONCLUSIONS This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20986.
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Affiliation(s)
- Nadine Marlin
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Carol Rivas
- UCL Social Research Institute, University College London, London, United Kingdom
| | - John Allotey
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Julie Dodds
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Andrew Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth Ball
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
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6
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Brusic A, Esler S, Churilov L, Chowdary P, Sleeman M, Maher P, Yang N. Deep infiltrating endometriosis: Can magnetic resonance imaging anticipate the need for colorectal surgeon intervention? Eur J Radiol 2019; 121:108717. [PMID: 31739271 DOI: 10.1016/j.ejrad.2019.108717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/27/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify magnetic resonance imaging (MRI) features associated with colorectal surgical bowel resection for treatment of deep infiltrating endometriosis (DIE). MATERIALS AND METHODS 122 preoperative pelvic MRIs in women with laparoscopically-proven DIE and subsequent surgery (2006-2015) were identified, and retrospective cohort analysis performed. MRIs were reviewed independently by two radiologists blinded to surgical/histopathological outcomes. Associations between MRI characteristics of middle/posterior compartment endometriosis and surgical outcomes were investigated to identify MRI features associated with colorectal surgical bowel resection. RESULTS MRI features associated with colorectal surgical intervention were: presence of an MRI bowel lesion (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.79); MRI bowel lesions ≥20 mm in length (sensitivity 91%, specificity 77%, ROC-AUC 0.84); MRI bowel lesions invading the muscularis or submucosa/mucosa layers (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.90). CONCLUSION This study identifies MRI features that have potential diagnostic utility in identifying the need for colorectal surgical intervention in patients with DIE.
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Affiliation(s)
- Ana Brusic
- Austin Hospital, Radiology Department, Level 2 Lance Townsend Building, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia.
| | - Stephen Esler
- Austin Hospital, Radiology Department, Level 2 Lance Townsend Building, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience & Mental Health, Statistics and Decision Analysis Academic Platform, 245 Burgundy St Heidelberg, Victoria, 3084, Australia
| | - Prathima Chowdary
- Mercy Hospital for Women, Endosurgical Unit, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Matthew Sleeman
- Mercy Hospital for Women, Endosurgical Unit, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Peter Maher
- Mercy Hospital for Women, Endosurgical Unit, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Natalie Yang
- Austin Hospital, Radiology Department, Level 2 Lance Townsend Building, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia
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Carneiro MM, Costa LMP, Ávila ID. To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF). JBRA Assist Reprod 2017; 21:120-125. [PMID: 28609279 PMCID: PMC5473705 DOI: 10.5935/1518-0557.20170027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain.
There is little evidence of a clear connection between DIE and infertility, and
the absolute benefits of surgery for DIE have not been established. This paper
aimed to review the current literature on the effect of surgery for DIE on
fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a
comprehensive clinical history is useful to identify patients at risk for
endometriosis, although many women remain asymptomatic. Imaging can be useful to
plan surgery. The effect of surgery on the fertility of women with DIE remains
unanswered due to the heterogeneous nature of the disease and the lack of trials
with enough statistical power and adequate follow-up. Surgery is not recommended
when the main goal is to treat infertility or to improve IVF results. Decisions
should be tailored according to the individual needs of each woman. Patients
must be provided information on the potential benefits, harm, and costs of each
treatment alternative, while the medical team observes factors such as presence
of pelvic pain, patient age, lesion location, and previous treatments. In this
scenario, management by a multidisciplinary endometriosis team is a key step to
achieving successful outcomes.
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Affiliation(s)
- Márcia Mendonça Carneiro
- Endometriosis Multidisciplinary Team, Mater Dei Hospital, Belo Horizonte, MG, Brazil.,Human Reproduction Center at Mater Dei Hospital, Belo Horizonte, MG, Brazil.,Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Brazil.,Endometriosis Multidisciplinary Team, Biocori Hospital, Belo Horizonte, MG, Brazil
| | - Luciana Maria Pyramo Costa
- Endometriosis Multidisciplinary Team, Mater Dei Hospital, Belo Horizonte, MG, Brazil.,Endometriosis Multidisciplinary Team, Biocori Hospital, Belo Horizonte, MG, Brazil
| | - Ivete de Ávila
- Human Reproduction Center at Mater Dei Hospital, Belo Horizonte, MG, Brazil.,Endometriosis Multidisciplinary Team, Biocori Hospital, Belo Horizonte, MG, Brazil
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8
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Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health 2015; 15:39. [PMID: 25952159 PMCID: PMC4450847 DOI: 10.1186/s12905-015-0196-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/24/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health. METHODS A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence. RESULTS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking. CONCLUSION Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management.
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Affiliation(s)
- Hedyeh Riazi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Saeideh Ziaei
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, P.O Box 13185-1488, Tehran, Iran.
- Faculty of Humanity Sciences, University of Science & Culture, ACECR, Tehran, Iran.
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