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Moro F, Ianieri MM, De Cicco Nardone A, Carfagna P, Mascilini F, Vizzielli G, Biasioli A, Pontrelli G, Virgilio BA, Ladisa I, Carlea A, Lo Turco A, Beneduce G, Arcieri M, Scaglione G, Fanfani F, Scambia G, Testa AC. Comparison of clinical and ultrasound examinations in assessing the parametria in patients with deep infiltrating endometriosis: a multicentre prospective study. Reprod Biomed Online 2024; 48:103733. [PMID: 38401251 DOI: 10.1016/j.rbmo.2023.103733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 11/17/2023] [Indexed: 02/26/2024]
Abstract
RESEARCH QUESTION How do clinical rectovaginal examination and transvaginal ultrasound examination perform in the diagnosis of parametrial infiltration in patients with endometriosis? DESIGN This was a multicentre prospective observational study. Patients with suspected deep endometriosis at clinical examination and/or at ultrasound evaluation and scheduled for surgery were included. Following multicentre multidisciplinary meetings, consensus was obtained on terms and methodology to define the parametrium at pelvic anatomy, ultrasound and surgery. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios were calculated for clinical and ultrasound examinations with respect to surgery. RESULTS In total, 195 women were selected for the present study and 164 were included in the analysis. Ultrasound examination had good to high specificity (>80%) for all parameters, except the left lateral parametrium (78.8%). The sensitivity of ultrasound examination was good to high for fixity of the right and left ovaries, uterosacral ligaments, retrocervix and rectovaginal space; and low for the anterior and lateral parametria, vagina, bladder and bowel. Clinical examination had good to high specificity for fixity of the left ovary, anterior parametrium, right uterosacral ligament, retrocervix and vagina; and low specificity for fixity of the right ovary, lateral parametrium, left uterosacral ligament and rectovaginal space. The sensitivity of clinical examination was good for the uterosacral ligaments and rectovaginal space, and low for the remaining parameters. CONCLUSION Ultrasound examination provided good specificity for all the parameters, but sensitivity was low for the anterior and lateral parametria. Clinical examination provided good specificity for the anterior and posterior parametria, but sensitivity was low for the anterior and lateral parametria. Further prospective studies are needed to validate this methodology and confirm the results.
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Affiliation(s)
- Francesca Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Manuel Maria Ianieri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Pietro Carfagna
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Floriana Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Maternal and Child Health, Obstetrics and Gynaecology Clinic, University Hospital of Udine, Udine, Italy; Department of Medical Area, University of Udine, Udine, Italy
| | - Anna Biasioli
- Department of Medical Area, University of Udine, Udine, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynaecology, Policlinico of Abano Terme, Abano Terme, Italy
| | - Bruna Anna Virgilio
- Department of Obstetrics and Gynaecology, Policlinico of Abano Terme, Abano Terme, Italy
| | - Irene Ladisa
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Annunziata Carlea
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Alice Lo Turco
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giuliana Beneduce
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynaecology, 'Santa Maria della Misericordia' University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Giulia Scaglione
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Antonia Carla Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
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Ianieri MM, De Cicco Nardone A, Greco P, Carcagnì A, Campolo F, Pacelli F, Scambia G, Santullo F. Totally intracorporeal colorectal anastomosis (TICA) versus classical mini-laparotomy for specimen extraction, after segmental bowel resection for deep endometriosis: a single-center experience. Arch Gynecol Obstet 2024:10.1007/s00404-024-07412-6. [PMID: 38512463 DOI: 10.1007/s00404-024-07412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The surgical approach to bowel endometriosis is still unclear. The aim of the study is to compare TICA to conventional specimen extractions and extra-abdominal insertion of the anvil in terms of both complications and functional outcomes. METHODS This is a single-center, observational, retrospective study conducted enrolling symptomatic women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between September 2019 and June 2022. Women who underwent TICA were compared to classical technique (CT) in terms of intra- and postoperative complications, moreover, functional outcomes relating to the pelvic organs were assessed using validated questionnaires [Knowles-Eccersley-Scott-Symptom (KESS) questionnaire and Gastro-Intestinal Quality of Life Index (GIQLI)] for bowel function. Pain symptoms were assessed using Visual Analogue Scale (VAS) scores. RESULTS The sample included 64 women. TICA was performed on 31.2% (n = 20) of the women, whereas CT was used on 68.8% (n = 44). None of the patients experienced rectovaginal, vesicovaginal, ureteral or vesical fistula, or ureteral stenosis and uroperitoneum, and in no cases was it necessary to reoperate. Regarding the two surgical approaches, no significant difference was observed in terms of complications. As concerns pain symptoms at 6-month follow-up evaluations on stratified data, except for dysuria, all VAS scales reported showed significant reductions between median values, for both surgery interventions. As well, significant improvements were further observed in KESS scores and overall GIQLI. Only the GIQLI evaluation was significantly smaller in the TICA group compared to CT after the 6-month follow-up. CONCLUSIONS We did not find any significant differences in terms of intra- or post-operative complications compared TICA and CT, but only a slight improvement in the Gastro-Intestinal Quality of Life Index in patients who underwent the CT compared to the TICA technique.
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Affiliation(s)
- Manuel Maria Ianieri
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Alessandra De Cicco Nardone
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Antonella Carcagnì
- Catholic University of the Sacred Heart, Rome, Italy
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Fabio Pacelli
- Catholic University of the Sacred Heart, Rome, Italy
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Carfagna P, De Cicco Nardone A, Benvenga G, Nardone FDC, Greco P, Campolo F, Pafundi PC, Alesi MV, Testa AC, Scambia G, Ianieri MM. Preoperative diagnosis of ureteral medial deviations secondary to deep endometriosis using transvaginal ultrasound examinations: Can we predict the need for ureterolysis during laparoscopic surgery? Int J Gynaecol Obstet 2024. [PMID: 38404039 DOI: 10.1002/ijgo.15434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate ureteral involvement using transvaginal sonography (TVS) regarding the distortion of the course of the ureters caused by deep endometriosis (DE), which can facilitate predicting the need for ureterolysis during surgery, even in the absence of ureteral stenosis or dilatation. METHODS This is a single-center, observational, retrospective pilot study of 88 consecutive patients who later underwent surgery for DE that used ultrasound preoperative diagnosis of ureteral medial deviation of one or both ureters between January 2019 and January 2022. At TVS, the course of the ureter was considered medialized if, in longitudinal and transversal section, any distance was detectable between the ureter and the cervix at the point where the ureter crosses the uterine artery. The primary end point was to determine sensitivity, specificity, and positive and negative predictive values of "ureteral medial deviation" diagnosed using TVS, in order to predict the need for ureterolysis. RESULTS Our series included 88 women with a median age of 39 (interquartile range 33-43) years. Ureteral medialization showed a relatively low false-positive rate (10.9%), with a specificity of 89.1% (95% confidence interval [CI] 81.4%-96.7%) and a sensitivity of 86.6% (95% CI 80.3%-92.9%), along with a high positive predictive value of 93.3% (95% CI 88.4%-98.1%), and a lower negative predictive value of 79.1% (95% CI 69.8%-88.5%), respectively. CONCLUSIONS This study introduced a new ultrasound sign with a high degree of accuracy to predict ureterolysis and this may have positive implications in the management and surgical planning of patients with ureteral endometriosis.
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Affiliation(s)
- Pietro Carfagna
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Greta Benvenga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Fiorenzo De Cicco Nardone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | | | - Federica Campolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Pia Clara Pafundi
- Faculty of Epidemiology and Biostatistics-GEMELLI GENERATOR, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Antonia Carla Testa
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Maria Ianieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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Ianieri MM, De Cicco Nardone A, Benvenga G, Greco P, Pafundi PC, Alesi MV, Campolo F, Lodoli C, Abatini C, Attalla El Halabieh M, Pacelli F, Scambia G, Santullo F. Vascular- and nerve-sparing bowel resection for deep endometriosis: A retrospective single-center study. Int J Gynaecol Obstet 2024; 164:277-285. [PMID: 37555349 DOI: 10.1002/ijgo.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve- and vascular-sparing approach. METHODS A single-center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles-Eccersley-Scott-Symptom [KESS] questionnaire and Gastro-Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery. RESULTS Sixty-one patients were enrolled. No patients had Clavien-Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self-catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity. CONCLUSION Our vascular- and nerve-sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery.
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Affiliation(s)
- Manuel Maria Ianieri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | | | | | - Pia Clara Pafundi
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Federica Campolo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Miriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Pacelli
- Catholic University of the Sacred Heart, Rome, Italy
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Ianieri MM, Nardone ADC, Pavone M, Benvenga G, Pafundi MP, Campolo F, Foschi N, Greco P, Brutto M, Scambia G. Are ureterolysis for deep endometriosis really all the same? An anatomical classification proposal for ureterolysis: A single-center experience. Int J Gynaecol Obstet 2023; 162:1010-1019. [PMID: 37069787 DOI: 10.1002/ijgo.14790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Ureteral endometriosis has an incidence of 0.1% to 1%. The type of surgery required is either conservative (ureterolysis) or radical treatment, depending on the degree of ureter infiltration. The incidence of intraoperative and postoperative complications is heterogeneous. Thus, the aim of the current study was to propose a classification of ureterolysis based on the anatomical structure of the ureter and differing complication rates with procedures. METHODS A total of 139 ureterolysis procedures were included in the study. Patients were divided into three groups according to the depth of ureterolysis required. Differences were recorded across the three types of ureterolysis in terms of intraoperative and postoperative complications. RESULTS The incidence of ureteral fistula was reported in 0.7% of cases, with postoperative ureteral stenosis in 2% of type 2 ureterolysis. In the case of type 3 ureterolysis, after conservative procedures, 52.9% of patients required an ureteroneocystostomy to solve the ureteral stenosis. CONCLUSION The risk of ureteral injury and ureteroneocystostomy after conservative procedures appears to be associated with type 3 ureterolysis, probably due to excessive devascularization, secondary to the incision of adventitia. Obviously, these data should be confirmed through a prospective study of a larger number, but our proposed classification can provide the basis for making data from future studies more comparable.
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Affiliation(s)
- Manuel Maria Ianieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Matteo Pavone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Greta Benvenga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Maria Pia Pafundi
- Facility of Epidemiology and Biostatistics - GEMELLI GENERATOR, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Nazario Foschi
- Urology Division, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Pierfrancesco Greco
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Mariafrancesca Brutto
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Nero C, Romito I, Spadola S, Romito A, Turco LC, Cosentino F, De Ninno M, Catena U, De Cicco Nardone A, Moroni R, Zannoni G, Fagotti A, Scambia G. Infiltrating T lymphocytes and programmed cell death protein-1/programmed death-ligand 1 expression in endometriosis-associated ovarian cancer. Fertil Steril 2021; 117:160-168. [PMID: 34656305 DOI: 10.1016/j.fertnstert.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize T lymphocyte infiltration and programmed cell death protein-1 (PD-1)/programmed death-ligand 1 (PD-L1) expression in early-stage endometriosis-associated ovarian cancer (EAOC), ovarian endometriosis (OE), atypical endometriosis (AE), and deep endometriosis (DE). DESIGN Case-control, retrospective study. SETTING Research University Hospital. PATIENT(S) A total of 362 patients with a histologic diagnosis of EAOC, OE, AE, or DE were identified between 2000 and 2019 from Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Gemelli Molise SpA tissue data banks. A 1:1 propensity score-matched method yielded matched pairs of 55 subjects with EAOC, 55 patients with OE, 12 patients with AE, and 42 patients with DE, resulting in no differences in family history of cancer, parity, and use of oral contraceptives. INTERVENTION(S) Immunohistochemistry assays using the following primary antibodies: CD3+; CD4+; CD8+; PD-1; and PD-L1. MAIN OUTCOME MEASURE(S) To characterize T lymphocyte infiltration and PD-1/PD-L1 expression in 4 different endometriosis-related diseases. RESULT(S) Endometriosis-associated ovarian cancer cases displayed significantly higher levels of PD-1/PD-L1 expression compared with all other endometriosis-related diseases (vs. OE vs. AE vs. DE). Moreover, a significantly lower count of infiltrating T lymphocytes was observed in EAOC cases compared with OE ones. Finally, one-third of OE cases showed a cancer-like PD-1/PD-L1 expression profile. CONCLUSION(S) Endometriosis-associated ovarian cancer is characterized by higher levels of PD-1/PD-L1 expression compared with benign endometriosis-related diseases. This profile was found in one-third of clinically benign cases, suggesting that it develops early in the carcinogenesis process.
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Affiliation(s)
- Camilla Nero
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia.
| | | | - Saveria Spadola
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | | | - Luigi Carlo Turco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | | | - Maria De Ninno
- Gynecologic Oncology Division, Gemelli Molise SpA, Campobasso, Italia
| | - Ursula Catena
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | - Rossana Moroni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | - Gianfranco Zannoni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Anna Fagotti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
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De Cicco Nardone A, Carfagna P, De Cicco Nardone C, Scambia G, Marana R, De Cicco Nardone F. Laparoscopic Ethanol Sclerotherapy for Ovarian Endometriomas: Preliminary Results. J Minim Invasive Gynecol 2020; 27:1331-1336. [DOI: 10.1016/j.jmig.2019.09.792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/30/2019] [Accepted: 09/06/2019] [Indexed: 10/24/2022]
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Mancini F, Milardi D, Carfagna P, Grande G, Miranda V, De Cicco Nardone A, Ricciardi D, Pontecorvi A, Marana R, De Cicco Nardone F. Low-dose SKA Progesterone and Interleukin-10 modulate the inflammatory pathway in endometriotic cell lines. Int Immunopharmacol 2017; 55:223-230. [PMID: 29272819 DOI: 10.1016/j.intimp.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Francesca Mancini
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy
| | - Domenico Milardi
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy; Division of Endocrinology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Piero Carfagna
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Giuseppe Grande
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy.
| | | | - Alessandra De Cicco Nardone
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Domenico Ricciardi
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Alfredo Pontecorvi
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy; Division of Endocrinology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Riccardo Marana
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy; Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Fiorenzo De Cicco Nardone
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
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