Opportunities and clinical significance of preoperative diagnosis of infiltrative endometriosis

Abstract

Aim. To optimize preoperative diagnosis of infiltrative forms of genital endometriosis.
 Materials and methods. We analyzed the results of the preoperative examination and surgical treatment of 667 patients from 22 to 49 years old (31.4 [27.3; 34.2]) with external endometriosis presented with pelvic pain, dysmenorrhea, dyspareunia (n=580), and primary or secondary infertility (n=215). The duration of the disease ranged from 1 to 16 years. Seventy-eight (11.69%) patients had a history of surgery for external endometriosis. The serum concentration of the CA-125 tumor marker was measured by immunochemiluminescence assay. Colonoscopy was performed in 655 cases, and cystoscopy in 66 cases. In addition, pelvic ultrasound was performed for all patients. Pelvic magnetic resonance imaging (MRI) was performed with an intravenous bolus injection of a contrast agent.
 Results. Patients with endometrioid ovarian cysts (n=564) and "minor" forms of endometriosis (n=44) predominated. Endometrioid infiltrates occurred in 59 (8.84%) patients. In the group of patients with infiltrates, 18.64% had a history of surgery for endometriosis; 5.7% had a recurrence. Patients with retrocervical endometriosis and endometriosis of uterosacral ligaments predominated among females with infiltrative forms. No statistically significant differences in CA-125 concentration between patients with and without infiltrates were observed. The infiltrate was revealed, and its topography was described in 49 (83.05%) patients using ultrasound and 56 (94.81%) patients using MRI. All patients with dysuria had ultrasound, MRI, colonoscopy and cystoscopy.
 Conclusion. The combined use of pelvic ultrasound and MRI provides high accuracy in diagnosing infiltrative endometriosis.