Diagnosis Of Deep Infiltrating Endometriosis Research Articles

Assessing The Role and Accuracy of Ultrasonographic Imaging in The Diagnosis of Deep Infiltrating Endometriosis: A Cross-Sectional Study.

Deep infiltrating endometriosis (DIE) is described as an endometriotic tissue that penetrates more than 5 mm under the peritoneal surface. It's suggested that trans vaginal sonography (TVS) is 79% sensitive and 94% specific in the assessment of intestinal DIE. Considering the possibility that DIE ultrasonography (rectal and\or vaginal ultrasonography) might be more accurate, we designed this study to assess this study to evaluate the accuracy of DIE ultrasonography. In this retrospective cross-sectional study, we designed and conducted this study from 2019 to 2020 on patients suspected of severe endometriosis. Our patients underwent ultrasonographic imaging and based on the results became candidates for surgery. We compared histopathological results with sonographic findings using crosstabulation and chi-square tests were used to measure accuracy. P<0.05 were considered statistically significant. Following pathological assessments of 109 cases, 97 cases had ovarian endometrioma, 42 cases had intestinal involvement and 56 cases had uterosacral DIE. The results for accuracy were as the following; uterosacral ligament (USL) involvement SE: 96.4% and SP: 59.1%; intestinal involvement SE: 97.6% and SP: 73.8%; and Cul de sac involvement with SE: 100% and SP: 50.8%. With regards to ovarian endometrioma, ultrasonographic imaging was 99.0% sensitive and 84.6% specific. With regards to intestinal involvement, ultrasonography performed a reliable overall diagnosis (97.6% sensitive and 73.8% specific). However, the results showed lower accuracy regarding the level of intestinal involvement. The accuracy for other sites and cavities was low except for ovarian endometrioma. The results of the present study demonstrated that pre-operative TVS and Transrectal ultrasound (TRUS) can be a helpful paraclinical tool in the assessment and diagnosis of DIE and endometriosis in general and particularly with adnexal and bowel lesions, it can have some shortcomings with respect to cul de sac and USLs.

Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome.

Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality.

Management Challenges of Deep Infiltrating Endometriosis.

Deep infiltrating endometriosis (DIE) is the most aggressive of the three phenotypes that constitute endometriosis. It can affect the whole pelvis, subverting the anatomy and functionality of vital organs, with an important negative impact on the patient’s quality of life. The diagnosis of DIE is based on clinical and physical examination, instrumen- tal examination, and, if surgery is needed, the identification and biopsy of lesions. The choice of the best therapeutic approach for women with DIE is often challenging. Therapeutic options include medical and surgical treatment, and the decision should be dictated by the patient’s medical history, disease stage, symptom severity, and personal choice. Medical therapy can control the symptoms and stop the development of pathology, keeping in mind the side effects derived from a long-term treatment and the risk of recurrence once suspended. Surgical treatment should be proposed only when it is strictly necessary (failed hormone therapy, contraindications to hormone treatment, severity of symp- toms, infertility), preferring, whenever possible, a conservative approach performed by a multidisciplinary team. All therapeutic possibilities have to be explained by the physicians in order to help the patients to make the right choice and minimize the impact of the disease on their lives.

Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery: A Systematic Review of the Literature.

Endometriosis is a common gynecologic condition affecting as many as 1 per 10 women. Transvaginal ultrasound (TVUS) has become a frontline tool in the diagnosis of deep infiltrating endometriosis (DIE) before surgery. The primary aim of this review was to determine the accuracy of TVUS for DIE. The secondary aim was to determine accuracy specifically when a sonographer performed the TVUS examination. A systematic review was performed, searching literature by following a population, intervention, comparator, and outcome outline. MEDLINE, Embase, Emcare, and Google Scholar were searched in July 2018 and in November 2019. Including "sonographer" in the search terms yielded no results, so our terms were expanded. Two hundred and four articles were returned from the searches, and 35 were ultimately included in the final review. Analysis of the returned articles revealed the TVUS is a valuable diagnostic tool for DIE before surgery. Sensitivities ranged from 78.5% to 85.3%, specificities from 46.1% to 92.5%, and accuracies from 75.7% to 97%. Most authors reported site-specific sensitivities and specificities, which varied greatly between locations. Site-specific sensitivities ranged from 10% to 88.9% (uterosacral ligaments), 20% to 100% (bladder), 33.3% to 98.1% (rectosigmoid colon), and 31% to 98.7% (pouch of Douglas). Site-specific specificities ranged from 75% to 99.6% (uterosacral ligaments), 96.4% to 100% (bladder), 86% to 100% (rectosigmoid colon), and 90% to 100% (pouch of Douglas). Transvaginal ultrasound is an accurate tool in the diagnosis of DIE; however, limited data exist as to whether this technique is accurate when performed by sonographers. More evidence surrounding the reliability between operators is also needed.

Factors associated with deep infiltrating endometriosis versus ovarian endometrioma in China: a subgroup analysis from the FEELING study

BackgroundTo compare potential factors associated with deep infiltrating endometriosis (DIE) versus ovarian endometrioma (OMA) among endometriosis patients in China.MethodsA subgroup analysis of factors associated with DIE versus OMA was performed in Chinese women from the FEELING study. This study included 156 OMA patients and 78 DIE patients. Retrospective information on symptoms and previous medical history was collected via face-to-face interviews; patients also completed a questionnaire to provide information on current habits. Univariate and multivariate logistic regression analyses were conducted to identify potential factors that are associated with DIE versus OMA.ResultsFrom univariate analysis, women who were married, at older age, had any siblings, prior pregnancy, or longer time since age at menarche on the day of visit were more likely to be diagnosed with DIE (P < 0.05). Also, the incidence of previous uterine surgery, menstrual and ovulatory disorders, deep dyspareunia, and gastrointestinal symptoms during menstruation were major factors that were significantly associated with the diagnosis of DIE (P < 0.05). Multivariate analysis showed that women with any siblings, gastrointestinal symptoms during menstruation, or eating a greater number of fruit/vegetables per day were more likely to be diagnosed with DIE. Meanwhile, eating organic food and experiencing stress were major factors that are associated with the diagnosis of OMA.ConclusionsThe findings provide additional information on the potential risk factors that are associated with DIE, compared with OMA among Chinese endometriosis patients. The results may help to better understand DIE versus OMA, and aid in earlier risk stratification and diagnosis of the patients.Trial registrationNCT01351051. Registered 10 May 2011.

Anatomic distribution of endometriosis: A reappraisal based on series of 1101 patients

ObjectiveTo reappraise the anatomic distribution of endometriosis lesions in cases with Superficial Implants (SI), Ovarian Endometrioma (OMA) and Deep Infiltrating Endometriosis (DIE). Materials and MethodsA prospective observational study was operated between January 1989 to June 2009. A total of 1333 consecutive patients with a laparoscopic diagnosis of endometriosis, were extracted from our database. Due to missing data or repeated operations, 232 patients were excluded from the study. Finally, 1101 patients who met the selected criteria were included in the present analysis.. Primary outcome of study was the anatomic location of endometriotic lesions. Secondary outcomes were laterality of lesions as well as location of adhesions. ResultsMean age of patients was 33.06 years (range 15–63 years) while the mean BMI was 21.5. The ovary was the most frequent site of endometriotic lesions (737 patients, 66.94%) followed by the utero-sacral ligaments (USL) (45.51%), the ovarian fossa (32.15%), the pouch of Douglas (29.52%) and the bladder (21.25%). Deep Infiltrating Endometriosis (DIE) was diagnosed in 159 patients (14.4%) with an increasing rate starting from the mid-nineties. The left side was predominant for all locations except fromr ovarian SI and fallopian tube, but for this latter location the number of cases was limited. 600 (54.4%) patients had adhesions wjth the adnexa being the most frequent site of location (47.4%). ConclusionsOvary was the main site of endometriotic lesions followed by the utero sacral ligaments. Left side was predominant for all locations except for ovarian SI and fallopian tube. The diagnosis of DIE has constantly being increased since mid-nineties. The large cohort of patients included in the study has strengthened previous reported data.

Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound?

Surgical treatment of deep infiltrating endometriosis (DIE) is complex, and preoperative diagnosis benefits both surgeon and patient. Studies in expert centres have reported high accuracy for transvaginal ultrasound (TVUS) diagnosis of DIE. External validation of these findings has been limited, and no information is available on how quickly these skills can be acquired. The aim of this study was to measure the learning curve of DIE-TVUS and to identify the causes for inaccuracies in the diagnosis of bowel lesions and Pouch of Douglas (POD) obliteration. Following one week of training at the University of São Paulo (Brazil), 205 consecutive women with a history of endometriosis symptoms were prospectively assessed by TVUS after minimal bowel preparation. TVUS findings were correlated with laparoscopic findings in eighty-five cases to assess the accuracy. The LC-CUSUM and CUSUM were used to assess the learning curve and maintenance of competency, respectively. The sensitivity and specificity for DIE of the bladder, vagina and bowel were 33% and 100%, 80% and 100%, and 88% and 93%, respectively. The sensitivity and specificity for the presence of POD obliteration were 88% and 90%, respectively. LC-CUSUM analysis confirmed that competency for DIE-TVUS was achieved within 38 scans for the detection of POD obliteration and within 36 scans for the detection of bowel nodules. Competency was maintained for the remainder of the scans as assessed by the CUSUM. After one week of DIE-TVUS training, competency can be achieved within forty procedures, allowing diagnosis of DIE with similar diagnostic accuracy as reported by centres of excellence.

Magnetic Resonance Imaging of Deep Infiltrating Endometriosis: Comparison of 2DT2- and 3DT2-Weighted TSE Sequences

Purpose The purpose of this study was to compare image quality and diagnostic confidence of 3DT2 (SPACE) and 2DT2 magnetic resonance (MR) imaging for the evaluation of deep infiltrating endometriosis (DIE). Methods A total of 121 patients, referred for MR imaging because of suspected DIE with bowel involvement, underwent both 2DT2 and 3DT2 MR imaging. Two independent readers assessed both datasets for presence of DIE, artefacts and overall image quality. Inter-rater agreement scores were calculated using Cohen's kappa, and image quality and diagnostic confidence scores were compared using the Wilcoxon rank sum test. Results Inter-rater agreement scores for diagnosis of DIE (located retrocervical/vaginal cuff, or involving the bowel or bladder) using both 3DT2 SPACE and 2DT2, or solely 3DT2 and 2DT2 were excellent. Diagnostic confidence scores were similar for 3DT2 and 2DT2. Analysis of the 3DT2 dataset in combination with 2DT2 showed significant higher diagnostic confidence compared with solely 2DT2 for 1 location, which differed per reader. In 2DT2, artefacts were significantly lower, and overall image quality was significantly higher (p&lt;0.01 and p&lt;0.001, respectively). Conclusions Although 3DT2 SPACE could replace routine 2DT2-weighted imaging, the authors prefer 2DT2 over 3D, because of significantly fewer artefacts and a higher overall image quality with almost similar diagnostic confidence scores. Thus 3DT2 might be added to the standard protocol in indistinct cases.

Comparison of 3D and 2D FSE T2-weighted MRI in the diagnosis of deep pelvic endometriosis: Preliminary results

To evaluate image quality and diagnostic accuracy of two- (2D) and three-dimensional (3D) T2-weighted magnetic resonance imaging (MRI) for the evaluation of deep infiltrating endometriosis (DIE). One hundred and ten consecutive patients with suspicion of endometriosis were recruited at two institutions over a 5-month period. Twenty-three women underwent surgery, 18 had DIE at histology. Two readers independently evaluated 3D and 2D MRI for image quality and diagnosis of DIE. Descriptive analysis, chi-square test for categorical or nominal variables, McNemar test for comparison between 3D and 2D T2-weighted MRI, and weighted "statistics" for intra- and interobserver agreement were used for statistical analysis. Both readers found that 3D yielded significantly lower image quality than 2D MRI (p<0.0001). Acquisition time for 3D was significantly shorter than 2D MRI (p<0.01). 3D offered similar accuracy to diagnose DIE compared to 2D MRI. For all locations of endometriosis, a high or variable intra-observer agreement was observed for reader 1 and 2, respectively. Despite a lower overall image quality, 3D provides significant time saving and similar accuracy than multiplanar 2D MRI in the diagnosis of specific DIE locations.

Anatomical localization of deep infiltrating endometriosis: 3D MRI reconstructions

The goal of this study was to determine the accuracy of three-dimensional (3D) MRI reconstructions obtained with segmentation technique in the preoperative assessment of deep infiltrating endometriosis (DIE) and in particular to evaluate rectosigmoid and bladder wall involvement. Institutional review board approval for this study was obtained, and each patient gave written informed consent. Fifty-seven consecutive patients with diagnosis of DIE who had undergone pelvic MRI at 1.5 T before surgery between 2007 and 2011, were retrospectively evaluated and 3D post-processed in order to obtain a detailed mapping of DIE. A blinded reader interpreted images. MRI results were compared with surgical findings and were scored by using a four-point scale (0_3 score). 36/57 patients with symptomatic DIE underwent surgery: 18/36 had endometriotic nodules infiltrating the rectouterine pouch, 12/36 the vesicouterine pouch, and 6/36 the rectovaginal pouch. The sensitivity of MRI and 3D MRI vs. surgery was, respectively, 64% vs. 83%; diagnostic accuracy of 3D MRI respect to MRI alone was 86% vs. 67% for localization; 86% vs. 67% for dimension; 79% vs. 58% for rectosigmoid infiltration; 92% vs. 75% for bladder infiltration. In this preliminary study, 3D MRI reconstructions obtained with semi-automatic method of segmentation provided encouraging results for staging DIE preoperatively. In fact, the addition of 3D MRI reconstructions improved diagnostic accuracy and staging of DIE providing the exact volume of the lesions and enabling a precise mapping of these before surgery.

Matrix metalloproteinase 7 expression of endometrial epithelial cells: a potential marker for patients with deep infiltrating endometriosis?

Matrix metalloproteinase 7 expression of endometrial epithelial cells: a potential marker for patients with deep infiltrating endometriosis?