Diagnosis Of Endometrioma Research Articles

Does ovarian endometrioma affect the number of oocytes retrieved for in vitro fertilization?

To investigate the effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization (IVF). The presence of endometrioma may be the most important predictor of a poor reproductive outcome. Literature data suggest that ovarian endometriomas might affect the response to ovarian stimulation and oocyte retrieval. The present retrospective study evaluates 2,023 women who applied to our center with an infertility complaint. Twenty-nine women with endometriomas (group 1) who were treated with IVF were included in the study. They were compared with 51 women with unexplained infertility (group 2) regarding the number of retrieved oocytes after egg retrieval and number of metaphase II oocytes. The diagnosis of endometrioma was made via ultrasound examination with the identification of low-density cystic masses in the ovaries. The patients underwent a controlled ovarian hyperstimulation (COH) with either the long agonist mini-dose protocol or the multi-dose antagonist protocol. The incidence of endometrioma in infertile women was found to be 1.4 %. The women's ages ranged between 24 and 45 years, and the duration of their infertility ranged between 12 and 216 months. The endometrioma was bilateral in 24 % of the cases. The mean endometrioma diameter was 26.2±7.3 mm for the right ovary and 23.2±6.1 mm for the left ovary. The average number of retrieved oocytes after egg retrieval in groups 1 and 2 was 12.4±8.3 and 12.2±8.6, respectively. The average number of metaphase II oocytes in groups 1 and 2 was 8.6±6.1 and 9.4±7.3, respectively. The number of retrieved oocytes after egg retrieval and the number of metaphase II oocytes in both endometrioma group and unexplained infertile group were similar (p >0.05). Endometrioma did not reduce the number of retrieved oocytes in a COH cycle for IVF treatment. However it should be noted that the ovarian response is affected by the size of endometriomas, bilaterality, previous surgeries, recurrence, and the patient's age (Tab. 1, Ref. 31).

The new possibilities of differenzial diagnosis of endometriomas

Objective: Endometriomas are found in 17% to 44% of patients with endometriosis and represent 35% of benign ovarian cysts requiring surgery. In recent years, laparoscopy has become the gold-standard for the treatment of endometriomas. But with two-dimensional pelvic ultrasound sometimes it is difficult to differentiate them from other diffuse, low-level echoes cysts, that increases the frequency of unnecessary surgical treatment. Our aim was to estimate the three-dimensional power Doppler ultrasound parameters for the discrimination of ovarian endometriomas from hemorrhagic cysts.

Abdominal Wall Endometriosis

The purpose of this presentation is to show the diagnostic characteristics of abdominal wall endometriosis, one of the extraperitoneal localizations of this disease, not widely described. We evaluated 11 patients examined with US between March 2007 and January 2011 who came to our service with pain located in the anterior abdominal wall. All of them suffered surgery, and histopathologic diagnosis was endometriosis. All of the patients (range 24-33 years) had history of surgery in the pelvis (4 laparoscopic surgeries of ovarian endometriosis and 7 caesareans). They all presented with abdominal pain, exacerbated in the menstrual period. At the US examination, they all presented a hypoechoic, solid or mixed lesion in the abdominal wall, between 18 and 25 mm, well-delimited edges and located next to the scar in the rectus abdominis muscles. The differential diagnoses to be considered are granuloma, tumor, hernia and haematoma. The surgical treatment consisted in complete resection of the lesion with histopathological confirmation. To diminish or avoid recurrence, resection must was performed with wide margins. In female patients with abdominal pain, especially if it worse during the menstrual period and they have a history of abdominal surgeries, the diagnosis of endometrioma should be considered if the US reveals a well-delimited solid or mixed mass in the abdominal wall.

CA 125 serum values in surgically treated endometriosis patients and its relationships with anatomic sites of endometriosis and pregnancy rate

Endometriosis is a benign gynecologic disease defined as the presence of functional endometrial glands and stroma outside the uterine cavity, causing dysmenorrhea, dyspareunia, menstrual irregularities, and infertility. Serum CA-125 measurement is now a consolidated method for diagnosing this condition, and its interpretation has posed a number of problems, particularly regarding utility in diagnosing minimal-mild endometriosis, whereas its value as a diagnostic aid in moderate-severe stages is well recognized. In our cohort, serum CA-125 values were significantly elevated in patients with ovarian and mixed endometriosis lesions (median levels 48 U/mL), compared with those who had exclusively extraovarian foci (median levels 27 U/mL), and so the correlation between this marker and the surgical and pathologic finding of ovarian and deep endometriosis was found to be statistically significant; however, the location did not affect the fertility rate.

Learning curve of transvaginal ultrasound for the diagnosis of endometriomas assessed by the cumulative summation test (LC-CUSUM)

A specific statistical tool (the cumulative summation test for learning curve or LC-CUSUM) was used to monitor the learning curve of four trainees for the diagnosis of endometriomas by transvaginal ultrasound. A large intertrainee variability in the learning curves was found, justifying a tailored training to learn this diagnosis.

Abdominal Wall Endometrioma; A 10-Year Experience and Brief Review of the Literature

Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of Cesarean section or hysterectomy. Certain factors relating to knowledge of the clinical pattern of this disease make correct diagnosis and treatment difficult. The aim was to identify the different forms of presentation of this disease entity through publishing the results from our experience of surgical management of such lesions. Patients diagnosed with abdominal wall endometrioma over a period of 10 y were identified from the comprehensive surgical database of our institution. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, current operation, and recurrences were surveyed and analyzed. There were 40 patients with a mean age of 32.3 ± 5.2 y. All of the patients (100%, n = 40) had an abdominal mass in or adjacent to surgical scars. The main symptom was pain, noncyclic (45%, n =18), or cyclic (40%, n = 16) in nature. The mean duration of symptoms was 18.2 ± 23.4 mo. The preoperative diagnosis was correct in 47.5% (n = 19) of the cases. Surgical treatment failed in 3 cases (3/33, 9.1%), and the operations were performed once again. Abdominal wall endometriosis may be difficult to diagnose as it is comparatively an unfamiliar entity that has not received its due attention among general surgeons, so far. Therefore, in patients with a palpable subcutaneous mass in or around surgical scars with a history of violation of uterus, a thorough history and physical examination is necessary, and usually sufficient to make correct diagnosis of endometrioma.

The value of urocortin and Ca-125 in the diagnosis of endometrioma

In this study, we sought to establish the value of a new molecule, urocortin (Ucn), in the diagnosis of endometrioma and compare with Ca-125 to identify superiority of urocortin. Of the patients operated on at our hospital with the initial diagnosis of adnexal mass, 88 patients whose pathology results were endometrioma and benign ovarian cyst were included in the study. As a result of the pathological examination, the patients were assessed in two groups. Group 1 consisted of 42 cases of endometrioma and Group 2 included 46 cases of benign ovarian cyst (control group). The serum Ucn and CA 125 levels of patients were measured from the blood samples drawn prior to the operation. While the serum Ucn level was 4.8 ± 1.00 ng/ml in the endometrioma group, it was 4.5 ± 1.03 ng/ml in the control group (P = 0.21). The difference was statistically not meaningful. On the other hand, mean serum Ca-125 level was 43.8 U/l (11.7-251) in the endometrioma group, it was 16.5 U/l (4.3-121.1) in the control group. The difference was statistically meaningful (P = 0.001). When the cut-off point for Serum Ca-125 level was taken as 21.38, sensitivity and specificity levels were found to be 88.1 and 63%. When the cut-off point for Ucn was taken as 4.16, sensitivity was 76.2%, and specificity 45.7%. Ucn was not found to be efficient in distinguishing endometrioma from other benign ovarian cysts or to be superior to CA125 in the diagnosis of endometrioma.

CASE REPORT;Endometrioma of the Abdominal Wall

We present the case of a 39-year-old woman with a 2- to 3-month history of a soft tissue mass involving the abdominal wall and increasing symptoms that fluctuated relative to her menses. Magnetic resonance imaging showed a hemorrhagic multiloculated mass within the rectus abdominus muscle. Correlation of the clinical history and imaging finding suggested a preoperative diagnosis of endometrioma of the abdominal wall. This was confirmed on histologic analysis of the resected specimen.

Plasma Urocortin Levels in the Diagnosis of Ovarian Endometriosis

Urocortin is a neuropeptide, member of the corticotropin-releasing hormone family, that is produced by the human endometrium. Ovarian endometrioma is a prevalent gynecologic disorder still lacking specific serum markers. In the present study we measured systemic levels of urocortin to assess the diagnostic performance of its determination in distinguishing endometriomas from other benign ovarian cysts. Plasma urocortin was measured by radioimmunoassay in women with ovarian endometrioma (n=40) and in women with benign, nonendometriotic ovarian cysts (n=40). The diagnostic accuracy of urocortin measurement was evaluated by receiver operating characteristic curve and compared with the standard marker, CA 125. To support the local origin of the peptide, we also evaluated its localization in endometriomas by immunohistochemistry and its concentrations in cyst fluid and peritoneal fluid of 12 women with endometrioma. Plasma urocortin levels were twice as high in women with endometrioma (median 49 pg/mL, interquartile range 41-63 pg/mL) than in the control group (19 [15-23] pg/mL, P<.001) and significantly higher in the cystic content of endometriomas than in the peritoneal fluid and plasma (P<.05). The peptide was immunolocalized in endometrioma glands and stromal capillary vessels. Elevated plasma urocortin levels detected 88% of the cases of endometrioma with 90% specificity, whereas CA 125 detected only 65% of the cases with the same specificity. Plasma urocortin is increased in women with endometriomas, and its measurement may be useful for the differential diagnosis of endometrioma compared with other benign ovarian cysts. II.

Evidence-based gynaecological practice: clinical review 1

In this review, the first of a series of evidence-based reviews of clinical practice commissioned by Gynaecological Surgery, we introduce the concept of applying the evidence to focused questions asked frequently by patients about specific treatment options. We pose the question about the appropriate treatment of ovarian endometriomas and search the readily available literature including systematic literature reviews, randomised controlled trials (RCTs) and observational studies. In addition to an overview of the pathophysiology and diagnosis of endometriomas we explore the search strategies used along with methods of focusing the clinical question into a question that can be asked of the literature. The treatment options identified are then used to inform any discussion that one might have with regards to the treatment of endometriomas. We conclude that endometriomas are best treated surgically by capsule stripping and that there is little evidence for the efficacy of adjuvant medical treatment either pre- or post-operatively. The risk of ovarian failure following surgical treatment appears to be small.

Variations in Appearance of Endometriomas

Because of the range of patient ages with endometriosis, the persistence of endometriomas, and the degradation of internal blood products over time, the appearance of endometriomas is variable. The purpose of this study was to identify the prospective diagnoses in cases of surgically proven endometriomas and to illustrate the variety of appearances of endometriomas. Sonographic images from 325 women with histologic confirmation of an adnexal mass during a 16-month period were reviewed. Eighty-seven endometriomas in 71 women were found. Prospective diagnoses were scored as follows: 1, the diagnosis was endometrioma only; 2, the differential diagnosis listed endometrioma first; 3, the differential diagnosis listed endometrioma but not first; 4, the diagnosis did not include endometrioma but included a complex or hemorrhagic cyst; and 5, the diagnosis did not include endometrioma. Lesions with the classic appearance of an endometrioma (hypoechoic mass with diffuse low-level internal echoes) or an atypical appearance were chosen for illustration. Thirty-five (60.3%) of 58 endometriomas measuring at least 2 cm in greatest dimension included endometrioma in the differential diagnosis at sonography. In 6 (10.3%) of 58, the lesions were described as complex or hemorrhagic cysts. Atypical endometriomas included cases with retracted clots that appeared solid but without blood flow, endometriomas in pregnant patients, and endometriomas in postmenopausal women with heterogeneous internal echoes and central calcification. A ruptured endometrioma was interpreted as pelvic inflammatory disease. Five endometriomas were suspected to be malignancies because of a solid appearance, blood flow, surrounding adhesions, and, in 1 pregnant patient, extensive decidualization. Recognition of the varied appearance of endometriomas should aid the interpreting physician in giving an appropriate prospective diagnosis of endometriomas.

Removal of Endometriomas Before in vitro Fertilization Does Not Improve Fertility Outcomes: A Matched, Case-Control Study

Debate continues about the effect of ovarian endometriomas on techniques of assisted reproduction. Possibly, an ovarian endometriotic cyst could impair oocyte quality and limit the response to ovarian hyperstimulation. Alternately, previous surgery may be the problem, not the endometriosis itself. This retrospective case-control study, conducted in connection with 2 academic in vitro fertilization (IVF) programs, examined outcomes in 189 women with endometriosis who underwent IVF with embryo transfer. Of these patients, 133 had previously undergone laparoscopic cystectomy for an ovarian endometrioma. The remaining 56 women proceeded directly to IVF. The diagnosis of endometrioma was confirmed histologically in all surgical cases. None of the participants had a known infertility factor other than endometriosis. The case and control women were similar with respect to age and ovarian reserve, and there were no significant differences in the duration of stimulation. There were, however, significant differences in the total dose of gonadotropins administered and peak estradiol levels on the day of giving human chorionic gonadotropin. These differences favored the women who went directly to controlled ovarian hyperstimulation. Comparable numbers of mature oocytes were obtained from women in the 2 groups. No significant group differences were found in fertilization rate, the number of embryos obtained per cycle, or the number of embryos transferred. Finally, rates of implantation, pregnancy, and miscarriage were similar in the 2 groups. Although laparoscopic cystectomy for ovarian endometriosis does not impair oocyte quality, it also does not offer superior fertility outcomes to asymptomatic women. Proceeding directly to controlled ovarian hyperstimulation in women who lack symptoms might reduce the time to pregnancy and lower patient costs as well as avoiding possible surgical complications. Symptomatic women may be told that conservative ovarian surgery does not lessen the chance of successful IVF.

Staging of Pelvic Endometriosis: Role of Sonographic Appearance in Determining Extension of Disease and Modulating Surgical Approach

Study Objective To estimate whether laparoscopic staging of endometriosis can be predicted by ultrasound findings. Design Prospective study (Canadian Task Force classification II-2). Setting Obstetrics and Gynecology Department, University of Rome Tor Vergata. Patients One hundred twenty-one women with histologically confirmed sonographic diagnosis of endometriomas. Intervention Ultrasonographic staging and laparoscopic assessment. Measurements and Main Results All patients underwent transvaginal and/or transrectal sonographic evaluation of ovarian endometriomas and other sonographic markers (anatomic sites and their relation to abdominovaginal palpation, adhesions, deep or infiltrating nodules) to stage the disease before surgery. These results were compared with laparoscopic staging. Concordance between methods was 83.5%. Specificity and sensitivity of ultrasonographic staging of stages 3 and 4 disease were 86% and 82% and 76% and 91%, respectively. Conclusion Ultrasonographic findings can predict pelvic extension and stage of endometriosis.

Transvaginal ultrasonography combined with three-dimensional ultrasonography in the diagnosis of endometrioma

Objective: To assess the diagnostic accuracy of transvaginal ultrasonography alone and combined with three-dimensional ultrasonography in differentiating ovarian endometrioma from other nonendometriotic mass.

The characterization of common ovarian cysts in premenopausal women.

The evaluation of the predictive value of transvaginal ultrasound in the assessment of benign adnexal pathology in premenopausal women, based on the recognition of characteristic morphologic patterns particular to endometriotic and dermoid ovarian cysts. This was a prospective study. All premenopausal women undergoing surgery for a suspected ovarian cyst underwent a transvaginal ultrasound examination in the week prior to surgery. Between June 1997 and January 2000, 132 women underwent surgery for a suspected ovarian endometrioma or dermoid cyst. The endpoints were either the direct visualization of the cyst wall and contents at surgery, or the histologic evaluation of removed tissues. Of 83 suspected endometriomas (11 bilateral), 80 were confirmed at surgery and of 68 suspected benign cystic teratomas (eight bilateral), 66 were confirmed by histology. The positive predictive value of transvaginal ultrasonography for the diagnosis of endometrioma and dermoid cysts was 96.4% and 97.1%, respectively. The false positive rates were 3.8% and 3.0%, respectively. There were no malignancies in either group. Based on the recognition of characteristic ultrasound patterns alone, the positive predictive value of transvaginal ultrasonography for the diagnosis of these common, benign cysts in premenopausal women is very high and can be used reliably to select women for appropriate surgery.

All that chocolate—but where did it come from?

I read with confusion the article by Jain and Dalton regarding chocolate ovarian cysts (1). Part of my confusion relates to the authors’ opinion that all chocolate cysts are endometrioma cysts, and thus the terms can be used interchangeably. This is especially confusing in light of their later acknowledgment that not all chocolate cysts are endometrioma cysts. In support of this opinion, they claim a 97% sensitivity in diagnosis of endometriomas by visual means alone, ignoring other studies that have found sensitivities of only 0% (2) and 47% (3). Indeed, most of the chocolate cysts in Sampson’s study (3) were histologically proved not to be endometriosis, and generations of authors have made the same misinterpretation of this work that Jain and Dalton make.

Endometriomas: diagnostic performance of US.

To determine the diagnostic performance of specific ultrasonographic (US) features in discriminating endometriomas from other adnexal masses. Two sonologists independently reviewed the sonograms of 252 adnexal masses in 226 women and recorded US features by using a standardized checklist. The diagnostic performance of specific US features and overall reviewer impression in discriminating endometriomas from other adnexal masses were evaluated. There were 40 endometriomas. Diffuse low-level internal echoes were present in 38 (95%) endometriomas and 40 (19%) nonendometriomas (positive likelihood ratio, 5). The positive likelihood ratio for the diagnosis of endometrioma increased to 8 if masses with neoplastic features at gray-scale US were excluded, allowing identification of 30 endometriomas (75%). The presence of multilocularity or hyperechoic wall foci further increased the positive likelihood ratio to 48, allowing the identification of 18 endometriomas (45%). An adnexal mass with diffuse low-level internal echoes and absence of particular neoplastic features is highly likely to be an endometrioma if multilocularity or hyperechoic wall foci are present. A patient with a mass with diffuse low-level internal echoes and other US features may benefit from additional imaging.

Abdominal Wall Endotnetriomas: Report of Eight Cases

Eight cases of abdominal wall endometrioma were encountered in seven patients from February 1994 through April 1996. The age of the patients ranged from 19 to 36 years, with an average age of 32.8 years. Ten abdominal procedures had been performed on these patients before the diagnosis of endometrioma: six cesarean sections, two diagnostic laparoscopics, one total vaginal hysterectomy, and one ventriculoperitoneal shunt. Symptoms occurred from 6 months to 10 years after their previous surgery. Only one patient had a prior diagnosis of endometriosis. The most common presentation was a cyclic painful abdominal mass. The differential diagnosis included endometrioma in four (50%) of the cases. Diagnostic tests used for preoperative evaluation included ultrasound, fine-needle aspiration, and computed tomography. All patients underwent wide local excision. There was one recurrence, requiring re-excision at 22 months postoperatively. The pathogenesis, diagnosis, treatment, and recent literature are discussed.

The diagnosis of endometriomas using colour Doppler energy imaging.

We studied the role of colour Doppler energy (CDE) (or power Doppler) imaging in the differentiation between endometriomas and other adnexal masses in premenopausal non-pregnant women. A total of 170 consecutive patients with persistent adnexal masses was submitted to B-mode transvaginal ultrasonography associated with CDE imaging evaluation. Plasma concentrations of CA125 were measured before surgery. Using CDE imaging evaluation of vessel distribution, the occurrence of one of the following findings was considered to indicate the likely presence of endometrioma: (i) a round-shaped homogeneous hypoechoic 'tissue' of low-level echoes without papillary proliferations associated with 'poor' vascularization; (ii) a round-shaped homogeneous hypoechoic 'tissue' of low-level echoes with an echogenic portion in which no flow was detected. The overall agreement between the test result and the actual outcome was calculated using the k index. The CDE imaging evaluation was more accurate in the diagnosis of endometriomas compared with B-mode ultrasonography alone (k = 0.88 and 0.80 respectively). According to the logistic regression equation obtained, the probability of the presence of endometrioma varied between a minimum of 1.4% for patients with no risk factors to a maximum of 95.6% for patients with two risk factors (CDE result and value of CA125 >25 IU/ml).

The role of transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler in the diagnosis of endometrioma

To assess the diagnostic accuracy of transvaginal ultrasonography alone and combined with color velocity imaging and pulsed Doppler in differentiating ovarian endometriomas from other nonendometriotic masses. Prospective study with pathological confirmation of sonographic diagnosis. Department of Obstetrics and Gynecology at a university hospital. A series of 78 consecutive patients diagnosed as having an adnexal mass and scheduled for surgery, between January 1995 and March 1996. Transvaginal ultrasonography and color velocity imaging and pulsed Doppler was performed before surgery in all patients. A total of 82 masses were diagnosed (four patients had bilateral masses). CA-125 plasma levels were measured in all patients. Ultrasound diagnosis was compared with definitive histopathological diagnosis. The presence of a round-shaped homogeneous cyst with low-level echoes was considered as sonographic diagnosis of ovarian endometrioma. The typical vascular pattern from endometrioma was considered as "pericystic flow at the level of the ovarian hilius." The sensitivity, specificity, and positive and negative predictive values were calculated for transvaginal ultrasonography alone and combined with color velocity imaging and pulsed Doppler. Twenty-seven (32.9%) of the 82 masses were proven to be ovarian endometriomas. Morphological assessment diagnosed correctly 24 (88.9%) of 27 endometriomas (false-positive rate: 9%). Typical flow pattern was present in 90.5% of endometriomas (false-positive rate: 80%). CA-125 levels in patients with endometrioma (45.6 +/- 6.3 U/mL; mean +/- SEM) were significantly higher than in patients with nonendometriotic masses (26.5 +/- 5.5 U/mL). The sensitivity, specificity, and positive and negative predictive values of transvaginal ultrasonography alone and combined with color velocity imaging and pulsed Doppler were 88.9%, 91%, 84.2%, and 94.5%, and 76.2%, 88.9%, 82.4%, and 82.4%, respectively. For CA-125 levels, using a cutoff > or = 35 U/mL, these figures were 79.3%, 84.6%, 79.3%, and 84.6%, respectively. The use of color velocity imaging and pulsed Doppler does not improve the diagnostic accuracy of transvaginal ultrasonography alone in the diagnosis of ovarian endometrioma.