Diagnosis Of Endometriosis In Women Research Articles

Autoimmune Markers for Non-Invasive Diagnosis of Endometriosis in Women

Autoimmune Markers for Non-Invasive Diagnosis of Endometriosis in Women

New Diagnosis of Endometriosis is Less Common in Women over Age Forty Presenting with Pelvic Pain

To investigate the incidence of new diagnosis of endometriosis in women at or above the age of 40 who present with previously undiagnosed pelvic pain and no previous surgical or sonographic evidence of endometriosis to a tertiary care clinic specializing in pelvic pain and endometriosis. Retrospective cohort study (on the basis of the Strengthening the Reporting of Observational Studies in Epidemiology guidelines) of the incidence of laparoscopically proven endometriosis in women presenting with previously undiagnosed pelvic pain on the basis of age category (age <40 years or ≥40 years). Adjusted odds ratios and 95% confidence intervals were calculated using a multivariable logistic regression model. Pelvic pain focused gynecology clinic at a tertiary care hospital. Premenopausal women between 18 to 51 years who presented with pelvic pain and were booked for laparoscopy for the diagnosis and the possible treatment of endometriosis between the years 2012 to 2016. Patients who had had previous laparoscopy and those who had sonographic evidence of endometriosis were excluded from the study. Laparoscopic visual evaluation and treatment was carried out in all patients by specialized gynecologists focusing on endometriosis surgery. Presence or absence of visualized endometriosis at laparoscopy. We evaluated 174 women who met the inclusion criteria. Endometriosis was diagnosed in 35% (19/55) of patients aged 40 years and above and in 67% (80/119) of patients below the age of 40 years. Odds ratio adjusted for body mass index and parity was 2.38 (1.09-5.00; p = .03). When assessed as a continuous curvilinear variable without division to age categories, age was significant even in the more comprehensive model including more potential confounders. Secondary outcome analysis demonstrated that deep infiltrating endometriosis was diagnosed in 5% (3/55) of the women at or above 40 years and in 8% (10/119) of women below 40 years (p = .76). In addition, a curvilinear relationship was found with age, and there was also a lower incidence of endometriosis of 50% (19/38) in the youngest cohort of women aged 18 to 25 years. The likelihood of a new diagnosis of endometriosis in women with pelvic pain, no previous laparoscopy and a normal sonogram in our referral center was lower in women aged 40 and above. Careful counseling and consideration of the risks and yield of surgery is recommended before performing a laparoscopy for investigation of pelvic pain in this age group.

Autoimmune markers for non-invasive diagnosis of endometriosis in women

Endometriosis is a common estrogen-dependent chronic disease in women of reproductive age; it is associated with dysregulation of the immune response, local inflammation, and increased formation of autoantibodies. The aim of the study was to investigate the profile of autoantibodies in women with endometriosis and to evaluate their diagnostic value using new modifications of enzyme immunoassay. In women with endometriosis of stage III-IV (n=39), a wide spectrum of autoantibodies was detected, mainly of class G, including antibodies to endometrial antigens (tropomyosin 3, tropomodulin 3), the enzyme α-enolase, steroid (estradiol, progesterone) and gonadotropic hormones. At the same time, the frequency of detection of IgG antibodies to tropomyosin 3, α-enolase, estradiol and human chorionic gonadotropin and their levels in patients with endometriosis were higher than in healthy women (n=26) (p<0.05). IgG-antibodies to tropomyosin 3, α-enolase and estradiol were characterized by higher diagnostic value for endometriosis. The diagnostic value was significantly increased when these antibodies were combined: the AUC reached 0.875 [0.772-0.978] (p<0.0001), the sensitivity and specificity were 83.3% each. Thus, autoantibodies to tropomyosin 3, α-enolase, and estradiol are promising for inclusion in the panel of biomarkers for non-invasive diagnosis of endometriosis.

Diagnosis of endometriosis in women with chronic pelvic pain

Purpose of investigation: To assess the accuracy of CA-125 determination associated with clinical history and of the neutrophil/lymphocyte (N/L) ratio for a presumptive diagnosis of endometriosis in women with chronic pelvic pain (CPP). Materials and Methods: This was a cross-sectional study of data from the medical records of women with CPP submitted to laparoscopy from August 1999 to January 2009 at the University Hospital. The performance of the evaluation of CA-125 and of the N/L ratio for the prediction of endometriosis was compared based on the corresponding ROC curves and their 95% confidence intervals. Results: CA-125 levels were significantly higher in women with CPP and endometriosis and their association with a complaint of dysmenorrhea improved their sensitivity. For a cut-off of 20 IU/ml, the predictive value for a diagnosis of endometriosis in women with CPP was 97.6%. Dyspareunia, subfertility, and N/L ratio were not useful for a diagnosis of endometriosis in women with CPP. Conclusion: The association of elevated CA-125 levels with a complaint of dysmenorrhea is adequate in a presumptive and accurate diagnosis of endometriosis in this specific group of women with CPP, permitting an early institution of clinical treatment without the need of previous laparoscopic confirmation.

Characterization of uterine natural killer cells in a baboon model of endometriosis

A growing body of evidence suggests that alterations in the frequency and activity of endometrial natural killer (eNK) cells may be involved in the pathogenesis of endometriosis in human. The aim of this study was to investigate the levels of CD56+, CD16+ or NKp30+ cells in the eutopic endometrium during the different stages of endometriosis in a Papio Anubis model. The use of a baboon model of endometriosis allows a tightly controlled environment, monitored progression, and investigation of early stages of the disease, since the average time from onset to diagnosis of endometriosis in women is 11 years.

The tangled web of reasons for the delay in diagnosis of endometriosis in women with chronic pelvic pain: will the suffering end?

Understanding the woman's experience with chronic pelvic pain and endometriosis is critical to decreasing her suffering. Further investigation must continue to determine the relation between endometriosis and pain, despite empirical treatment with GnRH agonists becoming routine in the United States.

The use of serum CA-125 as a marker for endometriosis in patients with dysmenorrhea for monitoring therapy and for recurrence of endometriosis.

To estimate the value of CA-125 for the diagnosis of endometriosis in women with dysmenorrhea, as well as its significance in monitoring therapy and follow-up. One hundred and fifty-seven women undergoing laparoscopy for dysmenorrhea were prospectively studied for serum CA-125 concentration. For those with advanced endometriosis receiving danazol treatment after conservative surgery, CA-125 was also determined every month during medication and once every 12 months after treatment. The sensitivity and specificity of serum CA-125 for the diagnosis of endometriosis were 61.1% and 87.5% respectively. Elevated CA-125 (>35 U/ml) was noted in 65/75 cases (86.70%) with advanced endometriosis, but in only 15/56 patients (26.8%) with minimal and mild endometriosis. Although there were significantly higher CA-125 levels in unmarried women, and a negative correlation (r=-0.1970, p=0.0284) between CA-125 and parity, there was no statistical difference in incidence of endometriosis by the status of marriage or parity. Ten women with advanced endometriosis were found with persistent endometriosis by laparoscopy during danazol treatment, even though they tested with normal CA-125 levels (<35 U/ml) at that time. Fifteen patients had elevated CA-125 levels before and one year after therapy, and were confirmed with recurrence of endometriosis by laparoscopy. Nine women with elevated CA-125 levels before treatment, were found without recurrence of endometriosis and had normal CA-125 levels one year after therapy. For endometriosis, CA-125 is a valuable adjuvant in the follow-up of recurrence in patients with advanced endometriosis and initially elevated CA-125 levels. It is not an effective screening tool for patients with dysmenorrhea, or for monitoring therapy. There was no significant correlation between the development of endometriosis and reproductive factors.

Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK.

We investigated the length of time between the onset of pain symptoms and the surgical diagnosis of endometriosis in women from the UK and the USA. A total of 218 women with surgically confirmed disease, recruited through endometriosis self-help groups, completed a postal questionnaire. The mean +/- SD delay in diagnosis for women from the USA was 11.73 +/- 9.05 years, significantly higher than the equivalent delay of 7.96 +/- 7.92 years for women from the UK (P < 0.01). The stage of disease did not effect the length of time between the onset of symptoms and diagnosis. Therefore there is considerable delay in the diagnosis of endometriosis for women from both the UK and the USA. Efforts to reduce this delay are required to minimize the suffering of women with this disease.

Is mild endometriosis always a disease?

The easy access to the pelvis via laparoscopy has led to an appreciable increase in the diagnosis of endometriosis in women with infertility or chronic pelvic pain. This could suggest a rising incidence of the disease but is probably largely related to the recently acquired ability to demonstrate minimal and mild lesions. However, estimates of the distribution of endometriosis in the female population might be unreliable due to lack of control of the variables which influence diagnosis of the disease in the initial stages. Analysis of data from prospective studies on asymptomatic women undergoing tubal sterilization reveals a markedly higher than expected frequency of endometriosis. This raises doubts on the clinical significance of the minimal lesions that are often found. The concept that initial endometriosis should always be treated to avoid worsening of the condition seems to lack a convincing rational basis and is not supported by definitive scientific evidence. Minimal/mild endometriosis could represent a temporary phase in an on-going process that usually results in cytolysis of recently implanted endometrial cells, whereas in a few immunologically 'tolerant' subjects, nodular, cystic and infiltrating lesions develop, with eventual progression to moderate and severe stages.