Diagnosis Of Ovarian Endometriosis Research Articles

(113) The Application of the Stable-Modifiable Model of Vulnerability and Resilience Processes in the Ovarian Endometriosis Population

Abstract Introduction Endometriosis is a painful, chronic inflammatory condition characterized by the presence of tissue similar to the lining of the uterus growing outside of the uterus, with the most common location being the ovaries (Audebert et al., 2018; O’Hara et al., 2021). Endometriosis can significantly disrupt sexual function and is associated with negative outcomes in mental health, relationship satisfaction, and quality of life (Friggi Sebe Petrelluzi et al., 2012; Smorgick et al., 2013). Although up to 10% of women are affected by endometriosis (As-Sanie et al., 2019), there is little research on the experience of sexual distress in people with endometriosis, especially in women who identify as sexual minorities. Most work in the area of pain has identified the risks that make one more susceptible to developing pain and pain-related distress, while little work has focused on potentially protective factors that might mitigate these risks and promote resilience (Darnell, 2021). By enlisting women who identify as a sexual minority (e.g., non-heterosexual), and thus taking a broader view of women’s healthy sexual activity, we may gain insight into ways in which any woman (with ovaries) may mitigate their sexual distress related to endometriosis. Objective The current study examined vulnerability and resilience factors contributing to sexual distress within an inclusive sample of women with ovarian endometriosis. It was hypothesized that women with ovarian endometriosis who reported lower levels of sexual self-consciousness and higher levels of sexual flexibility would experience lower levels of sexual distress, and women who identify as a sexual minority would report higher levels of sexual flexibility and lower levels of sexual distress resulting from ovarian endometriosis. Methods The current study was online in nature and recruited individuals with a self-reported clinician-identified diagnosis, or a self-reported suspected diagnosis, of ovarian endometriosis. All eligible participants completed measures assessing pain characteristics, sexual distress, and various resiliency and vulnerability constructs. Associations among these variables were examined via correlational analyses (Pearson’s r), differences between groups were examined via independent samples t-tests, and several moderated mediation models were run to determine what factor(s) predicted adaptive outcomes related to less sexual distress. Results Participants were 265 women who identified as a sexual majority (75.1%) or sexual minority (24.9%) with a confirmed (99.2%) or suspected (.8%) diagnosis of ovarian endometriosis. Results of the correlational analyses indicated: (1) sexual flexibility was negatively associated with sexual distress, r(226) = -.23, p <.001; (2) sexual flexibility was negatively associated with sexual self-consciousness, r(226) = -.19, p <.005; and (3) sexual self-consciousness was positively associated with sexual distress, r(227) = .45, p <.001. Results from independent samples t-tests and moderated mediation models were nonsignificant. Conclusions As the first investigation of the role of cognitive-affective factors in influencing sexual distress in an inclusive ovarian endometriosis population, the results of this study will contribute significantly to clinical practice in terms of providing novel targets for psychotherapeutic treatment options. Through investigating resilience processes, we may be able to ascertain whether adaptive factors (such as pain self-efficacy) account for functional health, independent of vulnerability factors (such as sexual self-consciousness). Disclosure No

Peculiarities of the course of genital endometriosis and its recurrence in women of reproductive age

Endometriosis remains one of the most studied pathologies in modern gynecology, as it is accompanied by such complications as constant pelvic pain, menstrual cycle disorders, and infertility. These complications not only prevent the implementation of a woman’s reproductive function, but also worsen the normal life of a woman in general. The early diagnosis and the right choice of treatment is the basis of prevention of disease recurrence. Therefore, most of the efforts of scientists are directed to this.The objective: to reduce the frequency of genital endometriosis recurrence and improve the implementation of reproductive functions based on the improved approaches to its diagnosis and treatment.Materials and methods. The study included two groups of patients. The 1st group included 60 women with a diagnosis of ovarian endometriosis, whose data were analyzed retrospectively based on the results of medical histories. The 2nd group was studied prospectively and included 60 women with a diagnosis of ovarian endometriosis.All patients had general clinical and laboratory examinations, specific laboratory and ultrasound examinations. In patients of the 2nd group tumor markers were additionally determined, in particular CA-125, HE4, CA 19-9, CA 72-4, CA 15-3, REA, and the level of anti-Müllerian hormone, magnetic resonance imaging was performed. Patients of both groups were operated and histological examination of the material obtained during the operation was performed.The difference in the management of the postoperative period in the 2nd group was that, in addition to anti-inflammatory therapy all women received hormonal therapy (gonadotropin-releasing hormone agonist (GnRH agonist) with subsequent use of combined oral contraceptives (COCs) or simultaneous use of GnRH agonist and COCs with subsequent transition in both variants for dienogest for 6 months continuously). Recurrence of the pathology was detected after 3 and 6 months on the basis of a repeated diagnosis of ovarian endometriosis.Results. The obtained data showed that in the postoperative period, 3 months after treatment 5 (8.3 %) women in the 1st group had a recurrence of ovarian endometriosis and 4 (6.7 %) patients – pelvic adhesions. Whereas in the 2nd group, there were no cases of recurrence and adhesions.In 6 months after treatment in the 1st group 11 (18.3 %) patients were diagnosed with ovarian endometriosis recurrence, and 6 (10.0 %) women were diagnosed with pelvic adhesions. In the 2nd group recurrence of ovarian endometriosis was found only in 1 (1.7 %) woman, pelvic adhesions were not detected (p<0.05). During the year after treatment the number of pregnant women among persons who wished to become pregnant and had a history of infertility was statistically higher in the 2nd group compared to the 1st group, in particular, 10 (16.7 %) and 2 (3.3 %) women, respectively (p<0.05).Conclusions. The proposed algorithm for the diagnosis and treatment of genital endometriosis minimizes the risk of its recurrence and improves reproductive function.

Accuracy of MRI Pelvis in the Diagnosis of Ovarian Endometrioma: Using Histopathology as Gold Standard.

BackgroundEndometriosis is defined as the ectopic presence of endometrial mucosa at locations other than the uterine cavity. It results in significant morbidity and is a leading cause of infertility as well. Magnetic resonance imaging (MRI) is establishing its role in the diagnosis of endometriosis and its complications. The objective of this study was to assess the accuracy of MRI in the diagnosis of ovarian endometriosis using histopathology as the gold standard.Materials and methodsAll patients presenting with clinical complaints and suspicion of endometriosis, undergoing MRI followed by surgical resection and confirmation by histopathology, were included in the study. Data were analyzed on a predefined proforma and parameters of accuracy were calculated.Results A total of 170 patients were included in this study, having a mean age of 36.8 years with a standard deviation of 10.4 years. The mean parity for included subjects was 2.25, with a standard deviation of 1.3. Overall, the sensitivity of MRI was 86.7% and the specificity was 81.9%. The positive predictive value (PPV) of MRI was 83.3%, while the negative predictive value (NPV) was 81.9%. Overall, the diagnostic accuracy of MRI was 84.7%.ConclusionThe accuracy of MRI in the diagnosis of endometriosis was found to be acceptable and comparable to most of the worldwide published literature. The routine use of MRI for diagnosis and preoperative planning is justified by the results of this study.

CfDNA in Diagnosis and Differential Diagnosis of Ovarian Endometriosis

cfDNA in Diagnosis and Differential Diagnosis of Ovarian Endometriosis

Predictive factors of ovarian carcinoma for women with ovarian endometrioma aged 45\xa0years and older in China

BackgroundTo explore the risk factors of endometriosis-associated ovarian cancer (EAOC) in women with ovarian endometriosis (OEM) aged 45 years and above in China.MethodsThis study reviewed the medical records of 1038 women in total who were aged 45 years and above, surgical-pathologically diagnosed with ovarian endometriosis, and were treated at Peking Union Medical College Hospital between December 1996 and December 2016. Histology evaluation was used to determine whether the ovarian endometriosis specimen was with (n = 30) or without (n = 1008) ovarian cancer.Results2.9% (30/1038) of women with the surgical-pathological diagnosis of ovarian endometriosis were found to have EAOC. Those patients with EAOC were prone to be in the postmenopausal status at the time of the diagnosis (OR 5.50, 95%CI 2.54–11.90, P < .001) and larger size of tumor (≥8 cm, OR 7.19, 95% CI 3.34–15.50, P < .001), and higher prevalence of coexisting with endometrial disorders (OR 4.11, 95%CI 1.73–9.73, P = .003). This study showed that patients of an older age when diagnosed with OEM, were at a higher risk of developing EAOC, respectively measuring of 1.7% (13/751) at 45–49 years, 5.6% (12/215) at 50–54 years, and 10.0%(5/50) at 55–59 years (P < 0.001).ConclusionsThis study showed that for women aged 45 years and above who were diagnosed with OEM, the independent risk factors of EAOC were menopausal status, tumor size of 8 cm or greater in diameter, and coexisting endometrial disorders. Therefore, intensive follow-ups or active interventions should be considered for them.

A Multivariate Analysis of Correlation between Severity and Duration of Symptoms, Patient Profile and Stage of Endometriosis

Background: Endometriosis is an important cause of infertility and chronic pelvic pain. Our study aims to understand the cause and effect relationship of endometriosis with these two clinical presentations. Objectives: 1) To study the correlation between stage of endometriosis with pain and infertility; 2) To evaluate role of transvaginal ultrasound for diagnosis of endometriosis using laparoscopic diagnosis as gold standard. Methodology: Total of 89 women presenting with infertility and or pain and with laparoscopic findings of endometriosis were included in the study. The results were analysed by logistic regression. Results: The mean age of women was 29.67 years. Seventy three percent of patients had moderate to severe disease while 31.46% of patients with endometriosis were infertile. Symptom of pain could be categorised as dysmenorrhea (71.47%), dyspareunia (41.5%) and dyschezia (15.7%). There was no association of endometriosis stage with the pain type, duration of symptoms. Transvaginal ultrasound seems a reliable test for diagnosis of ovarian endometriosis and advanced stage disease. 87.5% of patients with ovarian endometrioma had advanced disease (higher than Stage II rAFS). Conclusion: No correlation was found between the stage of endometriosis and severity of symptoms. Presence of endometrioma on USG was associated with advanced stage of endometriosis.

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.

Restorative treatment of patients with ovarian endometriosis

Reconstructive treatment of patients with ovarian endometriosis is most often performed by the doctor in the postoperative period. The peculiarity of this frequently occurring variety of ovarian tumor-like masses is the extreme polysymptomatic nature of the clinic. The cyclical nature of the manifestations, characteristic of endometriosis, is also seen in ovarian lesions, but both the painful symptom and menstrual function are significantly influenced by a pronounced adhesion process in the pelvis. This circumstance explains the comparative rarity of preoperative diagnosis of ovarian endometriosis - it varies about 7%.