Diagram to map the locations of endometriosis

Systematic radiological approach to utero-ovarian pathologies

Ultrasound is the first-line imaging modality for the evaluation of suspected adnexal masses, endometriosis and uterine tumors, whereas MRI is used as a secondary diagnostic tool to better characterize these lesions. The aim of this review is to summarize the latest advances in the imaging of these utero-ovarian pathologies.

Patient-completed or symptom-based screening tools for endometriosis: a scoping review

PURPOSE

The objective of this review was to evaluate existing patient-completed screening questionnaires and/or symptom-based predictive models with respect to their potential for use as screening tools for endometriosis in adult women. Validated instruments were of particular interest.

METHODS

We conducted structured searches of PubMed and targeted searches of the gray literature to identify studies reporting on screening instruments used in endometriosis. Studies were screened according to inclusion and exclusion criteria that followed the PICOS (population, intervention, comparison, outcomes, study design) framework.

RESULTS

A total of 16 studies were identified, of which 10 described measures for endometriosis in general, 2 described measures for endometriosis at specific sites, and 4 described measures for deep-infiltrating endometriosis. Only 1 study evaluated a questionnaire that was solely patient-completed. Most measures required physician, imaging, or laboratory assessments in addition to patient-completed questionnaires, and several measures relied on complex scoring. Validation for use as a screening tool in adult women with potential endometriosis was lacking in all studies, as most studies focused on diagnosis versus screening.

CONCLUSIONS

This literature review did not identify any fully validated, symptom-based, patient-reported questionnaires for endometriosis screening in adult women.

Agreement between the preoperative findings and the operative diagnosis in patients with deep endometriosis

INTRODUCTION

During the evaluation of patients with endometriosis, recognizing the location and characteristics of lesions is fundamental to define the type and evaluate the response of treatment, as well as for the preoperative surgical planning. However, the non-invasive diagnostic tests have specific limitations making the diagnostic laparoscopy been recommended as a tool necessary for the diagnosis of endometriosis lesions despite the high cost and the risks involved in this procedure.

OBJECTIVE

To evaluate the feasibility of mapping endometriosis lesions using clinical signs and image evaluation, comparing the pre- and postoperative findings of patients submitted to surgical treatment.

METHOD

A retrospective and prospective study included all patients who underwent surgical treatment for deep endometriosis between March 2011 and November 2014, at two centers of endometriosis in Rio de Janeiro. The positive finds registered during the clinical and image evaluation were compared with the surgical and histopathological results using a new instrument: the Lasmar's MAP of endometriosis

RESULTS

46 patients were included, age ranging from 23 to 47 years. For each site of endometriosis lesions, sensitivity, specificity, positive and negative predictive value, the positive and negative likelihood ratios and accuracy were calculated.

DISCUSSION

The results show a high sensitivity, specificity and accuracy of the preoperative clinical evaluation to identify the main sites of endometriosis lesions without the use of diagnostic laparoscopy.

Validation of a score to guide endometriosis therapy for the non-specialized gynecologist

OBJECTIVE

To validate a tool-the ECO system-developed to guide non-specialized gynecologists in the treatment of patients with suspected endometriosis in outpatient clinics.

METHODS

In a retrospective study, data were assessed from patients presenting to a center in Brazil or a center in Germany with suspected endometriosis and pelvic pain between July 2012 and June 2013. Data reviewed included patient complaints, clinical extent of disease, patient goals, recent use of medication, previous pelvic surgeries, visual analog pain scale, treatment provided, and histopathology after surgery. Data were transformed into a score according to the ECO system (0-6) indicating the suggested management, which was compared with the approach used in the study hospitals.

RESULTS

Among 166 patients, 78 (47.0%) were medically treated and 88 (53.0%) underwent therapeutic laparoscopy. All 3 patients scoring 2 had undergone hormonal treatment. Among 51 patients scoring 3, 49 (96.1%) were clinically managed and 2 (3.9%) underwent surgery. Among 52 patients scoring 4, 26 (50.0%) had undergone medical treatment and 26 (50.0%) surgical treatment. All 56 patients who scored 5 and the four patients who scored 6 underwent surgery.

CONCLUSION

The ECO system seems to effectively represent the management of patients with endometriosis in specialized services.