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Buffeteau A, Weyl A, Vavasseur A, Meilleroux J, Pointreau A, Griffier R, Chantalat E, Vidal F. MRI and rectal endoscopy sonography performance to diagnose the digestive depth infiltration of pelvic endometriosis. Arch Gynecol Obstet 2023; 307:51-58. [PMID: 35435484 DOI: 10.1007/s00404-022-06532-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main objective of this study was to evaluate the performances of MRI and rectal endoscopy sonography (RES) in predicting the depth of bowel wall infiltration by deep infiltrating endometriosis (DIE). MATERIAL AND METHOD We conducted a single center retrospective study from April 2014 to March 2020 including all patients who had undergone digestive tract resection (discoid or segmental) for DIE removal and who had benefited from full preoperative imaging workup based on both pelvic MRI and RES. RESULTS Fifty two patients were enrolled in the study. Median age was 35.8 years (26.1-44.5 years). Indications for surgery mainly comprised chronic pelvic pain (94.2%) and infertility (36.5%). Overall, pathological examination showed digestive involvement in 92.3% of patients, while transmural infiltration was found in 38.4% of cases. In contrast, both MRI and RES suspected transmural involvement in 42 patients (80.8%). Corresponding sensitivity and specificity were 0.95 [95% CI (0.751-0.999)] and 0.28 [95% CI (0.137-0.467)], respectively. Our results revealed agreement between MRI and RES in 85% of cases with a kappa at 0.5 [95% CI (0.207-0.803), moderate agreement]. Subgroup analysis in patients with transmural MRI lesions showed a sensitivity of 0.95 [95% CI (0.740-0.999)] and a specificity of 0.13 [95% CI (0.028-0.336)]. CONCLUSION Our study suggests that performing a second-line examination is not useful if there is no transmural impairment in MRI or RES. Nevertheless, the combination of these two preoperative examinations seems to be essential for the evaluation of the depth of digestive involvement of endometriosis to guide surgical management as effectively as possible. The constitution and training of multidisciplinary expert groups must be developed to be able to offer optimal patient management.
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Affiliation(s)
- Aurélie Buffeteau
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059, Toulouse, France. .,CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059, Toulouse, France.
| | - Ariane Weyl
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059, Toulouse, France
| | - Adrien Vavasseur
- Toulouse University Hospital, Imaging Unit, Rangueil Hospital, 31059, Toulouse, France
| | - Julie Meilleroux
- Toulouse University Hospital, Anatomopathology Unit, Purpan Hospital, 31059, Toulouse, France
| | - Adeline Pointreau
- Gastroenterology Department, Clinique de La Croix du Sud, 31130, Quint-Fonsegrives, France
| | - Romain Griffier
- Bordeaux University Hospital, Public Health Unit, Pellegrin Hospital, 33000, Bordeaux, France
| | - Elodie Chantalat
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059, Toulouse, France.,University of Toulouse III, IRIT, CNRS, UMR 5505, Toulouse, France
| | - Fabien Vidal
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059, Toulouse, France.,University of Toulouse III, IRIT, CNRS, UMR 5505, Toulouse, France
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Wang C, Yang X, Fan Q, Yuan J, Li Y, Wang Y. Feasibility and safety of cryoablation on the porcine ureter using a new balloon cryoprobe. Cryobiology 2020; 96:130-136. [PMID: 32707123 DOI: 10.1016/j.cryobiol.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Cryoablation, as a well-characterized technology, has multifarious clinical applications. But few are reported on ureteral endometriosis. Thus, we examined the feasibility and safety of cryotherapy with a novel balloon cryoprobe on ureter in a live porcine model. During the freezing and thawing cycle, temperature was recorded in different parts of the ureter in real-time. Two-minute cryoablation could induce necrosis within range in 1 cm diameter on serosa layer. The temperature respectively dropped to -136.5 °C, -96.1 °C and -17.5 °C at the cryotherapy center, 1 cm and 1.5 cm from center on serosal side. The ureters were harvested immediately, 2 weeks or 3 months after cryotherapy. No perforation, stricture, adhesions, or hydronephrosis was observed. Histopathologic representations of ureters after cryoablation indicated that full thickness necroses of ureters were seen in all samples. The results demonstrated ureteral cryoablation using a novel balloon probe was feasible, safe, and effective. These findings provided us reference before cryoablation could be applied in clinical practice in treating ureteral endometriosis.
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Affiliation(s)
- Chao Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xiaoming Yang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Qiong Fan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jiangjing Yuan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yuhong Li
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yudong Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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Kim C, Lee SK, Je H, Jang Y, Jung JW, Choi J. Assessment of a split-bolus computed tomographic enterography technique for simultaneous evaluation of the intestinal wall and mesenteric vasculature of dogs. Am J Vet Res 2020; 81:122-130. [PMID: 31985284 DOI: 10.2460/ajvr.81.2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the diagnostic usefulness of split-bolus CT enterography in dogs. ANIMALS 6 healthy Beagles. PROCEDURES CT enterography was performed in all dogs in a nonrandomized crossover study design involving 3 techniques: a dual-phase technique and 2 techniques involving splitting of the administered contrast agent dose (ie, split technique and split-bolus tracking technique). For the 2 techniques involving dose splitting (ie, split CT enterography), contrast agent was injected twice, with the first injection consisting of 60% of the total dose, followed by injection of the remaining 40%. Then, a single set of CT images was obtained when the arterial and venous phases matched (dual-phase and split techniques) or when enhancement of the abdominal aorta reached 100 HU (split-bolus tracking technique). Enhancement of the intestinal wall and mesenteric vessels was assessed qualitatively and quantitatively. RESULTS The total number of images required for interpretation was significantly lower for the split technique than for the dual-phase technique. The amount of time needed to complete CT enterography was significantly less for the split-bolus tracking technique than for the other 2 techniques. For all 3 techniques, adequate contrast enhancement of the mesenteric vessels and intestinal wall was achieved. The split technique provided contrast enhancement of the intestinal wall and mesenteric vessels similar to that provided with the dual-phase technique, whereas contrast enhancement of these structures was lowest for the split-bolus tracking technique. CONCLUSIONS AND CLINICAL RELEVANCE Split-bolus CT enterography at a contrast agent allocation ratio of 60:40 enabled simultaneous evaluation of the enhanced intestine wall and mesenteric vessels and yielded image quality similar to that of dual-phase CT enterography in healthy dogs.
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Biscaldi E, Barra F, Leone Roberti Maggiore U, Ferrero S. Other imaging techniques: Double-contrast barium enema, endoscopic ultrasonography, multidetector CT enema, and computed tomography colonoscopy. Best Pract Res Clin Obstet Gynaecol 2020; 71:64-77. [PMID: 32698994 DOI: 10.1016/j.bpobgyn.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
Double-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been successfully used for the diagnosis of bowel endometriosis. DCBE provides a complete overview of the entire colon and allows detecting cecal nodules. The accuracy of DCBE is operator dependent and, thus, it may have low specificity. It does not allow identifying the cause of the mass effect. DCBE requires the administration of barium and exposure to radiation. REU precisely estimates the distance between the rectosigmoid nodule and the anal verge. However, it allows investigating only the distal part of rectosigmoid, it misses anterior pelvic lesions, and it has poor sensitivity for the diagnosis of endometriomas. MDCT-e is accurate and reproducible in diagnosing intestinal endometriosis and in assessing its characteristics: the largest diameter of the nodule, the distance between the distal part of the nodule and the anal verge, and depth of infiltration of endometriosis in the intestinal wall. MDCT-e requires the administration of iodinated contrast medium (CM) and the exposure to radiations. CTC has good performance in the diagnosis of rectosigmoid endometriosis. It allows estimating the degree of intestinal stenosis CTC, and the distance between the intestinal endometriotic nodule and the anal verge. It requires exposure to radiations, and it may require the administration of an iodinated CM.
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Affiliation(s)
- Ennio Biscaldi
- Department of Radiology, Galliera Hospital, via Mura delle Cappuccine 14, Genova, 16128, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | | | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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Letter regarding “Diagnostic performance of computed tomography for bowel endometriosis: A systematic review and meta-analysis”. Eur J Radiol 2020; 126:108938. [DOI: 10.1016/j.ejrad.2020.108938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
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Diagnostic performance of computed tomography for bowel endometriosis: A systematic review and meta-analysis. Eur J Radiol 2019; 119:108638. [PMID: 31493726 DOI: 10.1016/j.ejrad.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/09/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis regarding the performance of CT for diagnosis of bowel endometriosis. MATERIALS AND METHODS Pubmed and EMBASE were systematically searched up to March 28, 2019. Diagnostic accuracy studies using CT for diagnosis of bowel endometriosis using laparoscopy followed by histopathology as the reference standard were included. Methodological quality of the included studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity and specificity were pooled using hierarchical summary receiver operating modelling. Meta-regression analysis was done to explore heterogeneity. RESULTS Twelve studies (1091 patients) were included. Pooled sensitivity and specificity were 0.92 (95% confidence interval [CI], 0.83-0.97) and 0.95 (95% CI, 0.88-0.98), respectively. Substantial heterogeneity was present: I2 = 92.38% for sensitivity and 89.09% for specificity. Deeks' asymmetry test suggested publication bias (p = 0.04). At meta-regression analysis, history of prior surgery for endometriosis was the only significant factor affecting heterogeneity (p < 0.01). Specifically, studies that included patients with such history demonstrated significantly greater specificity than studies that did not (0.95 [95% CI, 0.91-1.00] vs 0.75 [95% CI, 0.43-1.00]). CONCLUSIONS CT shows excellent performance in the diagnosis of bowel endometriosis. Due to small number of included studies and publication bias, further studies may be needed to validate these results.
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Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, Ferrero S. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2019; 24:710-730. [PMID: 30165449 DOI: 10.1093/humupd/dmy027] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The ureter is the second most common site affected by urinary tract endometriosis, after the bladder. Optimal strategies in the diagnosis and treatment of ureteral endometriosis (UE) are not yet well defined. OBJECTIVE AND RATIONALE The aim of this study was to systematically review evidence regarding the epidemiology, pathophysiology, diagnosis, medical and surgical treatment, impact on fertility and risk of malignant transformation of UE. SEARCH METHODS A systematic literature review, by searching the MEDLINE and PUBMED database until April 2018, was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/PROSPERO CRD42017060065). A total of 67 articles were selected to be included in this review. OUTCOMES The involvement of the ureter by endometriosis is often asymptomatic or leads to non-specific symptoms. When the diagnosis is delayed, UE may lead to persistent hydronephrosis and eventually loss of renal function. Ultrasonography is the first-line technique for the assessment of UE; alternatively, magnetic resonance imaging provides an evaluation of ureteral type involvement. The surgical treatment of UE aims to relieve ureteral obstruction and avoid disease recurrence. It includes conservative ureterolysis or radical approaches, such as ureterectomy with end-to-end anastomosis or ureteroneocystostomy performed in relation to the type of ureteral involvement. Fertility and pregnancy outcomes are in line with those observed after surgical treatment of deep infiltrating endometriosis (DIE). Current evidence does not support the potential risk of malignant transformation of UE. WIDER IMPLICATIONS In this article, we review available evidence on ureteral endometriosis, providing a useful tool to guide physicians in the management of this disease. Diagnosis and management of UE remain a challenge. In relation to the degree of ureteral involvement and the association with other DIE implants, the surgical approach should be planned and carried out in an interdisciplinary collaboration between gynecologist and urologist.
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Affiliation(s)
- Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| | - Carolina Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| | - Ennio Biscaldi
- Department of Radiology, Galliera Hospital, Genova, Italy
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic Sciences, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, 'Sacro Cuore - Don Calabria' Hospital, Negrar, Verona, Italy
| | - Carlo Terrone
- Department of Urology, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
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Computed Tomography–Colonography With Intravenous Contrast Medium and Urographic Phase for the Evaluation of Pelvic Deep Infiltrating Endometriosis of Intestinal and Urinary Tract. J Comput Assist Tomogr 2019; 43:513-518. [DOI: 10.1097/rct.0000000000000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Bolze PA, Descargues P, Poilblanc M, Cotte E, Sesques A, Paparel P, Charlot M, Hajri T, Rousset P, Golfier F. [Contribution of meb to endometriosis patients' diagnosis and treatment]. ACTA ACUST UNITED AC 2018; 47:3-10. [PMID: 30563784 DOI: 10.1016/j.gofs.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB. METHODS Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017. RESULTS Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis. CONCLUSION One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.
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Affiliation(s)
- P A Bolze
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Descargues
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - M Poilblanc
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Cotte
- Service de chirurgie digestive, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Sesques
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Service de médecine de la reproduction, hospices civils de Lyon, université Claude-Bernard Lyon 1, hôpital Femme-Mère-Enfant, 56, boulevard Pinel, 69500 Bron, France
| | - P Paparel
- Service de chirurgie urologique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - M Charlot
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - T Hajri
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Rousset
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Thomassin-Naggara I, Bendifallah S, Rousset P, Bazot M, Ballester M, Darai E. Performances et critères de qualité de l’IRM, du colo-scanner, de l’entéro IRM/CT pour le diagnostic d’endométriose pelvienne, RPC Endométriose CNGOF-HAS. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.gofs.2018.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Thomassin-Naggara I, Kermarrec E, Beldjord S, Bazot M, Tavolaro S, Darai E. [Imaging in the initial and preoperative assessment of endometriosis]. Presse Med 2017; 46:1166-1172. [PMID: 29153376 DOI: 10.1016/j.lpm.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022] Open
Abstract
The diagnosis of pelvic endometriosis is based on the combination of clinical examination, endovaginal ultrasonography and pelvic MRI. Ultrasonography displays a moderate sensitivity and a high specificity. Pelvien MRI displays a better sensitivity and lower specificity.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Sorbonne universités, UPMC univ Paris 06, institut universitaire de cancérologie, Assistance-publique - hôpitaux de Paris (AP-HP), hôpital Tenon, service d'imagerie, 4, rue de la Chine, Paris, France.
| | - Edith Kermarrec
- Sorbonne universités, UPMC univ Paris 06, institut universitaire de cancérologie, Assistance-publique - hôpitaux de Paris (AP-HP), hôpital Tenon, service d'imagerie, 4, rue de la Chine, Paris, France
| | - Selma Beldjord
- Sorbonne universités, UPMC univ Paris 06, institut universitaire de cancérologie, Assistance-publique - hôpitaux de Paris (AP-HP), hôpital Tenon, service d'imagerie, 4, rue de la Chine, Paris, France
| | - Marc Bazot
- Sorbonne universités, UPMC univ Paris 06, institut universitaire de cancérologie, Assistance-publique - hôpitaux de Paris (AP-HP), hôpital Tenon, service d'imagerie, 4, rue de la Chine, Paris, France
| | - Sebastian Tavolaro
- Sorbonne universités, UPMC univ Paris 06, institut universitaire de cancérologie, Assistance-publique - hôpitaux de Paris (AP-HP), hôpital Tenon, service d'imagerie, 4, rue de la Chine, Paris, France
| | - Emile Darai
- Sorbonne universités, UPMC univ Paris 06, institut universitaire de cancérologie, Assistance-publique - hôpitaux de Paris (AP-HP), hôpital Tenon, service d'imagerie, 4, rue de la Chine, Paris, France
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Raimondo D, Mabrouk M, Zannoni L, Arena A, Zanello M, Benfenati A, Moro E, Paradisi R, Seracchioli R. Severe ureteral endometriosis: frequency and risk factors. J OBSTET GYNAECOL 2017; 38:257-260. [PMID: 28969477 DOI: 10.1080/01443615.2017.1349083] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ureteral endometriosis (UE) can be classified as severe when there is obstruction to urinary flow (ureteral compression (UC)). In this retrospective study on 205 patients, we evaluated intraoperatively the frequency of severe ureteral endometriosis (UE) in women with UE and, secondarily, risk factors associated with UC. We documented intraoperatively ureteral UC in 124 (60.5%) patients with UE. A significantly lower body mass index (BMI) was observed in women with UC than in women without UC (p = .02). A significant association was found between UC and parametrial endometriosis (p = .001). In multivariable analysis, these variables remained significantly associated with UC. Ureteral compression is common in patients with UE, especially in women with parametrial infiltration and a low BMI.
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Affiliation(s)
- Diego Raimondo
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Mohamed Mabrouk
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy.,b Department of Obstetrics and Gynecology , Alexandria University , Alexandria , Egypt
| | - Letizia Zannoni
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Alessandro Arena
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Margherita Zanello
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Arianna Benfenati
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Elisa Moro
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Roberto Paradisi
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Renato Seracchioli
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
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Comparison of transvaginal sonography and computed tomography–colonography with contrast media and urographic phase for diagnosing deep infiltrating endometriosis of the posterior compartment of the pelvis: a pilot study. Jpn J Radiol 2017; 35:546-554. [DOI: 10.1007/s11604-017-0665-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 06/25/2017] [Indexed: 12/11/2022]
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Gimonet H, Laigle-Quérat V, Ploteau S, Veluppillai C, Leclère B, Frampas E. Is pelvic MRI in women presenting with pelvic endometriosis suggestive of associated ileal, appendicular, or cecal involvement? Abdom Radiol (NY) 2016; 41:2404-2410. [PMID: 27590068 DOI: 10.1007/s00261-016-0884-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. METHODS Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. RESULTS Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98-42.19), 5.8 (95% CI 1.12-30.07), and 6.74 (95% CI 1.23-36.77), respectively. CONCLUSIONS Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.
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Affiliation(s)
- Hélène Gimonet
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093, Nantes, France.
| | - Valérie Laigle-Quérat
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093, Nantes, France
| | - Stéphane Ploteau
- Service de gynécologie-obstétrique, Hôpital Femme-enfant-adolescent, CHU de Nantes, 38 boulevard Jean-Monnet, 44093, Nantes, France
| | - Cergika Veluppillai
- Service de gynécologie-obstétrique, Hôpital Femme-enfant-adolescent, CHU de Nantes, 38 boulevard Jean-Monnet, 44093, Nantes, France
| | - Brice Leclère
- Service d'évaluation médicale et d'épidémiologie, Hôpital St Jacques, CHU de Nantes, 85 rue St Jacques, 44093, Nantes, France
| | - Eric Frampas
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093, Nantes, France
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Seracchioli R, Raimondo D, Di Donato N, Leonardi D, Spagnolo E, Paradisi R, Montanari G, Caprara G, Zannoni L. Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series. Hum Reprod 2015; 30:833-9. [PMID: 25586785 DOI: 10.1093/humrep/deu360] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY QUESTION In women with deeply infiltrating endometriosis (DIE) what is the prevalence of involvement of endometriotic tissue and fibrosis in ureteral endometriosis (UE), as assessed by histological staining? SUMMARY ANSWER In women with DIE, ureteral involvement is more often due to endometriotic tissue rather than fibrosis. WHAT IS KNOWN ALREADY In the current literature, histological evaluation of ureteral endometriosis is mainly based on the degree of wall infiltration by endometriosis instead of the tissue composition. A few studies reported ill-defined and contradictory histological data on the tissue composition of UE. STUDY DESIGN, SIZE, DURATION Retrospective observational study based on clinical records of women affected by DIE, laparoscopically treated for UE at a tertiary referral center, between January 2010 and March 2013. All cases of ureteral nodule excision or ureterectomy with histological examination of the specimens were included. Exclusion criteria were other identified causes of hydroureteronephrosis, medical therapy for a period of at least 3 months before surgery and previous surgery for DIE. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 77 patients were included in the study and among them seven (9%) presented with bilateral ureteral involvement, giving a total of 84 cases of UE available for analysis. All patients had stage IV endometriosis. According, respectively, to the presence of endometrial glands and/or stroma cells or of fibrotic tissue only, the endometriotic UE and fibrotic UE groups were compared with regard to hydroureteronephrosis at pre-operative urinary tract computerized tomography scan, type of surgical procedure performed to treat UE (nodule removal or ureterectomy), association with other locations of the disease and post-operative complications (ureteral fistula or stenosis). MAIN RESULTS AND THE ROLE OF CHANCE For the 84 cases of UE, 65 (77%) and 19 (23%), respectively, showed endometriotic tissue and fibrotic tissue only. Presence of hydroureteronephrosis and endometriotic pattern of UE showed a significant association [endometriotic UE 44/65 (68%) versus fibrotic UE 8/19 (42%); P = 0.04]. Fibrotic pattern of UE and presence of concomitant recto-vaginal endometriosis showed a significant association [endometriotic group: 29/65 (45%) versus fibrotic group 18/19 (95%); P < 0.001]. LIMITATIONS, REASONS FOR CAUTION The retrospective and monocentric (tertiary referral center) study design. WIDER IMPLICATIONS OF THE FINDINGS Besides the distinction between extrinsic and intrinsic UE based on the degree of wall infiltration by endometriosis, a new classification according to the histological pattern of UE could be useful for clinicians, both in the diagnostic and therapeutic fields. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- R Seracchioli
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - D Raimondo
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - N Di Donato
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - D Leonardi
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - E Spagnolo
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Paradisi
- Department of Obstetrics and Gynecology and Reproductive Biology, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - G Montanari
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - G Caprara
- Department of Anatomo-Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - L Zannoni
- Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
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Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol 2014; 28:655-81. [DOI: 10.1016/j.bpobgyn.2014.04.010] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023]
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Biscaldi E, Ferrero S, Leone Roberti Maggiore U, Remorgida V, Venturini PL, Rollandi GA. Multidetector computerized tomography enema versus magnetic resonance enema in the diagnosis of rectosigmoid endometriosis. Eur J Radiol 2014; 83:261-7. [DOI: 10.1016/j.ejrad.2013.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/06/2013] [Accepted: 10/15/2013] [Indexed: 01/07/2023]
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Iosca S, Lumia D, Bracchi E, Duka E, De Bon M, Lekaj M, Uccella S, Ghezzi F, Fugazzola C. Multislice computed tomography with colon water distension (MSCT-c) in the study of intestinal and ureteral endometriosis. Clin Imaging 2013; 37:1061-8. [DOI: 10.1016/j.clinimag.2013.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/06/2013] [Accepted: 07/05/2013] [Indexed: 01/07/2023]
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