Diagnosis of Endometriosis at Laparoscopy: A Validation Study Comparing Surgeon Visualization with Histologic Findings

Gratton, Sara-Michelle; Choudhry, Abdul Jamil; Vilos, George A.; Vilos, Angelos G.; Baier, Kristina; Holubeshen, Simonne; Médor, Maria Cassandre; Mercier, Stéphanie; Nguyen, Vincent; Chen, Innie

doi:10.1016/j.jogc.2021.08.013

Cited by 20 publications

(17 citation statements)

References 30 publications

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“…far viewing distance at time of laparoscopic lesion identification, size and location of biopsies taken), which may have contributed to their high rate of OME detection 164 . Gubbels et al found OME in 39% of patients with clinically negative peritoneum on laparoscopy 165 and in the study by Gratton et al, 58% (7/17) of people with visually normal pelvises had evidence of endometriosis on histology 144 . The ability of histology to detect endometriosis that is not visibly apparent makes it a remarkably valuable tool for diagnosis.…”

Section: Histologymentioning

confidence: 95%

“…A recent study confirms the limitation of direct visualization with an overall accuracy of 77.1% (95% CI, 67.7–88.1%). Direct visualization has very poor specificity (40.0%; 95% CI, 21.1–61.3%) and NPV (58.8%; 95% CI, 36.0–78.4%) 144 . Amongst trained gynecological surgeons, it has been shown that endometriosis is less accurately diagnosed visually when lesions are black or red in color, small, superficial and disease is at an early stage (rASRM Stage 1) 145,146 .…”

Section: Diagnostic Methodsmentioning

confidence: 99%

“…Gubbels et al . found OME in 39% of patients with clinically negative peritoneum on laparoscopy 165 and in the study by Gratton et al ., 58% (7/17) of people with visually normal pelvises had evidence of endometriosis on histology 144 . The ability of histology to detect endometriosis that is not visibly apparent makes it a remarkably valuable tool for diagnosis.…”

Section: Diagnostic Methodsmentioning

confidence: 99%

“…Most DTA studies take place during routine clinical care and are not funded by grant agencies outside of typical remuneration pathways for surgeons. Conversely, due to lack of skill, perceived risk or incomplete surgical consent, surgeons may refrain from sampling/excising tissue that appears to be endometriotic, which precludes histological confirmation, leaving readers to trust the surgeon (bearing in mind, PPV is imperfect, with many surgeon-diagnosed lesions not being confirmed histologically) 144 . In these cases, if other areas are biopsied, it may be assumed that the area not removed is also endometriosis, but this is not a guarantee.…”

Section: Surgical Diagnosismentioning

confidence: 99%

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Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research

Pascoal

Wessels

Aas-Eng

et al. 2022

Ultrasound in Obstet & Gyne

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Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances.

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Section: Histologymentioning

confidence: 95%

Section: Diagnostic Methodsmentioning

confidence: 99%

Section: Diagnostic Methodsmentioning

confidence: 99%

Section: Surgical Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research

Pascoal

Wessels

Aas-Eng

et al. 2022

Ultrasound in Obstet & Gyne

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“…Still, the effectiveness of existing standard treatments is limited due to the aggressive nature of endometriosis and the high postoperative recurrence rate. Laparoscopy is the gold standard for the diagnosis of endometriosis, but the invasive nature of the technique limits its widespread clinical use [ 3 ]. Ultrasound and MRI are commonly used to diagnose and evaluate endometriosis conditions.…”

Section: Introductionmentioning

confidence: 99%

ASPN Is a Potential Biomarker and Associated with Immune Infiltration in Endometriosis

Wang

Sun

2022

Genes

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Objective: Endometriosis is a benign gynecological disease characterized by distant metastasis. Previous studies have discovered abnormal numbers and function of immune cells in endometriotic lesions. We aimed to find potential biomarkers of endometriosis and to explore the relationship between ASPN and the immune microenvironment of endometriosis. Methods: We obtained the GSE141549 and GSE7305 datasets containing endometriosis and normal endometrial samples from the Gene Expression Omnibus database (GEO). In the GSE141549 dataset, differentially expressed genes (DEGs) were found. The Least Absolute Shrinkage and Selection Operator (Lasso) regression and generalized linear models (GLMs) were used to screen new biomarkers. The expression levels and diagnostic utility of biomarkers were assessed in GSE7305, and biomarker expression levels were further validated using qRT-PCR and western blot. We identified DEGs between high and low expression groups of key biomarkers. Enrichment analysis was carried out to discover the target gene’s biological function. We analyzed the relationship between key biomarker expression and patient clinical features. Finally, the immune cells that infiltrate endometriosis were assessed using the Microenvironment Cell Population-Counter (MCP-counter), and the correlation of biomarker expression with immune cell infiltration and immune checkpoints genes was studied. Results: There were a total of 38 DEGs discovered. Two machine learning techniques were used to identify 10 genes. Six biomarkers (SCG2, ASPN, SLIT2, GEM, EGR1, and FOS) had good diagnostic efficiency (AUC > 0.7) by internal and external validation. We excluded previously reported related genes (SLIT2, EGR1, and FOS). ASPN was the most significantly differentially expressed biomarker between normal and ectopic endometrial tissues, as verified by qPCR. The western blot assay revealed a significant upregulation of ASPN expression in endometriotic tissues. The investigation for DEGs in the ASPN high- and low-expression groups revealed that the DEGs were particularly enriched in extracellular matrix tissue, vascular smooth muscle contraction, cytokine interactions, the calcium signaling pathway, and the chemokine signaling pathway. High ASPN expression was related to r-AFS stage (p = 0.006), age (p = 0.03), and lesion location (p < 0.001). Univariate and multivariate logistic regression analysis showed that ASPN expression was an independent influencing factor in patients with endometriosis. Immune cell infiltration analysis revealed a significant increase in T-cell, B-cell, and fibroblast infiltration in endometriosis lesions; cytotoxic lymphocyte, NK-cell, and endothelial cell infiltration were reduced. Additionally, the percentage of T cells, B cells, fibroblasts, and endothelial cells was favorably connected with ASPN expression, while the percentage of cytotoxic lymphocytes and NK cells was negatively correlated. Immune checkpoint gene (CTLA4, LAG3, CD27, CD40, and ICOS) expression and ASPN expression were positively associated. Conclusions: Increased expression of ASPN is associated with immune infiltration in endometriosis, and ASPN can be used as a diagnostic biomarker as well as a potential immunotherapeutic target in endometriosis.

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The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series

Fernandez,

Levine,

Shashoua

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo investigate the value of the sonographic identification of deep infiltrating endometriosis (DIE) in women presenting with complaints suggestive of DIE. Sonography findings were correlated with subsequent surgical exploration, and histologic verification.MethodsA retrospective observational case series was investigated to document the ability of the use of sonography to accurately detect the presence of deep infiltrating endometriosis. The clinical observations were performed consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for observational studies. Recognizing the real‐world office setting for this may introduce the importance of the practical clinical aspects of diagnostic procedures in general.ResultsThree‐dimensional transvaginal sonography was able to accurately identify deep invasive endometriosis in 92% of the 100 women subjectively complaining of the associated symptoms of endometriosis, who underwent sonography, surgical exploration, and pathologic analysis. Additional sonographic evidence of pelvic pathology was found during the course of this investigation, perhaps complementing other means for diagnosing endometriosis.ConclusionThree‐dimensional transvaginal sonography is a diagnostic tool that can effectively identify deep infiltrating endometriosis, which may otherwise go undetected and untreated. These findings should encourage the use of sonography for the detection of this subtype of endometriosis.

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Diagnosis of Endometriosis at Laparoscopy: A Validation Study Comparing Surgeon Visualization with Histologic Findings

Cited by 20 publications

References 30 publications

Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research

Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research

ASPN Is a Potential Biomarker and Associated with Immune Infiltration in Endometriosis

The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series

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