Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge

Abstract

Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions’ appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment.

Transvaginal Strain Elastosonography in the Differential Diagnosis of Rectal Endometriosis: Some Potentials and Limits

“…We sincerely thank Szabó et al [ 1 ] for their comments on our article [ 2 ] and their proposal for improving the differential diagnosis of bowel endometriosis by transvaginal elastosonography (ESG). This technique provides noninvasive information on the elasticity and stiffness of a lesion, as it is based on the principle that the compression of soft tissues produces a greater strain in soft and elastic lesions than in harder, more rigid lesions.…”

“…A correct diagnosis is of key importance, as treatment varies from the need for bowel segmental resection in case of cancer, to possible bowel surgery in endometriosis cases, to medical anti-inflammatory treatment and endoscopic balloon dilation in IBD. As we discussed in a previous article of ours [ 6 ], colon cancer growths typically extend outward from the mucosa and reach the serosa, whereas endometriosis lesions grow inward starting from the serosa, so the differential diagnosis is usually not difficult [ 2 ]. Patients with IBD commonly develop bowel strictures that may resemble deep infiltrating endometriosis of the bowel at ultrasound.…”

Endometriosis of the Canal of Nuck: A Systematic Review of the Literature

“…Due to the close relationship of endometriosis with estrogen secretion, postmenopausal women are rarely affected [ 3 ]. The diagnosis of endometriosis can be suspected by evaluation of cyclic pain and symptoms and can be enhanced with imaging findings [ 4 ]. In recent years, the role of ultrasonography has gained significant popularity as diagnostic tool in the detection of pelvic endometriosis as well of less common extragenital lesions [ 4 ].…”

“…The diagnosis of endometriosis can be suspected by evaluation of cyclic pain and symptoms and can be enhanced with imaging findings [ 4 ]. In recent years, the role of ultrasonography has gained significant popularity as diagnostic tool in the detection of pelvic endometriosis as well of less common extragenital lesions [ 4 ]. However, the definite diagnosis is only made by histologic confirmation of the excised specimens.…”

Transvaginal Strain Elastosonography May Help in the Differential Diagnosis of Endometriosis?

“…We read with great interest the paper entitled “Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge” of Scioscia et al [ 1 ]. We fully agree with the authors that with the spread of the International Deep Endometriosis Analysis (IDEA) group protocol, the detection rate of endometriosis has significantly increased among users.…”