Prevalence of occult microscopic endometriosis in clinically negative peritoneum during laparoscopy for chronic pelvic pain

Gubbels, Ashley L.; Li, Rui; Kreher, Donna A.; Mehandru, Natasha; Castellanos, Mario E.; Desai, N.; Hibner, M.

doi:10.1002/ijgo.13303

Cited by 20 publications

(11 citation statements)

References 11 publications

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“…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: 76%

“…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: 94%

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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: Diagnostic Methodsmentioning

confidence: 76%

Section: Histologymentioning

confidence: 94%

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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show abstract

“…With intensive pathologic evaluation, we subsequently reported an increased premenopausal prevalence of benign ectopic growths, including ES (37%), endometriosis (EM) (32%), paratubal cysts (47%), and Walthard’s nests (ectopic urothelial cell growths) (29%) in women with at-risk tissues age 31-50, with ES prevalence increasing to 66% after menopause, in contrast to a decrease in EM (5%), while 89% of post-menopausal specimens had some type of ectopic lesion and various lesion types could be present in the same patient [2]. Another recent study reporting EM in 39% of random biopsies of patients with chronic pelvic pain also found much higher prevalence than expected [3]. Sampling bias is the likely explanation for retrospective studies reporting an association of these benign peritoneal cavity cellular implants with malignancy [4–6], since the large majority of patients undergoing surgery for benign conditions do not have a histologic evaluation of all tissues as thorough as that performed for malignancy.…”

Section: Introductionmentioning

confidence: 99%

Uterine secretome initiates growth of gynecologic tissues in ectopic locations

Sunde,

Wasickanin,

Katz

et al. 2023

Preprint

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Endosalpingiosis (ES) and endometriosis (EM) refer to the growth of tubal and endometrial epithelium respectively, outside of their site of origin. We hypothesize that uterine secretome factors drive ectopic growth. To test this, we developed a mouse model of ES and EM using tdTomato (tdT) transgenic fluorescent mice as donors. To block implantation factors, progesterone knockout (PKO) tdT mice were created. Post-ovulatory endometrium was induced hormonally in donor tdT and wild-type (WT) female mice. tdT oviductal cells and WT endometrium were harvested for intraperitoneal injection into synchronized recipient WT mice. Ectopic lesions were identified using fluorescence in-vivo imaging and then harvested for histological evaluation. Fluorescent lesions were present after oviduct implantation with and without WT endometrium. Implantation was increased (p<0.05) when tdt oviductal tissue was implanted with endometrium compared to oviductal tissue alone. Implantation was reduced (p<0.0005) in animals implanted with minced tdT oviductal tissue with PKO tdT endometrium compared to WT endometrium. In conclusion, endometrial derived implantation factors are necessary to initiate ectopic tissue growth. We have developed an animal model of ectopic growth of gynecologic tissues in a WT mouse which will potentially allow for development of new prevention and treatment modalities.

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“…Around half of women who have clinically suspected endometriosis undergo surgery to confirm the diagnosis [ 6 ]. Clinical suspicion of endometriosis is an inconsistent predictor of disease; of women undergoing laparoscopy for suspected endometriosis, 18–77% have surgically confirmed disease [ 7 ], although recent evidence suggests that the rates of microscopic endometriosis in women with “negative laparoscopy” may be up to 39% [ 8 ]. There is a strong need for a reliable non-invasive diagnostic tool to reduce the need for laparoscopy to diagnose or exclude endometriosis.…”

Section: Introductionmentioning

confidence: 99%

A promising future for endometriosis diagnosis and therapy: extracellular vesicles - a systematic review

Scheck

Paterson

Henry

2022

Reprod Biol Endocrinol

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Endometriosis is a chronic, inflammatory gynaecological disease that can have severe negative impacts on quality of life and fertility, placing burden on patients and the healthcare system. Due to the heterogeneous nature of endometriosis, and the lack of correlation between symptom and surgical disease severity, diagnosis and treatment remain a significant clinical challenge. Extracellular vesicles (EVs) are biologically active particles containing molecular cargo involved in intercellular communication, that can be exploited for diagnostic and therapeutic purposes.We systematically reviewed studies exploring EVs and their role in endometriosis, specifically addressing diagnostic and therapeutic potential and current understanding of pathophysiology. Five databases (Pubmed, Embase, Medline, Web of Science, Google Scholar) were searched for keywords ‘endometriosis’ and either ‘extracellular vesicles’ or ‘exosomes’.There were 28 studies included in the review. Endometrium derived EVs contribute to the development of endometriosis. EVs derived from endometriosis lesions contribute to angiogenesis, immunomodulation and fibrosis. Such EVs can be detected in blood, with early data demonstrating utility in diagnosis and recurrence detection. EV isolation techniques varied between studies and only eight of twenty-eight studies fully characterised EVs according to current recommended standards. Reporting/type of endometriosis was limited across studies. Varied patient population, type of sample and isolation techniques created bias and difficulty in comparing studies.EVs hold promise for improving care for symptomatic patients who have never had surgery, as well as those with recurrent symptoms after previous surgery. We encourage further EV research in endometriosis with the inclusion of rigorous reporting of both the patient population and technical methodology used, with the ultimate goal of achieving clinical utility for diagnosis, prognosis and eventually treatment.

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Prevalence of occult microscopic endometriosis in clinically negative peritoneum during laparoscopy for chronic pelvic pain

Cited by 20 publications

References 11 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

Uterine secretome initiates growth of gynecologic tissues in ectopic locations

A promising future for endometriosis diagnosis and therapy: extracellular vesicles - a systematic review

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