Reconsidering evidence-based management of endometriosis

Koninckx, Philippe; Ussia, Anastasia; Al-Suwaidi, Shaima; Amro, Bedayah; Keckstein, J; Adamyan, L.V.; Donnez, Jacques; Dan, M.C.; Wattiez, Arnaud

doi:10.52054/fvvo.14.3.033

Cited by 20 publications

(31 citation statements)

References 87 publications

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“…Bayesian statistics is thought to provide a probabilistic framework that reduces the instability of the data. It can also omit limitations of traditional statistics when comparing parametric and non-parametric data, especially in endometriosis in which symptoms, the clinical experience of the doctor, and the patient’s needs are the most important factors in the diagnosis and treatment [ 32 ]. Looking for a non-invasive test for endometriosis, one should nowadays keep these new statistical tools in mind.…”

Section: Discussionmentioning

confidence: 99%

How to Improve Non-Invasive Diagnosis of Endometriosis with Advanced Statistical Methods

2023

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Background and Objectives: Endometriosis is one of the most common gynecological disorders in women of reproductive age. Causing pelvic pain and infertility, it is considered one of the most serious health problems, being responsible for work absences or productivity loss. Its diagnosis is often delayed because of the need for an invasive laparoscopic approach. Despite years of studies, no single marker for endometriosis has been discovered. The aim of this research was to find an algorithm based on symptoms and laboratory tests that could diagnose endometriosis in a non-invasive way. Materials and Methods: The research group consisted of 101 women hospitalized for diagnostic laparoscopy, among which 71 had confirmed endometriosis. Data on reproductive history were collected in detail. CA125 (cancer antigen-125) level and VEGF1(vascular endothelial growth factor 1) were tested in blood samples. Among the used statistical methods, the LASSO regression—a new important statistical tool eliminating the least useful features—was the only method to have significant results. Results: Out of 19 features based on results of LASSO, 7 variables were chosen: body mass index, age of menarche, cycle length, painful periods, information about using contraception, CA125, and VEGF1. After multivariate logistic regression with a backward strategy, the three most significant features were evaluated. The strongest impact on endometriosis prediction had information about painful periods, CA125 over 15 u/mL, and the lowest BMI, with a sensitivity of 0.8800 and a specificity of 0.8000, respectively. Conclusions: Advanced statistical methods are crucial when creating non-invasive tests for endometriosis. An algorithm based on three easy features, including painful menses, BMI level, and CA125 concentration could have an important place in the non-invasive diagnosis of endometriosis. If confirmed in a prospective study, implementing such an algorithm in populations with a high risk of endometriosis will allow us to cover patients suspected of endometriosis with proper treatment.

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Section: Discussionmentioning

confidence: 99%

How to Improve Non-Invasive Diagnosis of Endometriosis with Advanced Statistical Methods

2023

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“…This diversity underscores the need for a nuanced approach rather than a blanket recommendation for fertility preservation (FP) in all endometriosis patients. 49 Stratification criteria should be explored to identify those most likely to benefit from FP interventions. Secondly, the distinction between the disease itself and the potential adverse effects of treatment modalities on ovarian reserve deserves attention.…”

Section: Discussionmentioning

confidence: 99%

“…It's crucial to recognise that the severity of endometriosis, as determined by staging, does not always correlate directly with the extent of symptoms experienced by the patient. 49 Similarly, this lack of direct correlation extends to its impact on fertility, as cases of stage four endometriosis with rectal involvement may not necessarily have a more profound effect on fertility compared to instances involving ovarian endometriomas, highlighting the intricate and multifaceted nature of the disease's influence on reproductive health. 50,51 Early evidence suggested that laparoscopic excision of any visible endometriotic lesions in early stages of the disease, seem to improve the fecundity of these women, however that does not justify aggressive surgical treatments.…”

Section: The Impact Of Endometriosis On Fertility Performancementioning

confidence: 99%

Fertility preservation in patients with endometriosis: Realistic approach or Future fantasy?

Tsonis,

Gkrozou,

Paschopoulos

et al. 2023

Journal of Endometriosis and Pelvic Pain Disorders

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Fertility preservation techniques, such as cryopreservation of ovarian tissue, embryos, and oocytes, offer hope for future reproduction to individuals facing conditions like cancer or severe haematologic disorders. While the scientific evidence supporting fertility preservation is limited, it shows promise, and there is a growing trend among fertility experts to extend its application to patients with benign conditions that can cause fertility issues, such as endometriosis. Some forms of endometriosis may have a negative impact on fertility, affecting the ovarian reserve, oocyte quality, and the tubo-ovarian interface. Evaluating fertility preservation in endometriosis patients reveals several key considerations. The diverse nature of endometriosis calls for tailored approaches and distinguishing between the disease and treatment effects on ovarian reserve is crucial. Fertility preservation in endometriosis is complex, demanding consideration of disease variability, treatment effects, accurate assessment, and a clear distinction between ovarian reserve and conception ability. A personalised approach is essential for optimal outcomes in this field.

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“…Lesions appear in different forms as they progress from new clear/white, to red, then black lesions 6,7 and finally a white scar reflecting a loss of endometrial glands and stroma and increased collagen deposition 8 . However, macroscopically similar lesions have different behaviors and can cause different symptoms 4 . Lesion morphology is also heterogenous.…”

Section: Introductionmentioning

confidence: 99%

“…Endometriosis research, diagnosis, treatment and management is complicated by the heterogeneity of the disease 4 . The number or location of lesions does not correlate with symptoms 5 and for some patients, the disease is discovered when they undergo explorative laparoscopy for unexplained infertility.…”

Section: Introductionmentioning

confidence: 99%

New concepts on the etiology of endometriosis

Cousins

McKinnon

Mortlock

et al. 2023

J of Obstet and Gynaecol

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Endometriosis is a serious, chronic disorder where endometrial tissue grows outside the uterus, causing severe pelvic pain and infertility. It affects 11% of women. Endometriosis is a multifactorial disorder of unclear etiology, although retrograde menstruation plays a major role. It has a genetic component with over 40 genetic risk factors mapped, although their mechanism of action is still emerging. New evidence suggests a role for retrograde menstruation of endometrial stem/progenitor cells, now that identifying markers of these cells are available. Recent lineage tracing and tissue clearing microscopy and 3D reconstruction has provided new understanding of endometrial glandular structure, particularly the horizontal orientation and interconnection of basalis glands. New sequencing technologies, particularly whole genome DNA sequencing are revealing somatic mutations, including in cancer driver genes, in normal and eutopic endometrium of patients with endometriosis, as well as ectopic endometriotic lesions. Methylome sequencing is offering insight into the regulation of genes and the role of the environmental factors. Single cell RNA sequencing reveals the transcriptome of individual endometrial cells, shedding new light on the diversity and range of cellular subpopulations of the major cell types present in the endometrium and in endometriotic lesions. New endometrial epithelial organoid cultures replicating glandular epithelium are providing tractable models for studying endometriosis. Organoids derived from menstrual fluid offer a non‐invasive source of endometrial tissue and a new avenue for testing drugs and developing personalized medicine for treating endometriosis. These new approaches are rapidly advancing our understanding of endometriosis etiology.

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Reconsidering evidence-based management of endometriosis

Cited by 20 publications

References 87 publications

How to Improve Non-Invasive Diagnosis of Endometriosis with Advanced Statistical Methods

How to Improve Non-Invasive Diagnosis of Endometriosis with Advanced Statistical Methods

Fertility preservation in patients with endometriosis: Realistic approach or Future fantasy?

New concepts on the etiology of endometriosis

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