The Benefit of Transvaginal Elastography in Detecting Deep Endometriosis: A Feasibility Study

Xholli, Anjeza; Londero, Ambrogio P.; Cavalli, Elena; Scovazzi, Umberto; Ferraro, Mattia Francesco; Vacca, Ilaria; Schiaffino, Maria Giulia; Oppedisano, Francesca; Sirito, Giorgio; Molinari, Filippo; Cagnacci, Angelo

doi:10.1055/a-2028-8214

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…Although the classification system was relatively comprehensive and showed good interobserver agreement, it did not incorporate the elastography findings and may not be convenient for clinical application. Our results and those of some previous studies have demonstrated the value of elastography in diagnosing and assessing the severity of endometriosis and adenomyosis [ 6 , 11 , 21 – 23 ]. Elastography is also valuable in evaluating the efficacy of conservative treatment.…”

Section: Discussionsupporting

confidence: 83%

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Ren,

Dong,

Yuan

et al. 2023

Reprod Biol Endocrinol

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Background To determine whether there is a correlation between stiffness measured by strain elastography and the severity of dysmenorrhea and to determine the value of elastography in evaluating severe dysmenorrhea in patients with adenomyosis. Methods The correlation between tissue stiffness and dysmenorrhea was analyzed by performing elastography on premenopausal women diagnosed with adenomyosis. Expression levels of transforming growth factor-β (TGF-β), α-smooth muscle actin (α-SMA), and protein gene product 9.5 (PGP9.5) were detected by immunohistochemistry; the correlation of TGF-β and α-SMA levels with the tissue stiffness and the degree of fibrosis was further analyzed. Also, the relationship of the PGP9.5 expression level with the tissue stiffness and degree of dysmenorrhea was determined. Results The degree of dysmenorrhea was significantly positively correlated with lesion stiffness in patients with adenomyosis but not with the uterine or lesion volume. The cutoff for the strain ratio was > 1.36 between the adenomyosis and control groups, with an area under the curve (AUC) of 0.987. For severe dysmenorrhea, the cutoff for the strain ratio was > 1.65 in patients with adenomyosis, with an AUC of 0.849. TGF-β, α-SMA, and PGP9.5 expression levels were higher in adenomyotic lesions than in the endometrium of the adenomyosis and control groups. Both TGF-β and α-SMA levels were positively correlated with the tissue stiffness and degree of fibrosis. Additionally, the expression level of PGP9.5 showed a positive correlation with the tissue stiffness and degree of dysmenorrhea. Conclusions Elastography can be used to evaluate the degree of dysmenorrhea; the greater the tissue stiffness, the greater the degree of dysmenorrhea. In addition, elastography performed well in the diagnosis of adenomyosis and the evaluation of severe dysmenorrhea in patients with adenomyosis.

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Section: Discussionsupporting

confidence: 83%

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Ren,

Dong,

Yuan

et al. 2023

Reprod Biol Endocrinol

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“…Multiple logistic regression analysis showed that the presence of DIE did not affect symptoms manifestation following COVID-19 vaccination. In contrast to adenomyosis or ovarian endometriosis, DIE is mostly composed by a stiff highly fibrotic scar tissue [35], with little residual immune and inflammatory activity. Accordingly immune activation following COVID-19 vaccination, is presumably too little represented in DIE to play a significant role on symptom manifestation.…”

Section: Discussionmentioning

confidence: 99%

Effect of COVID-19 Vaccine in Women with Adenomyosis and Endometriosis

Xholli,

Schiaffino,

Vacca

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: It has been reported that coronavirus disease 2019 (COVID-19) vaccines could provoke flu-like symptoms and changes in menstrual cycles in some women, probably as a result of the immune response caused by the vaccination itself. Altered local immunity and inflammatory processes are found in women suffering from adenomyosis and endometriosis, this having a role in the typical symptomatic manifestations. This study aims to investigate the prevalence of side effects like abnormal uterine bleeding (AUB) or pain following the administration of COVID-19 vaccines in women with adenomyosis or endometriosis. Methods: A retrospective cohort study was performed on 172 patients referring to our Chronic Pelvic Pain Center, who underwent COVID-19 vaccination. A hystorical cohort of sixty-three non-vaccinated women was used as control. We collected anamnestic data and each woman scored menstrual pain, chronic pelvic pain, and the occurrence of AUB before and after vaccination. Results: Among control women, no one showed AUB, and only 2 women experienced a slight worsening of menstrual pain. Side effects were observed in 29/172 (16.8%) of COVID-19 vaccinated women, independent of whether they were on hormone therapy. In comparison to asymptomatic, symptomatic women had a higher prevalence of adenomyosis (82.7% vs 63.6%), adenomyosis being present in 100% of the 6 women with intermenstrual bleeding, in 79% of the 19 women with heavy menstrual bleeding and in 81% of the 16 women with pain worsening. Nine out of 55 (16.3%) women with endometrioma experienced side effects. Among these, the 3 women that were not on hormone therapy experienced a huge increase in endometrioma volume from +208% to +806%. In one case emergency surgery was necessary for endometrioma rupture and hemoperitoneum. Conclusions: In our sample, adenomyosis appears strictly related to the manifestation of post-vaccine side effects. Hormone therapy seems to be insufficient to protect from post-vaccine symptoms, but the increase in endometrioma volume was observed only in cases without hormone therapy.

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“…Strain elastography is an additional diagnostic modality employed for the evaluation of endometriosis. Xholli et al discuss the utilization of elastography, a technology with the ability to quantitatively assess tissue structure and elasticity, in the identification or the monitoring of the progression of established DIE nodules [28]. Brunelli et al emphasize the significant role of elastography in the accurate diagnosis of deep pelvic endometriosis lesions, exhibiting high sensitivity and specificity [29].…”

Section: Discussionmentioning

confidence: 99%

Transvaginal Ultrasound vs. Magnetic Resonance Imaging: What Is the Optimal Imaging Modality for the Diagnosis of Endometriosis?

Baușic,

Matasariu,

Manu

et al. 2023

Biomedicines

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Endometriosis, an intriguing gynecological illness, poses a substantial health concern for women of reproductive age, despite its widespread occurrence and limited comprehension. The objective of this study is to assess the diagnostic precision of transvaginal sonography (TVS) and pelvic magnetic resonance imaging (MRI) for the identification of deep infiltrated endometriosis (DIE). This study encompassed a cohort of 256 patients exhibiting signs and symptoms of endometriosis, with the aim of assessing the diagnostic accuracy over a span of four years. Both TVS and pelvic MRI were employed in the same centers to analyze each subject. The histopathologic analysis and laparoscopy were the most reliable and widely accepted methods for evaluation. TVS is a reliable diagnostic tool for ovarian endometriomas, obviating the necessity for MRI confirmation. The specificity of TVS in diagnosing ovarian endometriomas is 57.14%, while its sensitivity is 93.78%, resulting in an overall accuracy of 84.47%. In relation to parametrial lesions, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: TVS: 9%, 97%, 32%, MRI: 27.14%, 89.19%, and 40.11%. Concerning the uterosacral lesions, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: TVS:14.63%, 94.74%, and 55%, while MRI: 65.88%, 66.30%, and 66.1%. Regarding rectal endometriosis, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: 69.72%, 76.87%, and 73.82% for TVS, and 66.28%, 94.51%, and 80.79% for MRI. The results of the present study indicate that whereas MRI generally exhibits superior capability in assessing the severity of endometriosis, TVS demonstrates sufficient diagnostic accuracy in DIE comparable to MRI.

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The Benefit of Transvaginal Elastography in Detecting Deep Endometriosis: A Feasibility Study

Cited by 6 publications

References 27 publications

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Effect of COVID-19 Vaccine in Women with Adenomyosis and Endometriosis

Transvaginal Ultrasound vs. Magnetic Resonance Imaging: What Is the Optimal Imaging Modality for the Diagnosis of Endometriosis?

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