VALUTAZIONE CLINICA E DIAGNOSI PRECOCE
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VALUTAZIONE CLINICA E
DIAGNOSI PRECOCE
ENDOMETRIOSIS IS A GYNECOLOGIC PATHOLOGY THAT IS CONSIDERED
ldquoENIGMATICrdquo It is defined by the presence of a tissue similar to uterine endometrium that is located
in places other than physiologically appropriate most commonly in the pelvic cavity including the ovaries the uterosacral ligaments and the pouch of Douglas These endometrial heterotopic islets contain glands and stroma and are functionally capable of responding to exogenous endogenous or local hormonal stimuli
Obstet Gynecol 2013
Endometriosis A Disease That Remains Enigmatic P Acien and IVelasco
THE INVESTIGATION AND MANAGEMENT OF ENDOMETRIOSIS (2006)
The condition is predominantly found in women of reproductive age from all ethnic and social groups
The associated symptoms can impact on general physical mental and social wellbeing
DIAGNOSI
Accurata raccolta dellrsquoanamnesi Esame ginecologico Ecografia Risonanza Magnetica Nucleare Dosaggio plasmatico del Ca-125 Laparoscopia Conferma istologica
Rev Bras Ginecol Obstet 2013 Jun35(6)262-7
Correlation between serum Ca-125 levels and surgical findings in women with symptoms evocative of endometriosis
Zomer MT1 Ribeiro R Trippia CH Cavalcanti TC Hayashi RM Kondo W
Based on clinical and patient experience endometriosis can cause the
following symptoms
Severe dysmenorrhoea
Deep dyspareunia
Chronic pelvic pain
Ovulation pain
Cyclical or perimenstrual symptoms with or without abnormal bleeding or pain
Infertility
Chronic fatigue
Dyschezia
Dysuria
Irritable bowel syndrome
DOLORE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
ENDOMETRIOSIS IS A GYNECOLOGIC PATHOLOGY THAT IS CONSIDERED
ldquoENIGMATICrdquo It is defined by the presence of a tissue similar to uterine endometrium that is located
in places other than physiologically appropriate most commonly in the pelvic cavity including the ovaries the uterosacral ligaments and the pouch of Douglas These endometrial heterotopic islets contain glands and stroma and are functionally capable of responding to exogenous endogenous or local hormonal stimuli
Obstet Gynecol 2013
Endometriosis A Disease That Remains Enigmatic P Acien and IVelasco
THE INVESTIGATION AND MANAGEMENT OF ENDOMETRIOSIS (2006)
The condition is predominantly found in women of reproductive age from all ethnic and social groups
The associated symptoms can impact on general physical mental and social wellbeing
DIAGNOSI
Accurata raccolta dellrsquoanamnesi Esame ginecologico Ecografia Risonanza Magnetica Nucleare Dosaggio plasmatico del Ca-125 Laparoscopia Conferma istologica
Rev Bras Ginecol Obstet 2013 Jun35(6)262-7
Correlation between serum Ca-125 levels and surgical findings in women with symptoms evocative of endometriosis
Zomer MT1 Ribeiro R Trippia CH Cavalcanti TC Hayashi RM Kondo W
Based on clinical and patient experience endometriosis can cause the
following symptoms
Severe dysmenorrhoea
Deep dyspareunia
Chronic pelvic pain
Ovulation pain
Cyclical or perimenstrual symptoms with or without abnormal bleeding or pain
Infertility
Chronic fatigue
Dyschezia
Dysuria
Irritable bowel syndrome
DOLORE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
THE INVESTIGATION AND MANAGEMENT OF ENDOMETRIOSIS (2006)
The condition is predominantly found in women of reproductive age from all ethnic and social groups
The associated symptoms can impact on general physical mental and social wellbeing
DIAGNOSI
Accurata raccolta dellrsquoanamnesi Esame ginecologico Ecografia Risonanza Magnetica Nucleare Dosaggio plasmatico del Ca-125 Laparoscopia Conferma istologica
Rev Bras Ginecol Obstet 2013 Jun35(6)262-7
Correlation between serum Ca-125 levels and surgical findings in women with symptoms evocative of endometriosis
Zomer MT1 Ribeiro R Trippia CH Cavalcanti TC Hayashi RM Kondo W
Based on clinical and patient experience endometriosis can cause the
following symptoms
Severe dysmenorrhoea
Deep dyspareunia
Chronic pelvic pain
Ovulation pain
Cyclical or perimenstrual symptoms with or without abnormal bleeding or pain
Infertility
Chronic fatigue
Dyschezia
Dysuria
Irritable bowel syndrome
DOLORE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
DIAGNOSI
Accurata raccolta dellrsquoanamnesi Esame ginecologico Ecografia Risonanza Magnetica Nucleare Dosaggio plasmatico del Ca-125 Laparoscopia Conferma istologica
Rev Bras Ginecol Obstet 2013 Jun35(6)262-7
Correlation between serum Ca-125 levels and surgical findings in women with symptoms evocative of endometriosis
Zomer MT1 Ribeiro R Trippia CH Cavalcanti TC Hayashi RM Kondo W
Based on clinical and patient experience endometriosis can cause the
following symptoms
Severe dysmenorrhoea
Deep dyspareunia
Chronic pelvic pain
Ovulation pain
Cyclical or perimenstrual symptoms with or without abnormal bleeding or pain
Infertility
Chronic fatigue
Dyschezia
Dysuria
Irritable bowel syndrome
DOLORE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Based on clinical and patient experience endometriosis can cause the
following symptoms
Severe dysmenorrhoea
Deep dyspareunia
Chronic pelvic pain
Ovulation pain
Cyclical or perimenstrual symptoms with or without abnormal bleeding or pain
Infertility
Chronic fatigue
Dyschezia
Dysuria
Irritable bowel syndrome
DOLORE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
DOLORE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
helliplrsquoaggravamento della mia malattia che mentre nessuno la scopriva mi divorava dallrsquointerno galoppandohellip
hellipil dolore si faceva insopportabile non riuscivo nemmeno a camminare piugrave non riuscivo a stare sdraiata seduta riuscivo solo a piangerehellip
hellippiango rimango buttata sul divano per ore mordo i cuscini mi deprimohellip
hellipmestruazioni dolorose e abbondanti hanno sempre flagellato la mia esistenzahellip
hellipa volte il dolore egrave cosigrave forte che non sapevo se sbattere la testa contro il muro o buttarmi dal balconehellip
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
DISPAREUNIA PROFONDA
Dovuta allo stretching degli impianti endometriosici nel Douglas o nel setto retto-vaginale Descritta come dolore acuto lancinante profondo Si manifesta durante il rapporto sessuale e dura fino a 24-48 ore dopo Compare talora durante ogni coito talora solo in certi periodi del ciclo mestruale
Deep endometriosis of the rectovaginal septum is associated with the most severe forms of dyschezia and dyspareunia Seracchioli et al 2008
La dispareunia profonda puograve essere il primo sintomo di unrsquoendometriosi ancora altrimenti silente Vercellini Graziottin 2010
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Clinicians may consider the diagnosis of deep endometriosis in women with (painful) induration andor nodules of the rectovaginal wall found during clinical examination or visible vaginal nodules in the posterior vaginal fornix
Clinicians may consider the diagnosis of ovarian endometrioma in women with adnexal masses detected during clinical examination
Deeply infiltrating nodules are most reliably detected when clinical examination is performed during menstruation
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
bull
Endometriosis in adolescents is a hidden progressive and severe disease that deserves attention not just compassion Medicine Human Reproduction Volume 28 Issue 8 Pp 2026-31 April 2013
I Brosens S Gordts and G Benagiano
Notwithstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results recent findings indicate that
An early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence
An early identification of the disease may go a long way in slowing or preventing progression
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
DIAGNOSI PRECOCE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Clinicians may consider the diagnosis of endometriosis in women suspected of the disease
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in the presence of gynecological symptoms such as
bull dysmenorrhea
bull non-cyclical pelvic pain
bull deep dyspareunia
bull infertility
bull fatigue in the presence of any of the above
bull The GDG recommends that clinicians should consider the diagnosis of endometriosis in women of reproductive age with non-gynecological cyclical symptoms
bull dyschezia
bull dysuria
bull hematuria
bull rectal bleeding
bull shoulder pain
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
However the included studies all had retrospective design and
did not show a predictive value of these symptoms
for the presence of endometriosis
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
The predictive value of any one symptom or set of symptoms remains uncertain as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease
Even though endometriosis has been researched extensively it is a complex disease that can be challenging to diagnose and treat Many symptoms of endometriosis ndash severe painful menstrual cramps painful intercourse and gastrointestinal upsets such as diarrhea constipation and nausea ndash are similar to those for a wide variety of other conditions As well each woman with endometriosis will experience symptoms differently depending on the location and extent of her endometriosis
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Whatrsquos the delay A qualitative study of womenrsquos experiences of reaching a diagnosis of endometriosis Ballard KD Lowton K Wright JT Fertil Steril 2006861296-1301
This paper reports the findings of an interview-based study where they set out to investigate womenrsquos experiences of endometriosis and in particular the events that lead to a diagnosis of endometriosis
The study confirmed the findings of others showing that there continues to be a delayed diagnosis
of endometriosis
of around 8 frac12 years
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
AUTORE RIVISTA ANNO NAZIONE RITARDO (anni)
HADFLELD R Hum Reprod 1996 UK USA 1173 +- 905
GUNHILD KELLEBERG H Acta obst Gynec Scand 2003 Norvegia 67 +- 62
ARRUDA MS Hum Reprod 2003 Brasile 12
BALLARD KD Fertil Steril 2006 UK 8
BALLARD KD Fertil Steril 2006 Norvegia 67
NNOAHAM KE Fertil Steril 2011 Italia 7-10
NNOAHAM KE Fertil Steril 2011 Spagna 8
NNOAHAM KE Fertil Steril 2011 IrlandaBelgio 4-5
HUDELIST G Hum Reprod 2012 GermaniaAustria 104
PERLOE M Georgia Repr Spec 2013 North America 928
Australian Endom Soc 2013 44
New Zeland Endon 2013 10
DELAY OF DIAGNOSIS
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Le donne spesso ritardano nel raccontare il loro dolore considerandolo spesso NORMALE e ritenendosi SFORTUNATE non volendo apparire deboli ed incapaci di affrontare il dolore
Queste percezioni sono spesso confermate dalle donne della famiglia che hanno o hanno avuto sintomi simili
I medici talora affrontano il laquoproblema dismenorrearaquo come se fosse NORMALE limitandosi ad invitare la donna ad assumere antalgici o un estroprogestinico
Siffatte laquoindicazioniraquo mediche portano spesso la giovane donna a credere che il dolore laquoegrave nella propria testaraquo
Se a ciograve si aggiunge talvolta ci si limita ad eseguire una ecografia per lo piugrave trans-addominale che spesso risulta negativa ecco che
il concetto di NORMALITArsquo si rafforza ehellip
il ritardo diagnostico si incrementa
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Mysterious Pain
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Developing symptom-based predictive models of endometriosis as a clinical screening tool results from a multicenter study Nnoaham KE Hummelshoj L Kennedy SH Jenkinson C Zondervan KT World Endometriosis Research Foundation Womens Health Symptom Survey Consortium
Fertil Steril 2012 Sept 98 (3) 692-701
wwwendometriosisfoundationorgWERF- WHSS-Questionnaire-Englishpdf
Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Peripheral biomarkers of endometriosis a systematic review
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674 KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
A careful examination of the blood or urine may avoid the need for an invasive procedure (Brosens et al 2003a b) or at least could allow symptomatic women to be screened It has previously been suggested that a biomarker may be more clinical use in specific subgroups of women with endometriosis (DHooghe et al 2006)
We therefore decided to conduct a systematic review of the literature to determine which biomarkers have been proposed over the past 25 years as a potential diagnostic tests
The search identified more than 100 possible biomarkers that have been investigated however none of these has been clearly shown to be of clinical use
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
KE Maggio SA Conduit-Hulbert J Villar S Kirtley SH Kennedy e CM Becker
Hum Reprod Update 2010 Nov-Dec 16 (6) 651-674
One biomarker that has been used in clinical practice during the last 20 years is CA-125
However in a meta-analysis published in 1998 Mol et al (1998) have convincingly demonstrated that the performance of biomarker in the diagnosis of endometriosis was low although it has shown some promise in detecting more serious disease
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Postgenomic technologies for Identification of novel serum of
Endometrial markers are likely to
revolutionize future diagnosis of endometriosis
Curr Opin Obstet Gynecol 2003 Dec15(6)519-22
Non-invasive methods of diagnosis of endometriosis Brosens I Puttemans P Campo R Gordts S Brosens J
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
CONCLUSIONS The concomitant dosage of CA 125 CA 199 and IL-6
does not add significant information in respect to the CA 125 test alone in diagnosing either early or advances stages of endometriosis
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Am J Reprod Immunol 2013 Dec70(6)497-558
Increased nuclear expression of nuclear factor kappa-B p65 subunit in the eutopic endometrium and ovarian endometrioma of women with advanced stage endometriosis Kim SH1 Ihm HJ Oh YS Chae HD Kim CH Kang BM
Int J Med Sci 2013 Jul 3010(9)1199-208
Increased expression of pattern recognition receptors and nitric oxide synthase in patients with endometriosis Yeo SG1 Won YS Lee HY Kim YI Lee JW Park DC
Arch Gynecol Obstet 2013 Oct288(4)805-14
Diagnostic accuracy of interleukin-6 levels in peritoneal fluid for detection of endometriosis Wickiewicz D1 Chrobak A Gmyrek GB Halbersztadt A Gabryś MS Goluda M Chełmońska-Soyta A
J Reprod Immunol 2013 Mar97(1)95-103
Inducers of G-protein coupled estrogen receptor (GPER) in endometriosis potential implications for macrophages and follicle maturation Heublein S1 Vrekoussis T Kuhn C Friese K Makrigiannakis A Mayr D Lenhard M Jeschke U
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Identification and Validation of Novel Serum Markers for Early Diagnosis of Endometriosis R Gajbhiye A Sonawani S Khan A Suryawanshi S Kadam N Warty V Raut V Khole Hum Reprod 201227(2)408-417
The 2D Western Blot analysis resulted in the identification of three endometrial antigens tropomyosin 3 (TPM3) stomatin-like protein 2 (SLP2) and tropomodulin 3 (TMOD3) Serum levels of antibodies against the epitopes from the immunodominant region of proteins TPM3 SLP2 and TMOD3 were significantly elevated in endometriosis patients when compared with controls
Our results indicate that TPM3 SLP2 and TMOD3 could be potential biomarkers for the early detection of minimal-mild endometriosis due to high sensitivity specificity and accuracy with respect to other reported markers Based on the results we conclude that we have a serum assay for endometriosis which would utilize a combination of dominant antigenic epitopes of the three target proteins
Our results indicate that this assay could be a reliable preliminary screening test for patients suspected of having endometriosis
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Serum anti-PDIK1L autoantibody as a novel marker for endometriosis Nabeta M1 Abe Y Haraguchi R Kito K Kusanagi Y Ito M Fertil Steril 2010 Dec94(7)2552-7
Several autoAbs were identified ELISAs were established and serum autoAb titlers were estimated Among those identified anti-PDIK1L-autoAb levels were significantly elevated in endometriotic patients
Serum anti-PDIK1L-autoAb can be a new serum marker for the diagnosis of endometriosis This study validates further clinical evaluation of this novel marker
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Our study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR (Nuclear Magnetic Resonance spectroscopy for the analysis of biofluids and tissues) based metabonomics
Considering the immense potential of this branch of lsquoomicsrsquo our present study focuses on the identification of predictive biomarkers in serum for the early diagnosis of endometriosis in a minimally invasive manner using 1H-NMR
Metabonomics is defined as lsquolsquothe quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modificationsrsquorsquo
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
We here report for the first time a comprehensive analysis of global metabolic patterns of endometriosis The results not only indicate that metabonomic methods have sufficient sensitivity and specificity in distinguishing endometriosis from controls but also have the potential to be developed into a clinically useful diagnostic tool for contributing towards an improved understanding of a disease mechanism
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
For a definitive diagnosis of endometriosis visual inspection of the pelvis at
laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere
Positive histology confirms the diagnosis of endometriosis negative histology does not exclude it Whether histology should be obtained if peritoneal disease alone is present is controversial Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal In cases of ovarian endometrioma (greater than 3 cm in diameter) and in deeply infiltrating disease histology should be obtained to identify endometriosis and to exclude rare instances of malignancy
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
The GDG recommends that clinicians perform a laparoscopy to diagnose endometriosis although evidence is lacking that a positive laparoscopy without histology proves the presence of disease
The GDG recommends that clinicians confirm a positive laparoscopy by histology since positive histology confirms the diagnosis of endometriosis even though negative histology does not exclude it
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
The lesions most likely to be positive for endometriosis (75) were those gt10 mm in width and gt5 mm in depth mixed in color and located in the cul-de-sac ovarian fossa or on the utero-sacral ligaments
We found that most endometriosis lesions were subtle in color rather than the traditionally described black powder-burned appearance Furthermore all single-color lesions contained biopsy-confirmed endometriosis at about 60
However even surgeons knowledgeable and experienced in the characteristics of endometriosis lesions were able to correctly identify lesions with confirmed endometriosis only 64 of the time
Using location color size and depth to characterize and identify endometriosis lesions in a cohort of 133 women Barbara J Stegmann MD MPHa Ninet Sinaii PhD MPHb Shannon Liua James Segars MDa Maria Merino MDc Lynnette K Nieman MDa and Pamela Stratton MDa Fertil Steril 2008 June 89(6) 1632ndash1636
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Most gynecologists are familiar with the common black brown or blue powder burn appearance of peritoneal endometriosis however this manifestation accounts for only a minority of lesions (Becker amp Nezhat 2008) Endometrial implants may appear in a number of different ways including subtle red or white lesions clear bubble lesions small hemorrhagic cysts or white fibrotic lesions (Kennedy ESHRE 2005)
Video-assisted laparoscopy for the detection and diagnosis of endometriosis
safety reliability and invasiveness Erica Schipper1 and Camran Nezhat2 Int J Womens Health 2012 4 383ndash393 -
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
Indigo carmine is derived from a blue plant dye (indigo) and a red coloring agent (carmine) This deep blue stain is not absorbed by the epithelium in the gastrointestinal tract it pools in crevices between epithelial cells and highlights small or flat lesions and defines irregularities in mucosal architecture
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine A contrast stain such as indigo carmine is not absorbed by epithelial cells but accumulates in pits and valleys between cells highlighting the peritoneal architecture
revealing occult areas of endometriosis
that would have escaped the surgeonrsquos eye under normal circumstances
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine a new technique J Alejandro Rauh-Hain Marc R Laufer Department of Obstetrics and Gynecology Brigham and Womens Hospital Harvard Medical School Boston Massachusetts USA Fertil Steril 032011 95(3)1113-4
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surface during laparoscopy to detect loss of peritoneal integrity in patient with pelvic pain and suspected endometriosis During LS methylene blue dye (mixed 1200 with sterile saline solution) was sprayed into peritoneal surfaces then aspirated and rinsend with Lactated Ringer solution Areas of localizated dye uptake were evaluated for the presence of visible endometriotic lesions Areas of intense staining were resected [hellip] and examinated by scanning electron microscopy [hellip] revealed endometriosis and loss of peritoneal cell-cell contact compared to normal
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
Blue dye uptake was more common in women with endometriosis and cronic pelvic pain (85 vs 40) Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP Subjective pain relief was reported in 80 of subjects
This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at LS and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy
Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity
GRAZIE PER LrsquoATTENZIONE
GRAZIE PER LrsquoATTENZIONE
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