Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Gynecology-Oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of surgery, Rasoole Akram Hospital, Tehran, Iran.
Background and Objective: Endometriosis is one of the most common diseases in the female population. The range of diagnostic delays in this disease is long and leads to adverse health-related consequences. The aim of this study was to evaluate diagnostic experiences in patients with endometriosis who are candidates for laparoscopic surgery.
Methods: This cross-sectional study was performed on 433 patients with endometriosis who were candidates for laparoscopic surgery referred to Shohada-Tajrish Hospital in Tehran between January 2016 and December 2021. A questionnaire including demographic and clinical information, MRI, and pathology reports were collected from participants. The MRI lesions were segmented and the results were compared with pathology and clinical examination. For statistical analysis SPSS software, version 22 was used.
Results: A total of 433 patients in this study with a mean age of 34.18±7.99. The average estimated duration of disease symptoms (months) was 40.58±42.33. The predictive value of clinical symptoms is weak compared to MRI. However, the probability that the disease is not present when the clinical signs be negative is acceptable in most of the endometriosis sites. MRI considerably shows the true negative rate, but its sensitivity is only relatively acceptable for the diagnosis of ascites (67.66%). Calculating the accuracy of MRI reports probably shows the overall classification of the patients via MRI test.
Conclusion: despite extensive research, there are no suitable and accurate non-invasive methods for diagnosing endometriosis. MRI and clinical examination alone are not useful for definitive diagnosis and it is better to examine biomarkers and artificial intelligence for non-invasive and accurate diagnosis of this disease.
- 1. Moazzami B, Chaichian S, Samie S, Zolbin MM, Jesmi F, et al. Does endometriosis increase susceptibility to COVID-19 infections? A case–control study in women of reproductive age. BMC Women's Health. 2021 Dec;21(1):1-7. 2. Hickey M, Ballard K, Farquhar C. Endometriosis. Bmj. 2014;348(5):g1752-. 3. Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest. 2017;82(5):453-61. 4. Hoorsan H, Majd HA, Chaichian S, Mehdizadehkashi A, Hoorsan R, Moradi Y. Maternal anthropometric characteristics and adverse pregnancy outcomes in Iranian women: A confirmation analysis. Arch Iran Med. 2018;21(2). 5. Horton J, Sterrenburg M, Lane S, Maheshwari A, Li TC, Cheong Y. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(5):593-633. 6. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020; 382:1244–1256. 7. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. 8. Chalmers KJ, Catley MJ, Evans SF, Moseley GL. Clinical assessment of the impact of pelvic pain on women. Pain. 2017;158(3):498-504. 9. Soliman AM, Coyne KS, Zaiser E, Castelli-Haley J, Fuldeore MJ. The burden of endometriosis symptoms on health-related quality of life in women in the United States: a cross-sectional study. J Psychosom Obstet Gynaecol. 2017;38(4):238-48. 10. Fuldeore M, Chwalisz K, Marx S, Wu N, Boulanger L, Ma L, et al. Surgical procedures and their cost estimates among women with newly diagnosed endometriosis: a US database study. J Med Econ. 2011;14(1):115-23. 11. Kadivar M, Vafa A, Farahzadi A, Khani S. 6 years evaluation of prevalence of abdominal wall endometriosis in patients with definite histopathological diagnosis of endometriosis admitted in Rasool-Akram, Shariati and Atieh Hospitals in Tehran. RJMS. 2012;18:20-26. 12. Sarbazi F, Akbari E, Nouri B. Pain Management in Endometriosis. Interv Pain Med Neuromod. 2022;2(1):e128043. 13. Mikhaleva LM, Radzinsky VE, Orazov MR, Khovanskaya TN, Sorokina AV, Mikhalev SA, et al. Current knowledge on endometriosis etiology: a systematic review of literature. Int J Womens Health. 2021;13:525. 14. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698-704. 15. Seaman HE, Ballard KD, Wright JT, De Vries CS. Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case–control study—Part 2. BJOG. 2008;115(11):1392-6. 16. Soliman AM, Fuldeore M, Snabes MC. Factors associated with time to endometriosis diagnosis in the United States. J Womens Health. 2017;26(7):788-97. 17. Fourquet J, Sinaii N, Stratton P, Khayel F, Alvarez-Garriga C, Bayona M, et al. Characteristics of women with endometriosis from the USA and Puerto Rico. J Endometr Pelvic Pain Disord. 2015;7(4):129-35. 18. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s lives: a qualitative study. BMC women's health. 2014;14(1):1-2. 19. Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-73. 20. Nouri B, Baghestani AR, Pooransari P. Evening Primrose versus Misoprostol for Cervical Dilatation before Gynecologic Surgeries; a Double–blind Randomized Clinical Trial. J Obstet Gynecol Cancer Res. 2021;6(2):87-94. 21. Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27(12):3412-6. 22. Halis G, Mechsner S, Ebert AD. The diagnosis and treatment of deep infiltrating endometriosis. Dtsch Arztebl Int. 2010;107(25):446. 23. Kinkel K, Chapron C, Balleyguier C, Fritel X, Dubuisson JB, Moreau JF. Magnetic resonance imaging characteristics of deep endometriosis. Hum Reprod. 1999;14(4):1080-6. 24. Siegelman ES, Outwater E, Wang TS, Mitchell DG. Solid pelvic masses caused by endometriosis: MR imaging features. AJR Am J Roentgenol. 1994;163(2):357-61. 25. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232(2):379-89. 26. Kataoka ML, Togashi K, Yamaoka T, Koyama T, Ueda H, Kobayashi H, et al. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005;234(3):815-23. 27. Hoorsan H, Mirmiran P, Chaichian S, Moradi Y, Akhlaghdoust M, Hoorsan R, et al. Diet and risk of endometriosis: a systematic review and meta-analysis study. Iran Red Crescent Med J. 2017 Sep 1;19(9):e41248. 28. Koninckx PR, Ussia A, Adamyan L, Tahlak M, Keckstein J, Martin DC. The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear. Best Pract Res Clin Obstet Gynaecol. 2021;71:14-26.. 29. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354-e1. 30. Sarbazi F, Akbari E, Karimi A, Nouri B, Noori Ardebili S. The Clinical Outcome of Laparoscopic Surgery for Endometriosis on Pain, Ovarian Reserve, and Cancer Antigen 125 (CA-125): A Cohort Study. Int J Fertil Steril. 2021; 15(4): 275-279. 31. Nouri B , Roshandel S. Is Artificial Intelligence a New Diagnostic Approach for Patients with Endometriosis?. Interv Pain Med Neuromod. 2(1):e128720.