Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020)

Burghaus, Stefanie; Schäfer, Sebastian D.; Beckmann, Matthias W.; Brandes, Iris; Brünahl, Christian; Chvatal, Radek; Drahonovsky, Jan; Dudek, Wojciech; Ebert, Andreas D.; Fahlbusch, Christine; Fehm, Tanja; Fehr, Peter; Hack, Carolin C.; Haüser, Winfried; Hancke, Katharina; Heinecke, Volker; Horn, Lars‐Christian; Houbois, Christian; Klapp, C; Kramer, H.; Krentel, Harald; Langrehr, Jan M.; Matuschewski, Heike; Mayer, Ines; Mechsner, Sylvia; Müller, Andreas; Müller, Armelle; Müller, Michael; Oppelt, Peter; Papathemelis, Thomas; Renner, S.; Schmidt, Dietmar; Schüring, Andreas; Schweppe, Karl-Werner; Seeber, Beata; Siedentopf, Friederike; Sı̂rbu, Horia; Soeffge, Daniela; Weidner, Kerstin; Zraik, Isabella; Ulrich, U.

doi:10.1055/a-1380-3693

Cited by 33 publications

(53 citation statements)

References 40 publications

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“…International and national guidelines recommend a histological assessment after surgical procedures to make a diagnosis of endometriosis 5 , 6 . An initiative to evaluate the quality of care in endometriosis centers in German-speaking countries in Europe was recently published 7 .…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

Wetzk

Grübling

Forberger

et al. 2022

Geburtshilfe Frauenheilkd

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Objectives Endometriosis is a chronic disease which is diagnosed by surgical intervention combined with a histological work-up. Current international and national recommendations do not require the histological determination of the proliferation rate. The diagnostic and clinical importance of the mitotic rate in endometriotic lesions still remains to be elucidated. Methods In this retrospective study, the mitotic rates and clinical data of 542 patients with histologically diagnosed endometriosis were analyzed. The mean patient age was 33.5 ± 8.0 (17 – 72) years, and the mean reproductive lifespan was 21.2 ± 7.8 (4 – 41) years. Patients were divided into two groups and patientsʼ reproductive history and clinical endometriosis characteristics were compared between groups. The study group consisted of women with confirmed mitotic figures (n = 140, 25.83%) and the control group comprised women without proliferative activity according to their mitotic rates (n = 402, 74.27%). Results Women with endometriotic lesions and histologically confirmed mitotic figures were significantly more likely to have a higher endometriosis stage (p = 0.001), deep infiltrating endometriosis (p < 0.001), ovarian endometrioma (p = 0.012), and infertility (p = 0.049). A mitotic rate > 0 was seen significantly less often in cases with incidental findings of endometriosis (p = 0.031). The presence of symptoms and basic characteristics such as age, age at onset of menarche, reproductive lifespan and parity did not differ between the group with and the group without mitotic figures. Conclusion This study shows that a simple histological assessment of the mitotic rate offers additional diagnostic value for the detection of advanced stages of endometriosis. The possible role as a predictive marker for the recurrence of endometriosis or the development of endometriosis-associated cancer will require future study.

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Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the current guidelines give no clear statements about the specific procedures for the histological assessment 5 , 6 . Standardized quality indicators for diagnosis and therapy have not been implemented to date 7 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

Wetzk

Grübling

Forberger

et al. 2022

Geburtshilfe Frauenheilkd

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“…Endometriosis is a benign, hormone-dependent, chronic in ammatory gynecological disease accompanied by cyclic and acyclic pelvic pain and other complaints. The long lists of research recommendations in the AWMF guideline [5] and ESHRE Endometriosis Guideline [6] show that there is still a great need for research in all aspects of the disease. Diagnostic delay, de ned as the mean time between symptom onset and con rmed diagnosis, is a particular problem associated with endometriosis.…”

Section: Abstract Backgroundmentioning

confidence: 99%

Cross-sectional study for derivation of a cut-off value for identification of a timely versus late diagnosis of endometriosis based on analytical and descriptive research methods

Brandes

Kleine-Budde

Heinze

et al. 2022

Preprint

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BackgroundEndometriosis is a benign, hormone-dependent, chronic inflammatory gynecological disease accompanied by cyclic and acyclic pelvic pain and other complaints. The long lists of research recommendations in the AWMF guideline [5] and ESHRE Endometriosis Guideline [6] show that there is still a great need for research in all aspects of the disease. Diagnostic delay, defined as the mean time between symptom onset and confirmed diagnosis, is a particular problem associated with endometriosis. Some quantitative and qualitative studies have investigated possible reasons for this. A range of physician-related [7, 8] and patient-related factors [9] as well as stigmatization of the topic of menstruation by society have been identified [10, 11]. The consequences of the disease being diagnosed late (or too late) on the course of disease, the quality of life and the costs of the disease have already been documented in studies [12, 13]. However, a systematically derived cut-off value that clearly distinguishes between short and long delay is still lacking. Therefore, the aim of our study was to derive a threshold value for the definition of a target corridor for endometriosis diagnosis based on descriptive and analytical methods.MethodsSince our review of the rather sparse publications on diagnostic delay did not yield satisfactory results, we used descriptive statistics and location parameters to calculate a cut-off value for German population data from the EndoCost study. Statistical methods were used for correlation analysis of shortDD versus longDD (correlation analysis and logistic regression) and group membership (discriminant analysis). ResultsFive years was identified as the cut-off value that significantly differentiated between shortDD and longDD based on various disease-related variables. This suggests that endometriosis should be definitively diagnosed within less than five years to minimize the risk of an unfavorable course of the disease. Our findings confirmed that an early onset of endometriosis-related symptoms is the most important risk factor for a long diagnostic delay. Consequently, adolescent females should receive increased attention as an especially vulnerable group. Evidently, there is an urgent need to develop adequate concepts to improve the endometriosis education and care among this target group.

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“…After surgical treatment, hormonal suppressive therapy is routinely administered to reduce the risk of diaphragmatic recurrence, similar to the use of medical therapies for prevention of pelvic disease recurrence. In fact, the combination of surgery and postoperative medical treatment is considered the standard of care for thoracic endometriosis syndrome ( 2 , 14 , 15 ). Historically, GnRH agonists have been used postoperatively, especially for the prevention of endometriosis-related pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020)

Cited by 33 publications

References 40 publications

Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

Cross-sectional study for derivation of a cut-off value for identification of a timely versus late diagnosis of endometriosis based on analytical and descriptive research methods

Phrenic nerve paralysis after bipolar electrocoagulation of endometriosis of the diaphragm: case report and mini review

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