Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences

Hudelist, Gernot; Fritzer, N; Thomas, Almut E.; Niehues, Christiane; Oppelt, Peter; Haas, Dietmar; Tammaa, A; Sälzer, H.

doi:10.1093/humrep/des316

Cited by 373 publications

(324 citation statements)

References 13 publications

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“…The interval between the onset of first symptoms and clinical diagnosis of endometriosis is about 7-10 years [6]. The main diagnostic problems for endometriosis are the detection of the disease, especially in the absence of an endometriotic cyst or in the case of minimal lesions, and also the evaluation of the extent of the disease.…”

Section: Introductionmentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

207

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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Section: Introductionmentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

207

143

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“…Hudelist et al evaluated 171 women with histologically proven endometriosis. A delay of 10.3 years was observed for patients with extensive DIE, unfortunately similar to superficial/peritoneal endometriosis (10.5 years, = .87) [22]. Therefore, ΔCA-125 still might be helpful to make an early diagnosis of many patients with DIE, potentially decreasing the devastating effects of this disease.…”

Section: Discussionmentioning

confidence: 98%

How to use CA-125 More Effectively in the Diagnosis of Deep Endometriosis?

Raymundo

Oliveira

Soares

et al. 2017

Journal of Minimally Invasive Gynecology

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Deep infiltrative endometriosis (DIE) is a severe form of the disease. The median time interval from the onset of symptoms to diagnosis of endometriosis is around 8 years. In this prospective study patients were divided into two groups: cases (34 DIE patients) and control (20 tubal ligation patients). The main objective of this study was to evaluate the performance of CA-125 measurement in the menstrual and midcycle phases of the cycle, as well as the difference in its levels between the two phases, for the early diagnosis of DIE. Area Under the Curve (AUC) of CA-125 in menstrual phase and of the difference between menstrual and midcycle phases had the best performance (both with AUC = 0.96), followed by CA-125 in the midcycle (AUC = 0.89). The ratio between menstrual and midcycle phases had the worst performance. CA-125 may be useful for the diagnosis of deep endometriosis, especially when both are collected during menstruation and in midcycle. These may help to decrease the long interval until the definitive diagnosis of DIE. Multicentric studies with larger samples should be performed to better evaluate the cost-effectiveness of measuring CA-125 in two different phases of the menstrual cycle.

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“…Az első tünetek jelentkezésétől számítva Németországban és Ausztriá-ban például átlagosan 10 év [15], Norvégiában 6 év [16], míg Magyarországon 3,9 év telik el [17]. Pedig a korai diagnózis fontos volna, mivel a gyakran igen súlyos panaszokat okozó mélyen infiltráló endometriosis kedvezőtlenül befolyásolja a betegek életminőségét, növeli az egészségügyi kiadásokat és a csökkent munkaképesség miatt jelentős gazdasági kihatása is van [18].…”

Section: Megbeszélésunclassified

Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban

et al. 2017

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Bevezetés és célkitűzés:A colorectalis rendszert érintő endometriosis ellátása multidiszciplináris laparoszkópos teammel javasolt. A bélinfiltráció preoperatív felismerése ehhez elengedhetetlen. Betegek és módszer: 2009-2015 között prospektíven 383, endometriosissal diagnosztizált betegnél történt sigmoideoscopia. Intraluminalis endometriosis, fali infiltrációra jellemző másodlagos jelek (falmerevség, benyomat, megtöretés, vizsgálat alatti fájdalom, suffusio) kerül-tek feldolgozásra. Műtéti indikáció esetén a pozitív esetek multidiszciplináris, a negatív esetek nőgyógyász által vég-zett műtéten estek át. Eredmények: 224 (58,49%) pozitívnak talált beteg közül 108-nál multidiszciplináris műtét történt, a negatívnak bizonyult esetek közül 135 ginekológiai műtéten esett át. 108-ból 103 betegnél a műtét során is igazolódott a bél érintettsége, míg a negatív esetek közül nyolc esetben volt jelentős bélinfiltráció. Teljes sigmoideoscopiás vizsgálat 43,4%-ban volt kivitelezhető. Intraluminalis endometriosis 4,91%-ban, fali merevség 38,39%-ban, benyomat 45,54%-ban, megtöretés 57,14%-ban, fájdalom (narkózis nélkül végzett vizsgálatoknál) 26,06%-ban, suffusio 3,82%-ban fordult elő. A sigmoideoscopia szenzitivitása: 92,8%, specificitása: 96,2% volt. Következtetés: A sigmoideoscopia -tapasztalt endoszkópos esetében -kiemelkedő szenzitivitású eszköz a belet infiltráló endometriosis igazolásában. Orv. Hetil., 2017, 158(7), 264-269.Kulcsszavak: sigmoideoscopia, mélyen infiltráló endometriosis, bélinfiltráció, sebészet Prospective study to determine the diagnostic sensitivity of sigmoidoscopy in bowel endometriosis Introduction and aim: In the treatment of colorectal endometriosis a multidisciplinary laparoscopic resection is suggested, for this reason the correct selection of bowel infiltration is essential before surgery. Patients and method: Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. In endoscopically confirmed cases multidisciplinary surgery was performed, the remaining patients were operated by a gynecologic team only. Results: Endometriosis was endoscopically confirmed in 224 patients (58.49%), 108 of them underwent multidisciplinary operation, the negative 135 cases received gynaecological surgery. Bowel endometriosis was confirmed in 103 out of 108 cases intraoperatively, while in 8 cases of the sigmoidoscopically negative patients bowel infiltration was diagnosed intraoperatively by the gynaecological team. Complete sigmoidoscopy was performed in 43.47% of the cases. Intraluminal endometriosis was found in 4.91%, secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis) in 26.06% and suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. Conclusion: Sig...

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Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences

Abstract: No competing interests exist.

Cited by 373 publications

References 13 publications

Imaging for the evaluation of endometriosis and adenomyosis

Imaging for the evaluation of endometriosis and adenomyosis

How to use CA-125 More Effectively in the Diagnosis of Deep Endometriosis?

Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban

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