Modern approaches to noninvasive diagnosis of malignant transformation of endometriosis

Kobayashi, Hiroshi; Yamada, Yoshiaki; Kawahara, Naoki; Ogawa, Kenji; Yoshimoto, Chiharu

doi:10.3892/ol.2018.9721

Cited by 12 publications

(23 citation statements)

References 22 publications

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“…Excess labile and bioactive iron concentrations can enhance toxic radical generation and induce oxidative stress (10). A preclinical study revealed that the CF concentration of iron was associated with oxidative stress, and was involved in endometriosis progression and malignant transformation (11). The present study measured iron levels to assess whether iron-dependent oxidative stress is involved in infertility, as it has previously been demonstrated that oxidative stress is associated with infertility in endometriosis (12).…”

Section: Introductionmentioning

confidence: 81%

Effect of the cyst fluid concentration of iron on infertility in patients with ovarian endometrioma

et al. 2020

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The causes of infertility in women with endometriosis may range from anatomical distortions to various pathophysiological disturbances. The aim of the present study was to examine the effects of the cyst fluid (CF) concentration of iron on infertility in patients with ovarian endometrioma (OMA). Patients with histologically confirmed OMA were enrolled at the Department of Obstetrics and Gynecology, Nara Medical University Hospital between 2013 and 2019. The patients were divided into 2 groups, namely women experiencing current infertility (infertile group) and those without complaints of infertility (non-infertile group). There were 2 types of patients in the infertile group: Patients who failed to achieve a clinical pregnancy following ≥12 months of regular unprotected sexual intercourse and those who had already been treated at fertility clinics. The CF concentration of iron was measured by the inductively coupled plasma-optical emission spectrometry (ICP-OES) method. The clinical data were analyzed retrospectively. A total of 77 patients were enrolled in the present study. Among these, 32 (41.6%) patients had infertility. When compared with the non-infertile women, the infertile women were significantly younger (median age, 35 years; range, 24-47 years; vs. median age, 40 years; range, 21-53 years; respectively; P=0.003). The CF concentrations of iron (median, 324.8 mg/l; range, 71.3-1046.3 mg/l; vs. median, 226.5 mg/l; range, 65.3-737.5 mg/l; respectively; P=0.019) were significantly higher in the infertile group compared with the non-infertile group. Multivariate logistic regression analysis indicated that age at diagnosis (≤38 years), the CF concentrations of iron (>326.6 mg/l) and the infertility index (iron/age ratio, >8.37) were independent risk factors for endometriosis-related infertility. Multivariate analysis revealed that age (HR, 6.44; 95% CI, 2.06-20.12) and iron (HR, 4.90; 95% CI, were independent factors for the identification of patients with OMA who presented with a complaint of infertility. In addition, the infertility index (iron/age ratio, >8.37; HR, 4.85; 95% CI, 1.01-23.27) was an important predictor of infertility. ROC curve analysis also revealed that the areas under the ROC (AUC) for age, iron and infertility index were 0.699, 0.666 and 0.731, respectively. On the whole, the findings of the present study demonstrate that age at diagnosis and the CF concentration of iron may be potentially effective markers for predicting infertility in women with OMA.

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Section: Introductionmentioning

confidence: 81%

Effect of the cyst fluid concentration of iron on infertility in patients with ovarian endometrioma

et al. 2020

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“…Noninvasive quantification methods have been developed to measure important tissue components, such as iron, in the body. Recent studies focus on potential clinical applications of 2 methods: (1) MRI using magnetic resonance relaxometry, which measures the effective transverse relaxation rate (R2*) value [44, 45], and (2) the optical method using transvaginal near-infrared light [46]. Several researchers have demonstrated that the R2* values are suitable to assess the iron content in the brain, liver, or heart [44].…”

Section: Discussionmentioning

confidence: 99%

“…Yoshimoto et al [45] succeeded in noninvasive measurement of iron level in cystic fluids of OMA and ovarian cancer using MR relaxometry. Kobayashi et al [46] quantified iron level in OMA by near-infrared spectroscopy with high tissue penetration, applying the principle used in peripheral pulse oximeters. Iron levels can be measured by these noninvasive imaging methods, but they are currently premature to use in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Cyst Fluid Concentrations of Iron and Severity of Dysmenorrhea in Patients with Ovarian Endometrioma

Imanaka

Maruyama

Kimura

et al. 2021

Gynecol Obstet Invest

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Objectives and Design: Endometriosis-related pain can be caused by anatomical distortions as well as environmental factors such as inflammation and oxidative stress. The aim of this study is to investigate the relationship between the severity of dysmenorrhea in patients with ovarian endometrioma (OMA) and cyst fluid (CF) concentrations of irons, including total iron, heme iron, and free iron. Method: Eighty-three patients who were histologically diagnosed with OMA were enrolled in the Department of Gynecology, Nara Medical University Hospital, between 2013 and 2019. The patients were divided into 4 groups according to the severity of dysmenorrhea: no pain, mild, moderate, and severe. Iron concentration was measured by the inductively coupled plasma optical emission spectrometry method. Results: There were no significant differences among the 4 groups in variables such as age at diagnosis, preoperative CA125, preoperative CA19-9, cyst size, and tumor laterality (unilateral or bilateral). There was a positive correlation between the severity of dysmenorrhea and total iron (p < 0.001) and heme iron (p = 0.016) concentrations. Multiple regression analyses revealed that the CF concentration of total iron (hazard ratio 18.75, 95% confidence interval: 2.26–155.35, p = 0.007) was a significant independent variable associated with the severity of dysmenorrhea. A receiver operating characteristic curve analysis showed that a total iron exceeding 290.8 mg/L was associated with severe dysmenorrhea with a sensitivity of 90.9% and a specificity of 65.7%. Limitations: This study excluded patients with adenomyosis, superficial endometriosis, or deep endometriosis, resulting in a smaller number of cases. Iron levels could not be compared to the endometriosis stage using the r-ASRM score. Conclusions: There is no clear evidence that iron predicts the severity of endometriosis-related pain. However, iron may be closely associated with dysmenorrhea.

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“…In the future, however, the procedure for iron measurement can be done via various imaging methods and will be noninvasive. For example, near-infrared spectroscopy can be used for measuring iron levels in the cyst in a noninvasive manner [17].…”

Section: Discussionmentioning

confidence: 99%

Validation of magnetic resonance relaxometry R2 value and cyst fluid iron level for diagnosis of ovarian endometrioma

et al. 2021

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Objectives: Magnetic resonance (MR) R2 relaxometry is a safe, noninvasive diagnostic modality for the evaluation of iron levels in the contents of ovarian cysts. The study aims to investigate the sensitivity and specificity of the two methods, R2 value and iron level, in diagnosing OMA patients in the validation set. Methods: A prospective cohort study was conducted from 2013 to 2019. We investigated how R2 value was affected by iron-related compounds, antioxidants and bioelements in the cysts. Results: The sensitivity and specificity of CF iron-based diagnosis of OMA was 96.6% and 95.4%, respectively. The sensitivity and specificity for R2 value in diagnosing OMA were 86.2% and 70.7%, respectively. The outcomes of the two tests were highly correlated (r = 0.758; P <0.001). The R2 value was positively correlated with CF levels of iron-related compounds and antioxidants. The R2 value was affected not only by iron ions but also by calcium ions. Conclusion: Preoperative MR relaxometry may provide a noninvasive alternative to CF iron test in diagnosing OMA. The presence of paramagnetic cations in the cyst may be associated with reduced specificity.

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Modern approaches to noninvasive diagnosis of malignant transformation of endometriosis

Cited by 12 publications

References 22 publications

Effect of the cyst fluid concentration of iron on infertility in patients with ovarian endometrioma

Effect of the cyst fluid concentration of iron on infertility in patients with ovarian endometrioma

Relationship between Cyst Fluid Concentrations of Iron and Severity of Dysmenorrhea in Patients with Ovarian Endometrioma

Validation of magnetic resonance relaxometry R2 value and cyst fluid iron level for diagnosis of ovarian endometrioma

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