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Endometriosis: Advances in Diagnosis and Treatment

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (25 April 2022) | Viewed by 23327

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Special Issue Editor

Dr. Anastasia Prodromidou

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Guest Editor

Urogynecology Unit, 1st Department of Obstetrics & Gynecology, “Alexandra Hospital”, National and Kapodistrian University of Athens, Lourou 2, 11528 Athens, Greece
Interests: urogynecology; pelvic floor disorders; minimally invasive gynecology; benign gynecologic diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Endometriosis is a complex, chronic gynaecological disorder that mostly affects women of reproductive age, with an estimated prevalence of approximately 10% among this population. However, this proportion seems to vary significantly due to the insufficiency of preoperative diagnostic tools and the fact that a significant majority of women with endometriosis are asymptomatic. Pelvic pain or infertility are considered the main manifestations of the disease. Exploratory laparotomy and histological confirmation of the lesions are considered the gold standard to establish the final diagnosis of the disease. The management of endometriosis remains challenging. The optimal treatment should be tailored according to patient and disease characteristics including age, preferences, symptoms and extent of the disease, as well as previous therapeutic interventions. Unfortunately, a significant proportion of women will present with recurrent disease irrespective of the previous treatment modality. Therefore, it is of critical importance to expand our knowledge on the novel diagnostic modalities and new therapeutic approaches for the disease. In this Special Issue, we invite original articles, reviews and perspectives addressing new insights, challenges and available knowledge on the diagnosis and treatment of endometriosis.

Dr. Anastasia Prodromidou
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

endometriosis
pain
infertility
inflammation
exploratory laparoscopy
minimally invasive surgery
medical treatment
pathophysiology

Published Papers (5 papers)

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Research

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15 pages, 2388 KiB

Open AccessArticle

Deep Learning to Measure the Intensity of Indocyanine Green in Endometriosis Surgeries with Intestinal Resection

by Alicia Hernández, Pablo Robles de Zulueta, Emanuela Spagnolo, Cristina Soguero, Ignacio Cristobal, Isabel Pascual, Ana López and David Ramiro-Cortijo

J. Pers. Med. 2022, 12(6), 982; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12060982 - 16 Jun 2022

Cited by 3 | Viewed by 1777

Abstract

Endometriosis is a gynecological pathology that affects between 6 and 15% of women of childbearing age. One of the manifestations is intestinal deep infiltrating endometriosis. This condition may force patients to resort to surgical treatment, often ending in resection. The level of blood perfusion at the anastomosis is crucial for its outcome, for this reason, indocyanine green (ICG), a fluorochrome that green stains the structures where it is present, is injected during surgery. This study proposes a novel method based on deep learning algorithms for quantifying the level of blood perfusion in anastomosis. Firstly, with a deep learning algorithm based on the U-Net, models capable of automatically segmenting the intestine from the surgical videos were generated. Secondly, blood perfusion level, from the already segmented video frames, was quantified. The frames were characterized using textures, precisely nine first- and second-order statistics, and then two experiments were carried out. In the first experiment, the differences in the perfusion between the two-anastomosis parts were determined, and in the second, it was verified that the ICG variation could be captured through the textures. The best model when segmenting has an accuracy of 0.92 and a dice coefficient of 0.96. It is concluded that segmentation of the bowel using the U-Net was successful, and the textures are appropriate descriptors for characterization of the blood perfusion in the images where ICG is present. This might help to predict whether postoperative complications will occur during surgery, enabling clinicians to act on this information. Full article

(This article belongs to the Special Issue Endometriosis: Advances in Diagnosis and Treatment)

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Graphical abstract

16 pages, 2139 KiB

Open AccessArticle

Antibody Arrays Identified Cycle-Dependent Plasma Biomarker Candidates of Peritoneal Endometriosis

by Maja Pušić, Teja Klančič, Tamara Knific, Andrej Vogler, Ronny Schmidt, Christoph Schröder and Tea Lanišnik Rižner

J. Pers. Med. 2022, 12(6), 852; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12060852 - 24 May 2022

Cited by 2 | Viewed by 1935

Abstract

Endometriosis is an estrogen-dependent inflammatory disease affecting women in their reproductive age. Due to non-specific symptoms, women with endometriosis are often misdiagnosed or are accurately diagnosed only after several years. Diagnosis of peritoneal endometriosis is especially challenging and relies only on laparoscopic surgery. To date, different molecules have been proposed as potential non-invasive biomarkers of endometriosis; however, none have been confirmed as clinically useful. Therefore, this study aimed to discover novel plasma biomarker candidates for peritoneal endometriosis using an antibody array platform. This study included patients with endometriosis-like symptoms characterized by the absence (controls) or presence of peritoneal endometriosis (cases) after laparoscopic surgery and histological evaluation. Patients were further divided into secretory and proliferative groups, according to the phase of their menstrual cycle. Their plasma samples were collected and analyzed on an antibody array platform targeting more than 1350 proteins with over 1820 antibodies. In the proliferative group, the analysis revealed three differential proteins between cases and controls: ITB3, ITA2B2, and ACVL-1. In the secretory group, none of the examined proteins reached the log-fold change (logFC) and significance thresholds simultaneously. The potential of the identified differential proteins as plasma biomarker candidates for peritoneal endometriosis should be evaluated on a larger cohort, and their role in endometriosis should be investigated in further studies. Full article

(This article belongs to the Special Issue Endometriosis: Advances in Diagnosis and Treatment)

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Graphical abstract

11 pages, 283 KiB

Open AccessArticle

Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

by Augusto Pereira, Manuel Herrero-Trujillano, Gema Vaquero, Lucia Fuentes, Sofia Gonzalez, Agustin Mendiola and Tirso Perez-Medina

J. Pers. Med. 2022, 12(1), 101; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12010101 - 13 Jan 2022

Cited by 5 | Viewed by 5259

Abstract

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade. Full article

(This article belongs to the Special Issue Endometriosis: Advances in Diagnosis and Treatment)

15 pages, 11179 KiB

Open AccessFeature PaperArticle

Ultrasonography in the Differentiation of Endometriomas from Hemorrhagic Ovarian Cysts: The Role of Texture Analysis

by Roxana-Adelina Ștefan, Paul-Andrei Ștefan, Carmen Mihaela Mihu, Csaba Csutak, Carmen Stanca Melincovici, Carmen Bianca Crivii, Andrei Mihai Maluțan, Liviu Hîțu and Andrei Lebovici

J. Pers. Med. 2021, 11(7), 611; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm11070611 - 28 Jun 2021

Cited by 8 | Viewed by 10402

Abstract

The ultrasonographic (US) features of endometriomas and hemorrhagic ovarian cysts (HOCs) are often overlapping. With the emergence of new computer-aided diagnosis techniques, this is the first study to investigate whether texture analysis (TA) could improve the discrimination between the two lesions in comparison with classic US evaluation. Fifty-six ovarian cysts (endometriomas, 30; HOCs, 26) were retrospectively included. Four classic US features of endometriomas (low-level internal echoes, perceptible walls, no solid components, and less than five locules) and 275 texture parameters were assessed for every lesion, and the ability to identify endometriomas was evaluated through univariate, multivariate, and receiver operating characteristics analyses. The sensitivity (Se) and specificity (Sp) were calculated with 95% confidence intervals (CIs). The texture model, consisting of seven independent predictors (five variations of difference of variance, image contrast, and the 10th percentile; 100% Se and 100% Sp), was able to outperform the ultrasound model composed of three independent features (low-level internal echoes, perceptible walls, and less than five locules; 74.19% Se and 84.62% Sp) in the diagnosis of endometriomas. The TA showed statistically significant differences between the groups and high diagnostic value, but it remains unclear if the textures reflect the intrinsic histological characteristics of the two lesions. Full article

(This article belongs to the Special Issue Endometriosis: Advances in Diagnosis and Treatment)

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Review

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13 pages, 671 KiB

Open AccessReview

Tubal Endometriosis: From Bench to Bedside, A Scoping Review

by Anastasia Prodromidou, Nikolaos Kathopoulis, Dimitrios Zacharakis, Themos Grigoriadis, Ioannis Chatzipapas and Athanasios Protopapas

J. Pers. Med. 2022, 12(3), 362; https://0-doi-org.brum.beds.ac.uk/10.3390/jpm12030362 - 26 Feb 2022

Cited by 2 | Viewed by 2725

Abstract

Tubal endometriosis (EM) refers to the detection of ectopic endometrial implants on tubes. It may cause a significant defect of the tubes, translating into dysmenorrhea, pelvic pain, and infertility. We aimed to evaluate the disease characteristics, prevalence, histopathological findings and genetic profile of patients with tubal EM. A thorough search of three electronic databases was performed for studies that presented outcomes of patients with tubal EM. Thirteen studies (four observational, seven case reports, two genetic) were considered eligible for inclusion. The prevalence of tubal EM ranged from 6.9% to 69%. The predominant symptoms for referral of patients were infertility and abdominal pain. Women of reproductive age underwent salpingectomy for the management of the disease. Only one case of malignant transformation was recorded in a 60-year-old patient. The prevalence of tubal EM ranges depending on the indication for surgery, the presence of concomitant pelvic EM and the type of diagnosis and treatment. Further, more extensive, larger studies are warranted to evaluate the impact of tubal EM in the progression and prognosis of EM, the effect of salpingectomy in the improvement of disease-related symptoms and to designate the group of patients that could benefit from risk-reducing salpingectomy based on the risk of developing ovarian malignancy. Full article

(This article belongs to the Special Issue Endometriosis: Advances in Diagnosis and Treatment)

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