Clinical features, socio-demographic profile and ultrasound findings in women with endometriosis symptoms
DOI:
https://doi.org/10.15448/1980-6108.2018.4.30496Keywords:
endometriosis, diagnostic imaging, CA-125 antigen, female urogenital diseases, health profile.Abstract
AIMS: To describe clinical and socio-demographic features, as well as transvaginal ultrasound results, of women with endometriosis symptoms.
METHODS: A prospective cross-sectional study included patients who had at least one of the following symptoms: dyspareunia, dysmenorrhea, chronic pelvic pain, infertility, and urinary or bowel cyclic symptoms. The sample comprised women treated in a private gynecology clinic located in a small city in southern Brazil, from March to November 2016. All the participants, after signed an informed consent, were subjected to clinical anamnesis, transvaginal ultrasound with bowel preparation, and examination for the CA-125 antigen serum level. Association between two qualitative variables was assessed through Pearson's Chi-Square or Fisher's exact tests. Mean values of quantitative variables were compared through the two-tailed Student's t-test for independent samples. Significance level was set as p<0.05.
RESULTS: A total of 85 women, aged 18-49 years, participated in the study. Most were married (75.3%), with children (51.8%), showed no family history of endometriosis (89.4%), had no knowledge about endometriosis (77.6%) and completed high school (43.5%). Ultrasound findings suggested endometriosis in 25 (29.4%) women. Dysmenorrhea was the most prevalent symptom (88.2%), followed by dyspareunia (61.2%). In comparison to those without ultrasound signs, the patients whose ultrasound findings suggested endometriosis had an older age (37.16±6.83 years vs. 30.37±6.80 years, p<0.001) and a longer duration of symptoms (9.06±6.49 years vs. 5.27±4.79 years, p=0.004). In addition, they presented higher mean serum CA-125 antigen levels (50.07±54.05 U/mL vs. 17.71±14.09 U/mL, p=0.011). Endometriosis-compatible lesions were mainly found in the ovaries (60%) and in the rectosigmoid region (52%). The disease was confirmed in the nine cases that were subjected to videolaparoscopy.
CONCLUSIONS: Transvaginal ultrasound confirmed endometriosis in about one third of symptomatic patients, who were older, had symptoms for a longer time, and had higher serum CA-125 antigen levels in comparison to those without endometriosis diagnosis based on transvaginal ultrasound. Ovaries and rectosigmoid region were the sites with the highest frequency of ultrasound signs of endometriosis.
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References
Febrasgo. Federação Brasileira das Associações de Ginecologia e Obstetrícia. Manual de endometriose. São Paulo: Febrasgo; 2015.
Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40:464-9. https://doi.org/10.1002/uog.11102
Santos, TMV, Pereira AMG, Lopes RGC, Depez DB. Tempo transcorrido entre o início dos sintomas e o diagnóstico de endometriose. Einstein. 2012;10(1):39-43. https://doi.org/10.1590/S1679-45082012000100009
Nacul AP, Spritzer PM. Aspectos atuais do diagnóstico e tratamento da endometriose. Rev Bras Ginecol Obstet. 2010;32(6):298-307. https://doi.org/10.1590/S0100-72032010000600008
Noventa M, Saccardi C, Litta P. Ultrasound techniques in the diagnosis of deep pelvic endometriosis: algorithm based on a systematic review and meta-analysis. Fertil Steril. 2015;104(2):366-83. https://doi.org/10.1016/j.fertnstert.2015.05.002
Benacerraf BR, Groszmann Y. Sonography Should Be the First Imaging Examination Done to Evaluate Patients With Suspected Endometriosis. J Ultrasound Med. 2012;31:651-3. https://doi.org/10.7863/jum.2012.31.4.651
Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, Alcazar JL. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;46(5):534-45. https://doi.org/10.1002/uog.15667
Arruda MS, Camargo MMA, Camargo Jr. HSA, Teixeira SRC. Endometriose profunda: aspectos ecográficos. Femina. 2010;38(7):367-72.
Hudelist G, Ballard K, English J, Wright J, Banerjee S, Mastoroudes H, Thomas A, Singer CF, Keckstein J.Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2011;37(4):480-7. https://doi.org/10.1002/uog.8935
Acimovic M, Vidakovic S, Milic N, Jeremic K, Markovic M, Milosevic-Djeric A, Lazovic-Radonjic G. Survivin and vegf as novel biomarkers in diagnosis of endometriosis. J Med Biochem. 2015;35(1):63-8. https://doi.org/10.1515/jomb-2015-0005
IBGE. Instituto Brasileiro de Geografia e Estatística. Panorama: Ijuí, Rio Grande do Sul, Brasil. 2018 [cited 2018 October 30]. Available from: https://cidades.ibge.gov.br/brasil/rs/ijui/panorama
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, Exacoustos C, Installé AJ, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48:318-32. https://doi.org/10.1002/uog.15955
Guerriero S, Ajossa S, Gerada M, Virgilio B, Angioni S, Benedetto GM. Diagnostic value of transvaginal 'tenderness-guided' ultrasonography for the prediction of location of deep endometriosis. Human Reproduction. 2008;11:2452-7. https://doi.org/10.1093/humrep/den293
Ferrero S, Arena E, Morando A, Remorgida V. Prevalence of newly diagnosed endometriosis in women attending the general practitioner. Int J Gynaecol Obstet. 2010;110:203-7. https://doi.org/10.1016/j.ijgo.2010.03.039
Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009;92(6):1825-33. https://doi.org/10.1016/j.fertnstert.2008.09.005
Bellelis P, Dias Jr JA, Podgaec S, Gonzales M, Baracat EC, Abrão MS.Aspectos epidemiológicos e clínicos da endometriose pélvica - uma série de casos. Rev Assoc Med Bras. 2010;56(4):467-71. https://doi.org/10.1590/S0104-42302010000400022
Hernández AG, Rechy GO, García EG. Factores de riesgo asociados, métodos diagnósticos y tratamiento para endometriosis, utilizados en la clínica de endometriosis del servicio de Ginecología del Hospital General de México (2009- 2011). Ginecol Obstet Mex. 2012;80(10):637-43.
Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Laconte M, Borghese B, Chapron C. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod. 2009;24(3):602-7. https://doi.org/10.1093/humrep/den405
Cardoso EPS, Anselmo NM, Miguel KJ, Silva ABC. Endometriose em diferentes faixas etárias: perspectivas atuais no diagnóstico e tratamento da doença. Ciência et Praxis. 2011;4(8):53-8.
Goncalves MO, Podgaec S, Dias JA Jr, Gonzalez M, Abrao MS.Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod. 2010;25(3):665-71. https://doi.org/10.1093/humrep/dep433
Nominato NS, Prates LFVS, Lauar I, Morais J, Maia L, Geber S. Endometriose de cicatriz cirúrgica: Estudo retrospectivo de 25 anos. Rev Bras Ginecol Obstet. 2007;29(8):403-7. https://doi.org/10.1590/S0100-72032007000800007
Berek JS. Tratado de Ginecologia. 14 ed. Rio de Janeiro: Guanabara Koogan; 2008.
Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, Vieira M, Hasan W, Bricou A. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod. 2006;21(7):1839-45. https://doi.org/10.1093/humrep/del079
Cardoso MM, Junior HW, Berardo PT, Coutinho Junior AC, Domingues MNA, Gasparetto EL, Domingues RC. Avaliação da concordância entre a ultrassonografia transvaginal e a ressonância magnética da pelve na endometriose profunda, com ênfase para o comprometimento intestinal. Radiol Bras. 2009;42(2):89-95. https://doi.org/10.1590/S0100-39842009000200006
Massein A, Petit E, Darchen MA, Loriau J, Oberlin O, Marty O, Sauvanet E, Afriat R, Girard F, Molinié V, Duchatelle V, Zins M. Imaging of intestinal involvement in endometriosis. Diagn Interv Imaging. 2013;94(3):281-91. https://doi.org/10.1016/j.diii.2012.11.003
Stuparich MA, Donnellan NM, Sanfilippo JS. Endometriosis in the Adolescent Patient. Semin Reprod Med. 2017;35(1):102-9.
Holland TK, Cutner A, Saridogan E, Mavrelos D, Pateman K, Jurkovic D. Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study. MC Womens Health. 2013;13:43. https://doi.org/10.1186/1472-6874-13-43
Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. https://doi.org/10.1093/humrep/det457
Hirsch M, Duffy J, Davis CJ, Nieves Plana M, Khan KS; International Collaboration to Harmonise Outcomes and Measures for Endometriosis. Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis. BJOG. 2016;123(11):1761-8. https://doi.org/10.1111/1471-0528.14055
Zomer MT, Ribeiro R, Trippia CH, Cavalcanti TCS, Hayashi RM, Kondo W. Correlação entre os níveis de Ca-125 séricos e os achados cirúrgicos em mulheres com sintomas sugestivos de endometriose. Rev Bras Ginecol Obstet. 2013;35(6):262-7. https://doi.org/10.1590/S0100-72032013000600005
Doniatti, L. Endometriose, um estudo correlacional: estratégias de enfrentamento (coping) depressão, estresse e dor [dissertation]. [São Paulo]: Pontifícia Universidade Católica de São Paulo; 2014. Available from: https://tede2.pucsp.br/handle/handle/15390
Piessens S, Healey M, Maher P, Tsaltas J, Rombauts L. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Aust N Z J Obstet Gynaecol. 2014;54:462-8. https://doi.org/10.1111/ajo.12242
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