Title:Endometriosis Reccurence – is Ultrasound the Solution?
Volume: 20
Author(s): Ionel-Daniel Nati, Andrei Mihai Malutan*, Razvan Ciortea, Carmen Bucuri, Maria Patricia Rada, Cristina Mihaela Ormindean and Dan Mihu
Affiliation:
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
Keywords:
Endometriosis, Ultrasound, Recurrence, Diagnosis, Postoperative, Disease.
Abstract:
Background:
Transvaginal and transabdominal ultrasonography has become a widely used investigative method in the diagnostic workup of endometriosis, as
well as for the postoperative follow-up. The variety of lesions, the distorted anatomy caused by adhesions and the fibrosis process represent the
main challenges of the ultrasound evaluation. Regarding the recurrence of endometriosis, the diagnostic criteria are being imprecise, being adjusted
according to the development of ultrasound techniques.
Objective and Methods:
To this study, extensive research has been performed interrogating PubMed, Embase and Web of Science databases to identify published research
including patients with endometriosis who underwent surgery. Included patients had postoperative ultrasound investigations to detect evidence of
endometriosis recurrence. The selected timeframe was 5 years. We conducted a literature review on ultrasound markers of endometriosis
recurrence.
Results:
In this analysis, 2023 patients from 9 studies were included. The recurrence rate detected was 17.26%. The postoperative treatment was different in
the selected studies and they include the administration of progesterone, oral combined contraceptives, GnRh antagonists, aromatase inhibitors and
intrauterine devices with prolonged release of progesterone.
Discussion:
The recurrence rate is different in the selected studies as a result of the recurrence definition used by each author and the minimum dimension of
the lesions, in case of the cystic pattern. Innovative techniques of differential diagnosis by ultrasound are proposed, one of them being the textural
analysis performed by computer-aided diagnosis – CAD. In order to standardize the recommendations regarding imaging techniques, we propose
an algorithm for following up with patients in the postoperative period.
Conclusion:
The transabdominal or endovaginal ultrasound performed regularly represents a key factor to determine the recurrence of endometriosis in the
postoperative period and the imaging reassessment is recommended to be performed at a 6-month interval.
