From the Guidelines
The most recent and highest quality study on endometriosis recommends the use of expanded protocol transvaginal ultrasound (TVUS) and MRI for diagnosis, as these imaging modalities have been shown to decrease morbidity and mortality and reduce the need for repeat surgeries 1.
Diagnosis and Treatment
The diagnosis of endometriosis is challenging due to variable presenting symptoms and nonspecific physical examination findings 1. However, studies have shown that preoperative imaging is associated with decreased morbidity and mortality and reduces the need for repeat surgeries by reducing the number of incomplete surgeries 1.
Imaging Modalities
Expanded protocol TVUS studies have been developed to identify and “map” deep endometriosis (DE) 1. These studies are typically performed by a physician or expert in endometriosis imaging and are characterized by a more detailed imaging protocol that includes anatomy and scanning maneuvers that are not part of the female pelvic US as defined by the ACR–ACOG–AIUM–SPR–SRU Practice Parameter for the Performance of Ultrasound of the Female Pelvis 1. Some key points about imaging modalities include:
- Expanded protocol TVUS studies are associated with a learning curve of at least 40 examinations 1
- Studies comparing the expanded protocol to routine pelvic US have shown a significantly higher sensitivity of the expanded studies 1
- Expert consensus groups advise using an MRI protocol tailored for detection of DE, with moderate bladder distention and vaginal contrast recommended to help improve lesion conspicuity involving these structures 1
Recent Research
Recent research has also explored the use of other imaging modalities, such as fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT and fluoroestradiol, an estrogen analog PET agent, which have shown promise in detecting endometriosis 1.
Clinical Implications
The use of expanded protocol TVUS and MRI for diagnosis of endometriosis is recommended, as these imaging modalities have been shown to improve outcomes and reduce the need for repeat surgeries 1.
From the Research
Latest Research on Endometriosis
- Recent studies have focused on the multimodal approach to symptomatic endometriosis, emphasizing the importance of considering peripheral and central sensitization, mental health, and myofascial dysfunction in clinical management 2.
- A holistic approach to care for patients with endometriosis has been proposed, highlighting the role of complementary care, physical activity, and multidisciplinary team involvement in managing symptoms and mitigating long-term health consequences 3.
- Multidisciplinary surgical management of severe posterior compartment endometriosis has been demonstrated, showcasing the importance of interdisciplinary collaboration and preoperative imaging for optimal surgical planning 4.
- Advances in pharmacotherapy for endometriosis have been reviewed, with a focus on hormonal and biological therapies, including gonadotropin-releasing hormone (GnRH) antagonists and aromatase inhibitors (AIs) 5, 6.
Key Findings
- The use of GnRH antagonists, such as elagolix, has shown promising results in treating pain associated with endometriosis 5, 6.
- Aromatase inhibitors (AIs) have been identified as potential therapeutic options, but their use is limited by the possibility of adverse effects and the need for add-back therapy 5, 6.
- Multidisciplinary care and interdisciplinary collaboration are essential for providing specialized and high-quality care for patients with endometriosis 2, 3, 4.
- Further research is necessary to elucidate the pharmacologic characteristics, efficacy, and safety of new compounds and therapies for the treatment of endometriosis 6.