Clues to revising the conventional diagnostic algorithm for endometriosis

Clues to revising the conventional diagnostic algorithm for endometriosis Corresponding Author Andrew Spiers Department of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France Endometriosis Expert Center – Pays de la Loire, Angers, France Correspondence Andrew Spiers, Department of Gynecology-Obstetrics, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France. Email: [email protected] Search for more papers by this authorHorace Roman Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France Search for more papers by this authorMegan Wasson Department of Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona, USA Search for more papers by this authorCharles Chapron Department of Gynecology Obstetrics and Reproductive Medicine, Cochin University Hospital, Paris, France Department ‘Development, Reproduction and Cancer’, Institut Cochin, INSERM U1016, Descartes University, Paris, France Search for more papers by this authorPascal Rousset Department of Diagnostic and Interventional Imaging, Lyon Sud University Hospital, Lyon, France Search for more papers by this authorFrançois Golfier Department of Obstetrics and Reproductive Medicine, Lyon South University Hospital, Lyon, France Endometriosis Expert Center – Steering Committee of the EndAURA Network, Lyon, France Search for more papers by this authorRaffaele Fauvet Department of Obstetrics and Reproductive Medicine, Cote De Nacre University Hospital, Caen, France Search for more papers by this authorLéa Delbos Department of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France Endometriosis Expert Center – Pays de la Loire, Angers, France Search for more papers by this authorMathieu Poilblanc Department of Obstetrics and Reproductive Medicine, Lyon South University Hospital, Lyon, France Endometriosis Expert Center – Steering Committee of the EndAURA Network, Lyon, France Search for more papers by this authorVincent Lavoué Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France Search for more papers by this authorErick Petit Department of Obstetrics and Reproductive Medicine, Paris Saint Joseph Hospital, Paris, France Search for more papers by this authorFrédérique Perotte Department of Obstetrics and Reproductive Medicine, Paris Saint Joseph Hospital, Paris, France Search for more papers by this authorCherif Akladios Department of Obstetrics and Reproductive Medicine, Strasbourg University Hospital, Strasbourg, France Search for more papers by this authorBenjamin Merlot Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France Search for more papers by this authorThomas Dennis Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France Search for more papers by this authorAnne Sophie Boudy Department of Gynecology-Obstetrics and Medicine of Reproduction, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorBenjamin Fedida Department of Radiology, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorPierre Leguevaque Department of Gynecological Surgery, CHU Rangueil, Toulouse, France Search for more papers by this authorLudivine Genre Department of Radiology, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorClothilde Hennetier Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France Search for more papers by this authorMorgane Perrin Department of Gynecological Surgery, CHU Rangueil, Toulouse, France Search for more papers by this authorPatrice Crochet Department of Gynecological Surgery, CHU Rangueil, Toulouse, France Search for more papers by this authorClaire-Marie Roger Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France Search for more papers by this authorElodie Chantalat Department of Radiology, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorPierre Collinet Hôpital Privé le Bois, Groupe Ramsay Lille Métropole, Lille, France Search for more papers by this authorHervé Fernandez Department of Obstetrics and Reproductive Medicine, Paris Sud University Hospital, Kremlin Bicetre APHP, Paris, France Search for more papers by this authorPhilippe Descamps Department of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France Endometriosis Expert Center – Pays de la Loire, Angers, France Search for more papers by this authorSofiane Bendifallah Department of Surgery, Americain Hopsital of Paris, Neuilly sur seine, France Search for more papers by this authorCorresponding Author Andrew Spiers Department of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France Endometriosis Expert Center – Pays de la Loire, Angers, France Correspondence Andrew Spiers, Department of Gynecology-Obstetrics, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France. Email: [email protected] Search for more papers by this authorHorace Roman Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France Search for more papers by this authorMegan Wasson Department of Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona, USA Search for more papers by this authorCharles Chapron Department of Gynecology Obstetrics and Reproductive Medicine, Cochin University Hospital, Paris, France Department ‘Development, Reproduction and Cancer’, Institut Cochin, INSERM U1016, Descartes University, Paris, France Search for more papers by this authorPascal Rousset Department of Diagnostic and Interventional Imaging, Lyon Sud University Hospital, Lyon, France Search for more papers by this authorFrançois Golfier Department of Obstetrics and Reproductive Medicine, Lyon South University Hospital, Lyon, France Endometriosis Expert Center – Steering Committee of the EndAURA Network, Lyon, France Search for more papers by this authorRaffaele Fauvet Department of Obstetrics and Reproductive Medicine, Cote De Nacre University Hospital, Caen, France Search for more papers by this authorLéa Delbos Department of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France Endometriosis Expert Center – Pays de la Loire, Angers, France Search for more papers by this authorMathieu Poilblanc Department of Obstetrics and Reproductive Medicine, Lyon South University Hospital, Lyon, France Endometriosis Expert Center – Steering Committee of the EndAURA Network, Lyon, France Search for more papers by this authorVincent Lavoué Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France Search for more papers by this authorErick Petit Department of Obstetrics and Reproductive Medicine, Paris Saint Joseph Hospital, Paris, France Search for more papers by this authorFrédérique Perotte Department of Obstetrics and Reproductive Medicine, Paris Saint Joseph Hospital, Paris, France Search for more papers by this authorCherif Akladios Department of Obstetrics and Reproductive Medicine, Strasbourg University Hospital, Strasbourg, France Search for more papers by this authorBenjamin Merlot Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France Search for more papers by this authorThomas Dennis Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France Search for more papers by this authorAnne Sophie Boudy Department of Gynecology-Obstetrics and Medicine of Reproduction, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorBenjamin Fedida Department of Radiology, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorPierre Leguevaque Department of Gynecological Surgery, CHU Rangueil, Toulouse, France Search for more papers by this authorLudivine Genre Department of Radiology, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorClothilde Hennetier Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France Search for more papers by this authorMorgane Perrin Department of Gynecological Surgery, CHU Rangueil, Toulouse, France Search for more papers by this authorPatrice Crochet Department of Gynecological Surgery, CHU Rangueil, Toulouse, France Search for more papers by this authorClaire-Marie Roger Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France Search for more papers by this authorElodie Chantalat Department of Radiology, Hôpital Tenon, Sorbonne University, Paris, France Search for more papers by this authorPierre Collinet Hôpital Privé le Bois, Groupe Ramsay Lille Métropole, Lille, France Search for more papers by this authorHervé Fernandez Department of Obstetrics and Reproductive Medicine, Paris Sud University Hospital, Kremlin Bicetre APHP, Paris, France Search for more papers by this authorPhilippe Descamps Department of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France Endometriosis Expert Center – Pays de la Loire, Angers, France Search for more papers by this authorSofiane Bendifallah Department of Surgery, Americain Hopsital of Paris, Neuilly sur seine, France Search for more papers by this authorAbstract Endometriosis is a complex gynecologic disorder characterized primarily by symptoms of pelvic pain, infertility, and altered quality of life. National and international guidelines highlight the diagnostic difficulties and lack of conclusive diagnostic tools for endometriosis. Furthermore, guidelines are becoming questionable at an increasingly rapid rate as new diagnostic techniques emerge. This work aims to provide a knowledge synthesis of the relevance of various diagnostic tools and to assess areas of improvement of conventional algorithms. MEDLINE and Cochrane Library databases were searched from January 2021 to December 2023 using relevant key words. Articles evaluating the diagnostic relevance and performance of various tools were included and independently reviewed by the authors for eligibility. Included studies were assessed using the GRADE and QUADAS-2 tools. Of the 4204 retrieved articles, 26 were included. While anamnesis and clinical examination do contribute to diagnostic accuracy, their level of evidence and impact on the diagnostic process remains limited. Although imaging techniques are recommended to investigate endometriosis, ultrasonography remains highly operator dependent. Magnetic resonance imaging appears to exhibit higher sensitivities than ultrasound. However, concerns persist with regards to the terminology, anatomical definition of lesions, and accuracies of both ultrasound and magnetic resonance imaging. Recently, several biological markers have been studied and cumulative evidence supports the contribution of noncoding RNAs to the diagnosis of endometriosis. Marginal improvements have been suggested for anamnesis, clinical examination, and imaging examinations. Conversely, some biomarkers, including the saliva microRNA signature for endometriosis, have emerged as diagnostic tools which inspire reflection on the revision of conventional diagnostic algorithms. CONFLICT OF INTEREST STATEMENT AS, PD, and SB serve as advisory board members for Ziwig. No other authors report any conflicts of interest. DATA AVAILABILITY STATEMENT Data sharing is not applicable to this article as no new data were created or analyzed in this study. Supporting Information | Filename | Description | |---|---| | ijgo15840-sup-0001-TableS1.docxWord 2007 document , 48 KB | Table S1: Summary of the key characteristics for each of the included studies (N = 26). | Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. REFERENCES - 1Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020; 382(13): 1244-1256. doi:10.1056/NEJMra1810764 - 2Brandes I, Kleine-Budde K, Heinze N, et al. Cross-sectional study for derivation of a cut-off value for identification of an early versus delayed diagnosis of endometriosis based on analytical and descriptive research methods. 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