Endometriosis Diagnosis

Endometriosis is defined by the presence of tissue that is biologically and morphologically similar to the tonormal endometrium in places other than the endometrial cavity and myometrium. Although the cause of endometriosis has not been clearly established, clinical and experimental observations indicate that retrograde menstruation, vascular or lymphatic spread, direct implantation and metaplasia, alone or in concert, may be responsible. Other factors, such as genetic predisposition and immune disorders, may also play a role

Endometriosis is a benign gynecological disease defined by the ectopic presence of the endometrium and associated with pelvic pain and infertility. The etiology and pathogenesis have not been fully clarified. Many theories have been proposed, but no single theory takes sufficient account of all aspects of this enigmatic disease, probably involving various mechanisms. An alternative explanation is that endometriosis is a heterogeneous rather than a single disease: in other words, peritoneal, deeply infiltrating, ovarian and extra-pelvic endometriosis are manifestations of different pathological processes, each with its own etiology

Endometriosis Diagnosis

CPP in women can be due to a number of disorders of different organ systems, although endometriosis is the most likely cause of pain. History, physical examination and selected imaging and laboratory studies can effectively diagnose many of these disorders

Although laparoscopy remains the gold standard for diagnosis, endometriosis has many subtle visual appearances, making direct visualization difficult and challenging

The diagnostic process includes a complete medical examination with a pelvic exam and often a pelvic ultrasound. Exploratory laparoscopy provides the definitive diagnosis, allowing the gynecologist to view endometrial implants directly. Diagnostic imaging procedures, such as Computed Tomography (CT) or Magnetic Resonance (MRI), can often detect distant endometrial implants

Physical Examination

Making a diagnosis based on the symptoms alone is difficult since the presentation is so variable and other conditions, such as irritable bowel syndrome and pelvic inflammation, mimic the disease. A clinical examination is performed to identify, with the help of a speculum, bluish lesions behind the cervix. Bimanual vaginal examination is one of the most important diagnostic tools, including careful inspection of the posterior part of the cervix and the posterior wall of the vagina. Finding pelvic tenderness, fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries on examination suggests endometriosis, although the results may be normal 

Diagnosis is likely if deeply infiltrating nodules are found in the uterosacral ligament or Douglas sac and is confirmed if visible lesions are observed in the vagina or neck area. These nodules are detected more reliably when the examination is performed during menstruation

Lab test

Blood markers, including CA-125, CA 19-9 and PP14 serum protein (glucodeline), have been used to detect endometriosis, but generally lack sensitivity and specificity. Specifically, CA-125 is an antigen that is expressed by cell lines derived from the celomial epithelium, which is developed in Müller derivatives. High concentration has been reported in some women with endometriosis and appears to correlate with disease extension, but an in-depth assessment found that CA-125 levels lack sensitivity or specificity to be useful as a screening test. This is because a high serum CA-125 can also be found in other gynecological conditions, including pelvic inflammatory disease, uterine fibroids, ovarian cysts and ovarian cancer

A monoclonal antibody to CA-125 was produced by immunizing mice with human ovarian cancer antigens. Using this monoclonal antibody, CA-125 can be detected in the serum of patients with ovarian cancer, as well as endometriosis, leiomyoma, pelvic inflammatory disease and ovarian hyperstimulation syndrome. Testing this substance before and after treatment can predict disease recurrence, but it is not reliable as a diagnostic tool

Image studies

The imaging techniques used for the diagnosis of endometriosis consist of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) and may offer additional information, but are not useful for initial diagnosis. In general, these techniques have limited value

Ultrasound

Ultrasound, the first step in the image is ultrasound, which is available in most institutions and is inexpensive. The burden of patient research is not extraordinary. This test uses to create images of the inside of your body by high frequency sound waves

Transvaginal ultrasound

Transvaginal ultrasound is an accurate tool for predicting the presence of ovarian endometriomas and endometriosis of the bladder. High resolution images can be obtained through the transvaginal approach using a 7.5 MHz probe. In expert hands, it is also precise in predicting the involvement of the rectal wall in deeply infiltrating endometriosis. It should be noted that ovarian endometriosis occurs rarely on its own and is often part of an adhesive disease, which infiltrates adjacent organs. The ultrasound discovery of an ovarian endometrioma should prompt the investigator to carefully re-examine the patient for a deeply infiltrating disease

Computed Tomography
Computed tomography does not offer much additional information

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) has been suggested as a diagnostic tool due to the differences in signal strength of the endometrium compared to other pelvic tissues, although this technique has been shown to have limited value.100 A new The saturated fat magnetic resonance is useful for detecting small endometrial implants and has excellent sensitivity, specificity and predictive value compared to conventional magnetic resonance

Magnetic resonance imaging has played an important role as a non-invasive method. We describe the MRI imaging results of endometriotic cyst, endometriotic implant, adhesion, deep endometriosis, decidualized endometriotic cyst and neoplasms resulting from endometriosis

laparoscopy

Endometriosis is suspected based on history. This suspicion is intensified by careful physical examination. The final visual diagnosis is made by the laparoscopist or pathologist on the biopsies taken during laparoscopy

Laparoscopy, also known as diagnostic laparoscopy, is a surgical diagnostic procedure (general anesthesia) that is used to examine organs within the abdomen or pelvis. It is a minimally invasive, low risk procedure that requires only small incisions. Large incisions can be avoided during laparoscopy. because the surgeon uses an instrument named a laparoscope


The definitive diagnosis of endometriosis depends on the visual inspection of the pelvis by laparoscopy. It is good to use an instrument, such as a forceps, through a secondary door, to mobilize the pelvic organs and palpate the lesions, which can help determine their nodularity. It is also important to document in detail the type, location and extent of all injuries and adhesions. The surgeon can take a tissue sample (biopsy) for further tests. The added benefit of performing a laparoscopy is the ability to surgically treat the disease at the same time