(Press-News.org) OAK BROOK, Ill. – A new Society of Radiologists in Ultrasound (SRU) expert consensus statement to improve endometriosis evaluation was published today in the journal Radiology.
Endometriosis is a common condition with substantial diagnostic delay, leading patients to experience pain, infertility, lost wages and interrupted relationships.
The consensus provides recommendations for augmenting routine pelvic ultrasounds through additional maneuvers and imaging to improve diagnosis of deep endometriosis.
Endometriosis, the presence of endometrium-like tissue outside the uterus, is a prevalent and potentially debilitating condition. The condition is estimated to affect 10% of women of reproductive age and occurs in 21% of women undergoing hysterectomy with chronic pelvic pain. In the United States, there is an over seven-year delay between the onset of symptoms and a diagnosis of endometriosis.
Endometriosis is also associated with infertility and subfertility, affecting 20-50% of patients with these conditions. Deep endometriosis, extending to any depth beneath the peritoneal surface, is the most severe form of endometriosis.
Ultrasound is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis, but few centers in the U.S. utilize ultrasound to screen for deep endometriosis. Existing scan protocol limitations and lack of awareness lead to suboptimal detection of deep endometriosis on pelvic ultrasounds.
SRU convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis.
“The purpose of this consensus panel is to recommend methods that increase the diagnostic sensitivity for endometriosis on pelvic ultrasound by increasing awareness, improving interpretation, adding simple techniques that are high yield for deep endometriosis, and improving protocols to triage patients,” said the statement’s first author Scott W. Young, M.D., diagnostic radiology consultant, Division of Ultrasound, at the Mayo Clinic in Phoenix, Arizona.
The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus.
“The statement defines the targeted screening population, describes techniques for augmenting pelvic ultrasound, establishes direct and indirect observations for endometriosis on ultrasound, creates an observational grading and reporting system and makes recommendations for additional imaging and patient management,” Dr. Young said.
Panel recommendations include transvaginal ultrasound of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis.
“These additional techniques typically can be performed in less than five minutes and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients,” Dr. Young said.
The panel also recommends that direct and indirect observations of deep endometriosis should be assessed during the exam, and results should be reported using four categories: Incomplete (APU-0), Normal (APU-1), Equivocal (APU-2) and Positive (APU-3) with associated management recommendations.
“The SRU consensus on routine pelvic ultrasound for endometriosis aims to enhance deep endometriosis detection even at an initial ultrasound and with minimal additional time during imaging and no special patient preparation,” Dr. Young said. “Focusing imaging on anatomic regions where deep endometriosis is common can increase detection and decrease diagnostic delay.”
Dr. Young noted that these guidelines are meant for symptomatic patients at typical risk for endometriosis. Patients at high risk because of prior diagnostic or therapeutic laparoscopy for endometriosis or strong clinical indications may benefit from proceeding directly to advanced endometriosis imaging, particularly if they are likely to undergo surgery or if monitoring is needed in the setting of infertility and medical treatment.
The authors advise that validation studies will be necessary to prove the accuracy of augmented pelvic ultrasound in widespread clinical application.
###
“Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis.” Collaborating with Dr. Young were co-first author Priyanka Jha, M.B.B.S., Luciana Chamié, M.D., Ph.D., Shuchi Rodgers, M.D., Rosanne M. Kho, M.D., Mindy M. Horrow, M.D., Phyllis Glanc, M.D., Myra Feldman, M.D., Yvette Groszmann, M.D., Zaraq Khan, M.B.B.S., Steven L. Young, M.D., Ph.D., Liina Poder, M.D., Tatnai L. Burnett, M.D., Eric M. Hu, M.D., Susan Egan, R.D.M.S., and Wendaline VanBuren, M.D.
Radiology is edited by Linda Moy, M.D., New York University, New York, N.Y., and owned and published by the Radiological Society of North America, Inc. (https://pubs.rsna.org/journal/radiology)
RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)
For patient-friendly information on endometriosis, visit RadiologyInfo.org.
END
Researchers have discovered a blood protein that could help detect which children will experience ongoing concussion symptoms more than two weeks after an injury.
The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Neurotrauma, found the protein was a potential biomarker for delayed recovery from concussion in children.
For the study, blood samples were collected from children, aged five-18 years, who presented to the emergency department at The Royal Children’s Hospital less than 48 hours after a concussion.
Levels ...
Kent State University’s experimental archaeologists, along with those from several other universities, joined forces with the popular hunting, outdoors, and conservation media platform, MeatEater, Inc., for a unique animal processing experiment, shedding new light on ancient stone knives and showcasing the importance of testing and looking for equifinality. ‘Equifinality’ is when two or more distinct processes can lead to the same outcome or result.
The Kent State archaeologists included Professor Metin I. Eren, Ph.D.; Assistant Professor Michelle ...
WASHINGTON—New research published in The Journal of Clinical Endocrinology & Metabolism finds a high prevalence of type D personality among people with hypothyroidism.
Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones. Between 10-15% of people with treated hypothyroidism experience persistent symptoms despite achieving normal thyroid hormone levels, and the underlying causes are unclear.
Type D personality, which is characterized by pessimism, worry, stress, negative emotions and social withdrawal, is sometimes associated with poor health status and symptom burden, but this association has not previously ...
Researchers in China and Italy have made a significant breakthrough in understanding Dubin-Johnson syndrome (DJS), a rare inherited liver disorder. The team identified specific genetic mutations responsible for DJS in a pair of dizygotic twins, offering valuable insights into the cause of the disease and potentially improving diagnosis for patients with unclear symptoms.
DJS disrupts the liver's ability to eliminate waste products, leading to a buildup of bilirubin, a yellow pigment in the blood. This ...
Background and objectives
Sinonasal mucosal melanoma (SNMM) is a rare aggressive malignancy that presents with dismal outcomes and a high metastatic propensity. The prognostic factors as well as therapeutic regimens remain largely unknown due to the rarity of SNMM. This study aimed to assess the characteristics of SNMM patients associated with a better prognosis.
Methods
We performed an observational cross-sectional study to investigate the prognostic significance of tumor-infiltrating lymphocytes (TILs) and anti-programmed death-ligand 1 (PD-L1) therapy in 12 SNNM patients who were diagnosed at our institution and treated with anti-PD-L1 ...
Rapid climate change is prompting adaptation to threats such as tropical cyclones, wildfires, and droughts—but relatively trivial adaptation actions may lull people into inaccurate perceptions of their personal risk. Researchers from the University of California, Irvine; Stanford University; and the University of California, Los Angeles surveyed 2,774 Texas and Florida residents about tropical cyclones—also known in North America as hurricanes—five times between 2017 and 2022. The survey ...
Virtue is a normative concept comprising a set of moral and social codes acceptable to society. Historically, in the West, especially in ancient Greek and Christian belief systems, virtue was viewed as "excellence" aspirational to all human beings. In contrast, the East, especially in a Confucian belief system, viewed it similarly but being aspirational to only select individuals, such as rulers. However, the rise of modern values and sociopolitical overhauls almost pushed the concept of ...
Autism spectrum disorder (ASD) encompasses neurodevelopmental conditions where patients display repetitive behavior and impaired sociality. Genetic factors have been shown to influence the development of ASD. Additionally, recent studies have shown that the genes involved in chromatin modification and gene transcription are involved in the pathogenesis of ASD. Among the many genes implicated in this process, the gene KMT2C (lysine methyltransferase 2c), which codes for a catalytic unit of H3K4 (histone H3 lysine 4) methyltransferase complex, has been identified to be associated with the development ...
Relapses in a common form of leukemia may be preventable following new research which has identified how the cancer develops resistance to first line treatments.
New research published in iScience by researchers from the University of Birmingham, the Institute of Cancer Research (ICR), Newcastle University, the Princess Maxima Centre of Pediatric oncology and the University of Virginia identified changes in a mutated form of acute myeloid leukemia (AML) samples from patients who relapsed after receiving FLT3 inhibitor treatment.
The team found that the resistant cancer had up-regulated multiple other signalling pathways to overcome the drug’s action, and ...
Swimming in schools makes fish surprisingly stealthy underwater, with a group able to sound like a single fish.
The new findings by Johns Hopkins University engineers working with a high-tech simulation of schooling mackerel, offers new insight into why fish swim in schools and promise for the design and operation of much quieter submarines and autonomous undersea vehicles.
“It’s widely known that swimming in groups provides fish with added protection from predators, but we questioned whether it also contributes to reducing their noise,” said senior author Rajat Mittal. “Our results suggest that the substantial decrease in ...
