Journal of minimally invasive gynecology最新文献

Study objective: Endometriosis affects approximately 10% of women of reproductive age and is associated with an increased risk of adverse pregnancy outcomes. However, the relationship between preeclampsia, endometriosis, and subsequent adverse pregnancy outcomes remains unclear. The purpose of our study was to evaluate the association between endometriosis and preeclampsia, and to assess their combined effect on preterm birth and cesarean delivery.

Design: Women with diagnoses of endometriosis and preeclampsia were identified using ICD-9 codes. A multivariable logistic regression model was used to estimate adjusted odds ratios (aORs) for maternal age, race, insurance status, smoking, obesity, chronic hypertension, anxiety, depression, gestational hypertension, and gestational diabetes. Additionally, we evaluated the combined effects of endometriosis and preeclampsia on preterm birth and cesarean delivery.

Setting: The Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) 2004 to 2014.

Patients: 9,082,246 pregnant women aged 15-49 years.

Interventions: None.

Measurements and main results: There were 652,354 (7.18%) patients who had preterm delivery and 2,936,759 (32.3%) had Cesarean delivery. Endometriosis was diagnosed in 5,634 (0.1%), preeclampsia in 326,195 (3.6%), and both conditions in 318 (0.003%) patients. Women with endometriosis alone had 56% higher odds of preeclampsia (aOR = 1.556, 95% CI: 1.414-1.712). When evaluating the association with preterm birth, endometriosis alone increased the odds (aOR = 1.556, 95% CI: 1.414-1.712), preeclampsia alone quadrupled the odds (aOR = 4.08, 95% CI: 4.04-4.12), and the combined presence of both conditions further elevated the risk (aOR = 5.76, 95% CI: 4.41-7.52). Regarding cesarean delivery, the odds were also heightened: endometriosis alone had an aOR of 6.13 (95% CI: 5.73-6.56), preeclampsia alone had an aOR of 2.45 (95% CI: 2.43-2.47), and the combined exposure resulted in an aOR of 12.55 (95% CI: 8.82-17.87).

Conclusion: Endometriosis is associated with preeclampsia, and when both conditions co-occur, the likelihood of preterm birth and cesarean delivery is markedly amplified.

Objective: This study investigates whether quantitative analysis of preoperative Magnetic Resonance Imaging (MRI) scans can differentiate deep infiltrating endometriosis (DIE) lesion types (active or fibrotic) and associate them with reported pain symptoms.

Design: monocenter, observational, retrospective accuracy study SETTING: Academic Hospital IRCCS Policlinico di S. Orsola Bologna, Italy PARTICIPANTS: All patients with histologically confirmed DIE who had undergone pre-operative MRI were considered for recruitment during the study period (12/2022-12/2023).

Interventions: Histological assessment was performed on all surgical specimens categorizing the lesions in active lesions (AL) and fibrotic lesions (FL). All patients underwent pelvic MRI prior to surgery, and DICOM files were retrieved. Radiomic features were extracted using PyRadiomics (v3.1.0). In addition to radiomic data, morphological features were extracted. A genetic algorithm (GA) was used for features selection to identify relevant features and build classification models. Machine learning (ML) pipelines, tuned using leave-one-out cross-validation and evaluated via balanced accuracy, Matthews Correlation Coefficient, sensitivity and specificity, were developed to identify the most informative morphological and textural features for lesion classification and pain severity classification.

Results: Sixty-one women were enrolled. The integration of radiomic and graphomic enabled the extraction of insightful imaging features statistically linked to histological lesion types and pain symptomatology. The ML models proved promising classification performance under the leave-one-out cross-validation framework, identifying imaging biomarkers that differentiate fibrotic lesions from active stromal ones (balanced accuracy: 72.7%) and correlate with pain profiles (reaching a maximum of 88.0% of balanced accuracy for chronic pelvic pain). These results highlight the potential of imaging-based phenotyping in DIE.

Conclusions: The results support the feasibility of a non-invasive, image-based approach to preoperatively characterize DIE lesions. By combining radiomic, graphomic, and ML, our results showed that a rich characterization of active or fibrotic DIE lesions could enable their differentiation and their association with pain symptoms.

Study objective: To study if bilateral non-patency of fallopian tubes is correlated with a lower recurrence rate of endometriosis.

Design: Retrospective 2:1 matched case control study.

Setting: University hospital with tertiary referral center for fertility and endometriosis surgery in Leuven, Belgium.

Patients: All patients undergoing complete laparoscopic excision of any rASRM-stage endometriosis between 2010 and 2014 (n=896).

Intervention: Comparison between patients with bilateral non-patent or absent fallopian tubes versus matched controls with at least one patent fallopian tube.

Measurements and main results: Primary outcome was the recurrence rate which was analyzed on 4 levels: overall recurrence, symptom recurrence, recurrence on imaging and need for reintervention. Out of 896 patients, 49 had bilateral non-patent or absent fallopian tubes. These cases were compared with 98 matched controls with at least one patent fallopian tube. Symptoms recurred in 12.2% of the cases (n=6) and 25.5% of the controls (n =25) (P=0.09). Recurrence was confirmed by imaging in 8% of the cases (n=4) and in 10.2% of the controls (n=10) (P=0.77). In 3 patients of the case group and in 12 patients of the control group, there was a need for reintervention (P=0.39). Within this subgroup, recurrence of endometriosis was histologically confirmed in none of the patients of the case group and in 5 patients of the control group (P=0.51).

Conclusion: This study did not observe a statistically significant reduction in endometriosis recurrence in patients with bilateral occlusion/absence of the fallopian tubes after endometriosis surgery. A type II error may count for this result.