Sonographer-acquired ultrasound protocol for deep endometriosis
AbstractEndovaginal sonographic imaging has been shown to reliably identify pelvic endometriosis, but most United States imaging practices do not adequately assess locations and features of endometriosis beyond ovarian endometrioma. In this article, we propose a protocol for sonographer-acquired images and maneuvers to be interpreted subsequently by sonologists (radiologists or gynecologists). The purpose is to impr ove the sensitivity of endovaginal sonography for the detection of endometriosis in imaging practices that involve the non-physician sonographer as part of their workflow.
We present MRI and CT case examples, together with corresponding laparoscopic and histopathology images to enhance radiologists ’ understanding of this disease.
We reported two cases of endometriosis of the abdominal wall, with subcutaneous and intramuscular localization, that became symptomatic a few years after a cesarean intervention. These cases have a clinical pattern quite similar to cutaneous endometriosis, but they are more difficult to diagnose through physical examination because they are barely palpable. In this sense, coupled with suggestive symptoms, ultrasound examination can confirm the clinical suspicion of endometriosis without the use of computed tomography and/or magnetic resonance imaging.
ConclusionCervicovaginal aplasia can be successfully treated by laparoscopy-assisted neocervicovaginal reconstruction as demonstrated in the video.
The promise of real-world Evidence (RWE) to offer a cost-effective way to help drive transformations in healthcare and drug development is dependent on significant improvements being made in the way real-world data (RWD) is collected and developed into robust evidence. Challenges include limited access to databases, incomplete data and problems dealing with the enormous volume of data generated on a daily basis. Much time is spent on acquisition, cleansing, integration, standardisation and encryption, as well as analysis and extraction of insights. This is where closer collaboration between pharma and...
a D PMID: 31876340 [PubMed - as supplied by publisher]
Using ultrasound in combination with endometrial biopsy results and clinical...Read more on AuntMinnie.comRelated Reading: MRI helps predict outcomes of endometriosis surgery PET/CT makes case for directing cervical cancer treatment Contrast ultrasound identifies early cervical cancer
AbstractThank you for your interest in our study and commentary. We applaud your work to improve the adoption of ultrasound for identifying endometriosis preoperatively. We agree that significant improvements have been made in the detection of endometriosis by ultrasound. At our institution Dr. Beryl Benacerraf and colleagues are routinely employing ultrasound to assess for deep infiltrating endometriosis. Unfortunately, this assessment is not employed by all local radiologists and was not available to many women in our study. We have taken the opportunity to clarify the preoperative imaging reviewed in our study.
ConclusionCervico-vaginal aplasia can be successfully treated by laparoscopic assisted neocervico-vaginal reconstruction as demonstrated in the video.
A 41-year-old nulliparous woman underwent assisted reproductive technology (ART) for infertility (stimulation cycles for oocyte retrieval, and embryo transfers). After two biochemical miscarriages, ultrasound and laparoscopy were performed. She reported dysmenorrhea and left sided pelvic pain. Apart from hypothyroidism, her medical history was unremarkable: of note, there was no history of laparoscopic myomectomy. Initial laparoscopy revealed “bubbles of angry-looking tissue”: biopsy reported endometriosis; cytology on peritoneal washings was negative for malignancy.
Journal of Gynecologic Surgery, Ahead of Print.