Preoperative Diagnosis And Severity Assessment Of Ovarian Endometriosis

Objective:Aim to analyze the clinical characteristics of ovarian endometriosis and evaluate the severity of the disease before operation,which help to the further diagnosis and treatment.Methods and Materials:This is a retrospective analysis which collects 116 cases of ovarian endometriosis patients and 103 cases of benign ovarian tumor patients as control group from January 2015 to January 2017 in the Shanghai Xinhua hospital.All patients undergo detailed preoperative examination,and the final diagnos is is confirmed by operation and pathology.Collect and analyze the clinical symptoms,gynecological examination,laboratory examination and medical imaging characteristics.Find out the difference between two groups,whose diagnostic efficiency is further evaluated.Finally search for the factor which could be a reflex of r-AFS scores and predict the existence of DIE.Results:(1)Implications indicators to ovarian endometriosis include degree of dysmenorrhea,infertility,enlargement of uterine,deep vaginal fornix and Douglas cul-de-sac nodules and tenderness,elevated serum CA125,low or none echo mass with punctate features inside of ultrasound,high signal on T1WI(P<0.05).Elevated serum CA125,punctate features inside mass of ultrasound,high signal on T1 WI have higher Youden index for 0.58?0.54 and 0.68,and can be the risk factors for ovarian endometriosis.When a level of 25.93U/m L was used as the threshold,the differential diagnosis is most effective with a sensitivity of 0.83 and a specificity of 0.82.(2)Vaginal fornix and Douglas cul-de-sac tenderness and serum CA125 level(P<0.05)are different among different levels of r-AFS scores in the patients with ovarian endometriosis.Preoperative serum CA125 level is signif icantly correlated with r-AFS score and the correlation coefficients were 0.79 and 0.69,respectively.Deep vaginal fornix and Douglas cul-de-sac nodules and tenderness indicate existence of DIE.MRI help to diagnose rectal DIE,but fail to show DIE of sacral ligament and Douglas cul-de-sac.Conclusions:(1)Degree of dysmenorrhea,infertility,gynecological examination,serum CA125 and medical imaging are important in the differential diagnosis between ovarian endometrios is and other ovarian benign tumors.Especially elevated serum CA125,low or none echo mass with punctate features inside of ultrasound,high signal on T1 WI are reliable risk factors for ovarian endometriosis.So we should pay attention to the combined application of serum CA125 and medical imaging.(2)The presence of vaginal fornix and Douglas cul-de-sac tenderness may indicate a higher r-AFS score in endometriosis.Preoperative serum CA125 level is signif icantly correlated with r-AFS score.They could predict the difficulty of operation,like degree of adhesion.(3)Deep vaginal fornix and Douglas cul-de-sac nodules and tenderness indicate existence of DIE,and MRI help to diagnose rectal DIE.But there is still limitation on the display of the DIE for sacral ligament and Douglas cul-de-sac.Therefore,the diagnosis of DIE should focus on the combined application of gynecological examination and MRI.