Predicting the risk of developing infiltrative forms of genital endometriosis with involvement of adjacent organs

Backgorund. Women with endometriosis suffer from pelvic pain, dysmenorrhea, infertility. Deep infiltrating endometriosis (DIE) is diagnosed with a delay from 6 to 10 years after the first symptoms manifest.

The aim. To improve early diagnosis of DIE with adjacent organ involvement by identifying predictors based on a risk prediction model.

Methods. This retrospective comparative study included 67 patients with DIE stage III-IV according to the rASRM classification who were divided into 2 groups: group A – 32 patients with involvement of adjacent organs, group B – 35 patients without involvement of adjacent organs by endometriosis.

Results. Patients from Group A had a greater severity of pelvic pain (p < 0.001) when assessed via the VAS scale. Patients in Group A had a longer duration of complaints (p < 0.001). Dyspareunia was more common in patients in Group A (p = 0.011). According to the ultrasound data, patients in Group A more often had signs of adenomyosis (p < 0.001), retroflexion of the uterus (p = 0.005), retrocervical or prevesical infiltration (p < 0.001). According to MRI data, Group A more often showed signs of colon (p = 0.001) and vaginal infiltration (p = 0.015).

Conclusions. The main predictive signs of DIE with involvement of adjacent organs were identified: severity of pelvic pain of 5 points (VAS) or more (p = 0.003), retrocervical or prevesical infiltration according to pelvic ultrasound (p = 0.001), duration of symptoms for 22 months or more (p = 0.002), dyspareunia (p = 0.015). We created a predictive model of DIE with involvement of adjacent organs (sensitivity 93.7 %, specificity 82.9 %) that was approved via ROC-analysis.

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