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Diagnosing Deep Endometriosis Using Transvaginal Elastosonography

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Abstract

Transvaginal ultrasound (TVUS) and MRI are currently two mainstream imaging techniques used to diagnose deep endometriosis (DE) with comparable accuracy, but there is still ample room for improvement. As endometriotic lesions progress to fibrosis concomitant with the increase in tissue stiffness, transvaginal elastosonography (TVESG) is well-suited for diagnosing DE. To test the hypothesis that lesional stiffness as measured by TVESG correlates with the extent of lesional fibrosis, the markers of progression, hormonal receptor expression, and vascularity, we recruited 30 patients suspected to have DE who went through pelvic examination, TVUS and/or MRI, and TVESG and were ultimately diagnosed by histology. Their lesional tissue samples were subjected to immunohistochemistry analysis of markers for epithelial-mesenchymal transition (EMT), fibroblast-to-myofibroblast transdifferentiation (FMT), estrogen and progesterone receptors (ERβ and PR), microvessel density (MVD), and vascularity, as well as quantification of lesional fibrosis. We found that pelvic examination, TVUS, and MRI detected 83.3%, 66.7%, and 83.3% of all DE cases, respectively, while TVESG detected them all. The lesions missed by pelvic exam, TVUS and MRI were significantly smaller than those detected but nonetheless had higher lesional stiffness. Lesional stiffness correlated closely and positively with the extent of lesional fibrosis, negatively with the markers of EMT, MVD, vascularity, and PR expression, but positively with the marker for FMT and ERβ. Thus, through the additional use of information on differential stiffness between DE lesions and their surrounding tissues, TVESG improves diagnostic accuracy, provides a ballpark estimate on the developmental stage of the lesions, and may help clinicians choose the best treatment modality.

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Acknowledgments

The authors would like to thank Dr. Cai Chang and Na Hu from Shanghai Tumor Hospital, Fudan University, and Dr. Li Sun from Shanghai OB/GYN Hospital, Fudan University, for their expert assistance in the TVESG examination for the recruited DE patients. We thank an anonymous reviewer for his/her constructive comments and suggestions on an earlier version of this manuscript.

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  1. Ding Ding and Yishan Chen contributed equally to this work.

Authors and Affiliations

  1. Shanghai OB/GYN Hospital, Fudan University, Shanghai, 200090, China

    Ding Ding, Yishan Chen, Xishi Liu & Sun-Wei Guo

  2. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China

    Xishi Liu & Sun-Wei Guo

  3. Department of Obstetrics and Gynecology, The 7th Hospital, Ningbo, Zhejiang, 315202, China

    Zongqin Jiang & Xianjun Cai

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  1. Ding Ding
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Correspondence to Xishi Liu.

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This research was supported in part by grants 81530040 (SWG), 81771553 (SWG), and 81671436 (XSL) from the National Natural Science Foundation of China, and a grant from Ningbo Municipal Bureau of Science and Technology (2017A610169).

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Ding, D., Chen, Y., Liu, X. et al. Diagnosing Deep Endometriosis Using Transvaginal Elastosonography. Reprod. Sci. 27, 1411–1422 (2020). https://doi.org/10.1007/s43032-019-00108-2

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