轻度子宫内膜异位症诊断的研究进展

Research Progress of the Diagnosis of Minimal/Mild Endometriosis

子宫内膜异位症(endometriosis,EMs)是一种常见的妇科疾病,可导致盆腔疼痛和不孕。轻度EMs(Ⅰ~Ⅱ期)约占EMs的80%,其病灶常为腹膜型/浅表型,常规的超声检查常无阳性发现。患者早期症状和体征隐匿,缺乏可应用于临床的特异性生物标志物,导致大部分轻度EMs患者诊断及治疗延迟,发展成中重度EMs,因此轻度EMs的早期诊断面临着巨大挑战。腹腔镜检查是诊断EMs的金标准,但腹腔镜费用高且为有创检查,不适用于筛查。近年来,越来越多的诊断方法相继被提出,如临床症状、体征、生物标志物、影像学的组合模型,为轻度EMs的诊断提供了新的思路。这些方法展现了对轻度EMs的诊断潜力,但仍需提高诊断效能和扩大样本量进一步验证。集合临床特征、妇科检查和生物标志物等组合可能成为准确诊断轻度EMs的解决方案。

Endometriosis(EMs)is a common gynecological disease that causes pelvic pain and infertility.Minimal/mild EMs(rAFs stageⅠ-Ⅱ)accounts for about 80%of EMs,and its lesions are usually peritoneal or superficial with the negative ultrasound findings.Because minimal/mild EMs lacks specific symptoms,imaging findings and biomarkers,most of them were delayed in the diagnosis and treatment which always lead to the moderate/severe EMs.Therefore,the early diagnosis of minimal/mild EMs is still a great challenge.Laparoscopy combined with pathology is currently the gold standard.However,it is an invasive and costly procedure with potential risks for patients,suggesting that it is not suitable for the screening for early EMs.In recent years,more and more less-invasive methods have been proposed,such as a model combined with clinical symptoms,signs,biomarkers and imaging,which provide a new idea for the early diagnosis of minimal/mild EMs.Although these methods show the promising potential in the diagnosis of minimal/mild EMs,further validation with large sample size and better diagnostic performance is still needed.The combination of clinical signs,pelvic examination and biomarkers may be the solution for the diagnosis of minimal/mild EMs.