Selcuk Selcuk, Cam Cetin, Koc Nermin, Kucukbas Mehmet, Ozkaya Enis, Eser Ahmet, Karateke Ates
Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
Zeynep Kamil Training and Researching Hospital, Department of Pathology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:56-60. doi: 10.1016/j.ejogrb.2016.05.008. Epub 2016 May 20.
To evaluate the risk factors for the recurrence of ovarian endometrioma after laparoscopic cystectomy.
Reproductive aged patients who underwent laparoscopic ovarian endometriotic cystectomy and with histopathologically confirmed diagnosis of ovarian endometrioma were evaluated retrospectively. Histopathologic specimens were reevaluated and histopathologic characteristics of ovarian endometriotic cysts (thickness of cyst wall, thickness of fibrosis [ToF], thickness of ovarian tissue, the number of follicles per cyst, the depth of penetration [DoP] of endometrial tissue into the cyst wall) were determined. Along the determined histopathologic findings, demographic characteristics (age at surgery, number of pregnancies), clinical symptoms (dysmenorrhea, infertility), intraoperative findings (revised American Society for Reproductive Medicine [rASRM] stage), imaging features (bilaterality, cyst diameter), and biochemical parameters (Ca125, Ca19.9, Ca15.3) were evaluated as possible risk factors for the recurrence of endometrioma. The variables with p<0.2 in univariate analysis were introduced into regression analysis to determine the risk factors for recurrence.
There were statistically significant differences in age group (≤35 years and >35 years), the ToF and DoP between patients with recurrence and those with no recurrence. In Cox regression analysis, age ≤35 years and DoP were significant risk factors for presence of recurrence. DoP, ToF, preoperative cyst diameters in ultrasonographic examination were inversely correlated with recurrence interval. In multivariate regression analysis, the DoP was found the only significant risk factor for the recurrence interval. 1.2mm of DoP was found as the optimum cut off value for presence of recurrence according to Youden index criteria in ROC curve analyze. The sensitivity (62.9%), specificity (75%) were obtained at the cut off value of 1.2mm for DoP.
Histopathological features of ovarian endometriotic cyst may have important roles on predicting the recurrence of the endometrioma. Predicting the recurrence risk of particular patient is very important in future management of the disease. Knowing the recurrence risk of an endometrioma will help in deciding the optimal treatment modalities for each individual patient. High risk patients should be offered appropriate treatments according to the clinical status without delay and low risk patients should be protected from overtreatment.
评估腹腔镜囊肿切除术后卵巢子宫内膜异位囊肿复发的危险因素。
对接受腹腔镜卵巢子宫内膜异位囊肿切除术且经组织病理学确诊为卵巢子宫内膜异位囊肿的育龄患者进行回顾性评估。对组织病理学标本进行重新评估，确定卵巢子宫内膜异位囊肿的组织病理学特征（囊肿壁厚度、纤维化厚度[ToF]、卵巢组织厚度、每个囊肿的卵泡数量、子宫内膜组织向囊肿壁的浸润深度[DoP]）。根据确定的组织病理学结果，评估人口统计学特征（手术年龄、妊娠次数）、临床症状（痛经、不孕）、术中发现（修订后的美国生殖医学学会[rASRM]分期）、影像学特征（双侧性、囊肿直径）和生化参数（Ca125、Ca19.9、Ca15.3）作为子宫内膜异位囊肿复发的可能危险因素。将单因素分析中p<0.2的变量纳入回归分析以确定复发的危险因素。
复发患者与未复发患者在年龄组（≤35岁和>35岁）、ToF和DoP方面存在统计学显著差异。在Cox回归分析中，年龄≤35岁和DoP是复发的显著危险因素。DoP、ToF、超声检查术前囊肿直径与复发间隔呈负相关。在多因素回归分析中，DoP被发现是复发间隔的唯一显著危险因素。根据ROC曲线分析中的约登指数标准，DoP为1.2mm被发现是复发存在的最佳截断值。DoP为1.2mm的截断值时，敏感性为62.9%，特异性为75%。
卵巢子宫内膜异位囊肿的组织病理学特征可能对预测子宫内膜异位囊肿的复发具有重要作用。预测特定患者的复发风险在该疾病的未来管理中非常重要。了解子宫内膜异位囊肿的复发风险将有助于为每个患者确定最佳治疗方式。高风险患者应根据临床状况及时接受适当治疗，低风险患者应避免过度治疗。
