Department of Reproductive Medicine, Endometriosis Center, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.
Department of Surgery, Endometriosis Center, Amsterdam UMC-Location VUmc, De Boelelaan 1118, ZH7F20, 1081HZ, Amsterdam, The Netherlands.
Surg Endosc. 2020 Jan;34(1):96-104. doi: 10.1007/s00464-019-06736-8. Epub 2019 Apr 26.
For surgical endometriosis, treatment key is to properly identify the peritoneal lesions. The aim of this clinical study was to investigate if advanced imaging improves the detection rate by comparing narrow-band imaging (NBI), near-infrared imaging with indocyanine green (NIR-ICG), or three-dimensional white-light imaging (3D), to conventional two-dimensional white-light imaging (2D) for the detection of peritoneal endometriotic lesions.
This study was a prospective, single-center, randomized within-subject, clinical trial. The trial was conducted at Amsterdam UMC-Location VUmc, a tertiary referral hospital for endometriosis. 20 patients with ASRM stage III-IV endometriosis, scheduled for elective laparoscopic treatment of their endometriosis, were included. During laparoscopy, the pelvic region was systematically inspected with conventional 2D white-light imaging followed by inspection with NBI, NIR-ICG, and 3D imaging in a randomized order. Suspected endometriotic lesions and control biopsies of presumably healthy peritoneum were taken for histological examination. The pathologist was blinded for the method of laparoscopic detection. Sensitivity and specificity rates of the enhanced imaging techniques were analyzed. McNemar's test was used to compare sensitivity to 2D white-light imaging and Method of Tango to assess non-inferiority of specificity.
In total, 180 biopsies were taken (117 biopsies from lesions suspected for endometriosis; 63 control biopsies). 3D showed a significantly improved sensitivity rate (83.5% vs. 75.8%, p = 0.016) and a non-inferior specificity rate (82.4% vs. 84.7%, p = 0.009) when compared to 2D white-light imaging. The single use of NBI or NIR-ICG showed no improvement in the detection of endometriosis. Combining the results of 3D and NBI resulted in a sensitivity rate of 91.2% (p < 0.001).
Enhanced laparoscopic imaging with 3D white light, combined with NBI, improves the detection rate of peritoneal endometriosis when compared to conventional 2D white-light imaging. The use of these imaging techniques enables a more complete laparoscopic resection of endometriosis.
对于外科子宫内膜异位症，治疗的关键是正确识别腹膜病变。本临床研究旨在通过比较窄带成像（NBI）、近红外成像与吲哚菁绿（NIR-ICG）或三维白光成像（3D）与传统二维白光成像（2D），来探讨高级成像是否可以提高腹膜子宫内膜异位症病变的检测率。
这是一项前瞻性、单中心、随机自身对照的临床试验。试验在阿姆斯特丹 UMC-VUmc 进行，这是一家子宫内膜异位症的三级转诊医院。纳入了 20 名 ASRM 分期 III-IV 期子宫内膜异位症患者，这些患者计划接受腹腔镜子宫内膜异位症的选择性治疗。腹腔镜检查时，系统地用传统的二维白光成像进行盆腔检查，然后随机用 NBI、NIR-ICG 和 3D 成像进行检查。对疑似子宫内膜异位症病变和假定健康腹膜的对照活检进行组织学检查。病理学家对腹腔镜检测方法不知情。分析了增强成像技术的敏感性和特异性。采用 McNemar 检验比较 2D 白光成像的敏感性和 Tango 方法评估特异性的非劣效性。
总共采集了 180 个活检（117 个来自疑似子宫内膜异位症的病变；63 个来自假定健康腹膜的对照活检）。与 2D 白光成像相比，3D 显示出明显提高的敏感性（83.5%比 75.8%，p=0.016）和非劣效特异性（82.4%比 84.7%，p=0.009）。单独使用 NBI 或 NIR-ICG 并不能提高子宫内膜异位症的检测率。3D 与 NBI 相结合的结果导致敏感性率达到 91.2%（p<0.001）。
与传统的二维白光成像相比，3D 白光增强腹腔镜成像联合 NBI 可提高腹膜子宫内膜异位症的检测率。这些成像技术的使用可以使子宫内膜异位症的腹腔镜切除更完整。
