Xholli Anjeza, Molinari Filippo, Scovazzi Umberto, Londero Ambrogio Pietro, Perugi Isabella, Kratochwila Chiara, Cremonini Francesca, Cagnacci Angelo
Academic Unit of Obstetrics and Gynecology, IRCCS San Martino Hospital, Genoa, Italy.
Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal, and Infant Health (DiNOGMI), IRCCS San Martino Hospital, Genoa, Italy.
Ultrasonography. 2024 Nov;43(6):490-498. doi: 10.14366/usg.24117. Epub 2024 Sep 2.
Internal cervical os (ICO) stiffness is related to menstrual pain, a key symptom of endometriosis. The study evaluated whether women with endometriosis have a stiffer ICO than unaffected women.
A retrospective cross-sectional analysis was conducted using prospectively collected data from women with and without endometriosis, spanning from June 2020 to September 2022. Endometriosis was diagnosed through clinical and ultrasound evaluations, with histological confirmation in a subset of participants. Strain elastography (SE) was employed to measure tissue elasticity in four cervical regions of interest: the ICO and the anterior, posterior, and middle cervical compartments (ACC, PCC, and MCC, respectively). Tissue elasticity was quantified using a color-based scoring system ranging from 0.1 (blue, indicating less elasticity) to 3.0 (red, indicating greater elasticity).
Overall, 287 women were included, with 157 diagnosed with endometriosis and 130 controls. On SE, women with endometriosis exhibited a lower color score (mean±standard deviation), indicating lower elasticity, for the ICO (0.56±0.28 vs. 0.70±0.26, P=0.001) and PCC (0.69±0.30 vs. 0.80±0.27, P=0.002). Additionally, they had a lower ICO/MCC ratio (0.45±0.28 vs. 0.60±0.32, P=0.001) and ICO/ACC ratio (0.68±0.42 vs. 0.85±0.39, P=0.001). Multiple logistic regression analysis revealed that endometriosis was associated with the ICO color score (odds ratio, 0.053; 95% confidence interval, 0.014 to 0.202; R2=0.358; P=0.001), even after adjusting for confounding factors like the presence of myomas (P=0.040) and the use of hormonal therapy (P=0.001). The results were corroborated in women with histologically confirmed endometriosis (n=71).
The findings suggest a potential relationship between a stiffer ICO and endometriosis.
宫颈内口（ICO）僵硬与痛经相关，痛经是子宫内膜异位症的一个关键症状。本研究评估了患有子宫内膜异位症的女性的ICO是否比未受影响的女性更僵硬。
采用回顾性横断面分析，使用2020年6月至2022年9月期间前瞻性收集的有或无子宫内膜异位症女性的数据。通过临床和超声评估诊断子宫内膜异位症，部分参与者进行了组织学确认。应变弹性成像（SE）用于测量宫颈四个感兴趣区域的组织弹性：ICO以及宫颈前、后和中间隔室（分别为ACC、PCC和MCC）。使用基于颜色的评分系统对组织弹性进行量化，范围从0.1（蓝色，表示弹性较小）到3.0（红色，表示弹性较大）。
总体而言，纳入了287名女性，其中157名被诊断为子宫内膜异位症，130名作为对照。在SE检查中，患有子宫内膜异位症的女性的ICO（0.56±0.28 vs. 0.70±0.26，P=0.001）和PCC（0.69±0.30 vs. 0.80±0.27，P=0.002）的颜色评分较低，表明弹性较低。此外，她们的ICO/MCC比值（0.45±0.28 vs. 0.60±0.32，P=0.001）和ICO/ACC比值（0.68±0.42 vs. 0.85±0.39，P=0.001）也较低。多因素逻辑回归分析显示，即使在调整了肌瘤存在（P=0.040）和激素治疗使用情况（P=0.001）等混杂因素后，子宫内膜异位症仍与ICO颜色评分相关（比值比，0.053；95%置信区间，0.014至0.
