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Matwani, Samaa

University of British Columbia

Endometriosis recurrence is variably reported in the literature using different definitions and therefore causing variable recurrence rate between 0-89% Guo. The aim of the thesis was to report different endometriosis recurrence rates reported in the literature based on different definitions used. Medline and Embase search engines were searched for studies reporting endometriosis recurrence following endometriosis surgery. Outcomes of interest were collected which included recurrence definition used, reported recurrence rates and details on their disease. Endometriosis recurrence was classified into recurrence defined based on symptoms recurrence, surgical reoperation, imaging recurrence, or combined definitions. We also looked specifically at ovarian endometriosis studies to highlight the most common recurrence definitions in this specific phenotype and a meta-analysis was performed using the RCT studies on ovarian endometriosis studies to examine the significance of the difference between recurrence rates by imaging diagnosis compared to symptoms diagnosis. Finally, a framework was suggested for ovarian endometriosis recurrence reporting in future studies. The systematic review included 198 studies. Our study revealed that recurrence rates were non calculable due to great heterogeneity in the studies, however the most common recurrence definition used in all studies was combined definitions (N=85,42.9%), followed by recurrence using imaging modalities (N=59, 29.8%). On the other hand, out of the studies describing ovarian endometriosis (82 studies), imaging recurrence was the most common definition used (N=45, 54.9%), followed by the combined symptoms and imaging recurrence definition (N=45, 54.9%). Ultrasound was the imaging modality of choice in imaging recurrence definitions in most studies with the ultrasound performed most between 3-6 months following surgery. The most consistent terms used as criteria for diagnosis were round/cystic mass, homogenous, low echogenic fluid content with scattered internal echoes/ground glass appearance, and the absence of papillary proliferations. The cut-off diameter of the recurrent ovarian endometrioma used in most studies was 2 cm (23 studies, 59.0%). The meta-analysis of 4 RCT studies on ovarian endometriosis using the combined symptoms and imaging recurrence definitions revealed a significant difference between the recurrence rate with a total of 21 recurrences/322 patients diagnosed by imaging vs. 66 recurrences diagnosed by symptoms in 322 patients (OR:0.29, CI 0.17-0.50).

Text

2025-02-18

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/90384

Reproductive and Developmental Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/