Thoracic Endometriosis: A Cohort Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 50
- Locations
- 1
- Primary Endpoint
- Mean scores of the Short Form Survey, SF-12
Study Overview
Brief Summary
Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. It is an estrogen-dependent chronic inflammatory disease. Estimates show that up to 10% of premenopausal women have endometriosis. The most frequent forms of endometriosis are superficial peritoneal implants, ovarian cysts and deep nodules or plaques. However, the pelvis is not the exclusive site of endometriotic lesions: endometriosis can also affect the diaphragm, the pleura and the lung. All these localizations are included in the spectrum of "thoracic endometriosis".
Thoracic endometriosis may present with cough, wheezing, catamenial pneumothorax, hemothorax, hemoptysis and pulmonary nodules. If the diaphragmatic pleura is also involved, catamenial periscapular or neck pain may be associated with irritation of the phrenic nerve. The symptoms of thoracic endometriosis generally have catamenial onset. Thoracic endometriosis rarely occurs isolated. It is considered a progression of pelvic endometriotic disease. Due to its varied presentation, diagnosis can be particularly difficult and often only identified due to clinical suspicion. The instrumental diagnosis of pneumothorax and catamenial hemothorax can be obtained by radiography or computerized axial tomography of the chest. Magnetic resonance imaging is to be preferred in case of diaphragmatic involvement. The gold standard remains exploratory laparoscopy, possibly accompanied by Video Assisted Thoracic Surgery (VATS).
The first-line treatment is hormone therapy, aimed at suppressing ovulation and also preventing the onset of relapses. GnRH analogues are very effective in reducing the painful symptoms associated with endometriosis, but are not superior to other first-line treatments available. Furthermore, the prolonged hypoestrogenism can cause menopausal symptoms and osteoporosis.
Surgery should be considered a second-line treatment in case of intolerance or ineffectiveness of medical therapy. The surgical approach is multidisciplinary and involves the endoscopist gynecologist and the thoracic surgeon expert in VATS.
The principal aim of the study is the retrospective evaluation of thoracic endometriosis cases in our clinic over the last 20 years in order to evaluate the effectiveness of medical and surgical treatments in terms of satisfaction of patients suffering from this clinical condition. The secondary aim is to investigate the pathogenetic aspects of this clinical condition.
Detailed Description
Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. It is an estrogen-dependent chronic inflammatory disease, in which the ectopic endometrium grows and proliferate under the action of estradiol. Estimates show that up to 10% of premenopausal women and 35% to 50% of women with infertility, pelvic pain or both, have endometriosis.
The most frequent forms of endometriosis are superficial peritoneal implants, ovarian cysts (endometrioma) and deep nodules or plaques (which can individually involve and infiltrate the parametria, Douglas pouch, anterior rectal wall, posterior vaginal fornix, antero-uterine pouch, bladder detrusor, ureters and sigmoid colon).
However, the pelvis is not the exclusive site of endometriotic lesions: endometriosis can also be localized outside the pelvis, resulting in the implantation and growth of an ectopic endometrium and catamenial symptoms.
In the thoracic cavity endometriosis can affect the diaphragm, the pleura and, ultimately, the lung. All these localizations are included in the spectrum of "thoracic endometriosis".
Thoracic endometriosis may present with cough, wheezing, catamenial pneumothorax, hemothorax, hemoptysis and pulmonary nodules. If the diaphragmatic pleura is also involved, catamenial periscapular or neck pain may be associated with irritation of the phrenic nerve.
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Retrospective
Eligibility Criteria
- Ages
- 18 Years to 50 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •women aged 18-50 years
- •women with a diagnosis of thoracic endometriosis, in the presence or absence of other endometriotic localizations
- •women referred to our tertiary-care endometriosis center " Fondazione IRCCS Ospedale Maggiore Policlinico", Milan, from 1 January 2000 to 01 March 2022.
Exclusion Criteria
- •the presence of concomitant diseases of the respiratory system
- •women who denied their consensus
Outcomes
Primary Outcomes
Mean scores of the Short Form Survey, SF-12
Time Frame: 10 years
The SF-12 health survey, developed from the original SF-36 questionnaire, is a well-known, validated, self-administered 12-item instrument. It measures health dimensions covering functional status, well-being, and overall health. Information from the 12 items is used to construct Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) measures, with higher scores indicating better health perception.
Number of patients greatly improved, much improved, minimally improved, unchanged, minimally worsened, very worsened and greatly worsened
Time Frame: 10 years
Patients' Global Impression of Change (PGIC) scale, a composed of seven levels (greatly improved, much improved, minimally improved, unchanged, minimally worsened, very worsened, greatly worsened) to evaluate the effectiveness of medical and surgical treatments for thoracic endometriosis.
Number of patients with none, mild, moderate, severe or very severe symptoms
Time Frame: 10 years
Patients' Global Impression of Severity (PGIS) scale, a scale consisting of five levels (none, mild, moderate, severe, very severe)
Number of patients very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied and very dissatisfied
Time Frame: 10 years
a five-level Likert scale (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied and very dissatisfied) to evaluate the effectiveness of medical and surgical treatments for thoracic endometriosis.
Mean scores of HADS- Hospital Anxiety and Depression Scale
Time Frame: 10 years
The HADS questionnaire is a self-assessment mood scale specifically designed for use in non-psychiatric hospital outpatients to determine states of anxiety and depression. It comprises 14 questions, 7 for the anxiety subscale and 7 for the depression subscale. Lower scores indicate better psychological status
Secondary Outcomes
No secondary outcomes reported
Investigators
Direzione Ginecologia
Clinical Professor
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
