**8. References**

432 Endometriosis - Basic Concepts and Current Research Trends

The study of protein function and protein-protein interaction can clarify the biology of the disease more so than the application of genomics. This is because gene expression and biological effects are linked via complex protein synthesis and gene interaction pathways. **Genomics** includes hybridization techniques (e.g. differential colony hybridization), subtractive techniques (e.g. hybridization and representational difference analysis), gelbased techniques (e.g. RNA arbitrarily primed or differential display), and sequencing based techniques (e.g. expression sequence tags and serial analysis of gene expression). Furthermore, the use of DNA microarrays allows the search for new gene expression markers of endometriosis by identifying differentially expressed genes in endometriosis implants compared with endometrial tissue. The aim of the technique is to identify changes in gene expression characterizing the disease state so that we can understand the disease's

Apart from the better understanding of the pathophysiology and the metabolic pathways that lead to potential biomarkers for endometriosis, there are still issues to be clarified and applications to be achieved. Once a protein or small number of proteins have been shown to be differentially expressed in endometriosis, the next step will be to use this information to try to develop a non-invasive diagnostic test for endometriosis. This diagnostic test should ideally have good sensitivity and specificity as well as satisfactory positive and negative predicative values for the detection of endometriosis, and also be cost effective and readily

Genetic markers that are prognostic for endometriosis can be genotyped early in life and could predict individual response to various risk factors and treatment. Genetic predisposition revealed by genetic analysis for susceptibility genes can provide an integrated assessment of the interaction between genotypes and environmental factors, resulting in synergistically increased prognostic value of diagnostic tests. Thus, presymptomatic and early symptomatic genetic testing is expected to be the cornerstone of the paradigmatic shift from late surgical interventions to earlier preventative therapies. Thus, there is an urgent need for novel genetic markers that are predictive of endometriosis and endometriosis progression, particularly in treatment decisions for individuals who are

Such genetic markers may enable prognosis of endometriosis in much larger populations compared with the populations that can currently be evaluated by using existing risk factors

The availability of a genetic test may allow, for example, early diagnosis and prognosis of endometriosis, as well as clinical intervention to mitigate progression of the disease. The use of these genetic markers will also allow selection of subjects for clinical trials involving

The discovery of genetic markers associated with endometriosis will further provide novel targets for therapeutic intervention or preventive treatments of endometriosis and enable

One of the main objectives of the gynaecologist is to diagnose endometriosis without the use of laparoscopy or laparotomy. Currently, laparoscopy offers the most specific and sensitive

the development of new therapeutic agents for treating endometriosis.

progression and identify novel therapeutic targets.

recognized as having endometriosis.

available.

and biomarkers.

**7. Conclusions** 

novel treatment methods.


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**24** 

*Hong Kong* 

**Imaging Tools for Endometriosis: Role of** 

 **in Diagnosis and Planning Intervention** 

*2Department of Imaging and Interventional Radiology,* 

*The Chinese University of Hong Kong, Prince of Wales Hospital,* 

**Ultrasound, MRI and Other Imaging Modalities** 

Shalini Jain Bagaria1, Darshana D. Rasalkar2 and Bhawan K. Paunipagar2 *1Department of Obstetrics & Gynecology, UCMS & GTB Hospital, Dilshad Garden,* 

Endometriosis is the presence of endometrial glands as well as stroma at the locations outside uterus. It affects up to 10% of women. Grossly there are three forms of the disease, namely a) superficial endometrial implants, b) ovarian endometriomas or endometriotic cysts, and c) deep infiltrating endometriosis. All the three forms depict varied manifestation of a single disease and require a careful pre operative work up to know the extent and

The superficial implants are typically 2-3 mm in size rooted in the serosal tissue of the peritoneum. They initially appear as red highly vascular lesions. Later, repeated haemorrhage and inflammation triggers fibrosis and haemosiderin deposition in them causing raised powder burn lesions. It is hard to find such lesions by USG or MRI. Traditional method of diagnostic endoscopy still remains the golden standard of reference

Endometriomas of the ovary or chocolate cysts of the ovary contain degraded blood products. The dark and gelatinous material in them is surrounded by fibrous wall of variable thickness. Endomeriotic cysts are often bilateral and multiple. Both the USG and

The deep infiltrating endometriosis (DIE) is defined as the implant penetrating into the retroperitoneal space or the wall of the pelvic organs to the depth of at least 5mm. (Knoninckx et al). They usually appear as solid nodules. These types of lesions permeate deep into the surrounding fibromuscular tissues and induce smooth muscle proliferation and fibrous reaction effecting development of solid nodules. In case of visceral involvement, they can infiltrate into the muscle layer from the serosal layer. The resulting smooth muscle

The natural history of the symptomatic disease is uncertain. The lesions may either continue to be same or may evolve further or may regress. Its malignant transformation is uncommon

proliferation can lead to stricture formation and later obstruction.

distribution of the disease precisely as it is critical to frame the plan of management.

**1. Introduction** 

to diagnose and stage this form of disease.

MRI play key role in its evaluation.

**2. Natural history of the disease** 

