Smita Mandasad
BBC Health
For thousands of women, getting a diagnosis of endometriosis can take years.
A new scanning technique, developed in a pilot study at the University of Oxford, could enable earlier detection of the disease.
The method combines CT imaging with a molecular tracer to identify early changes in endometriosis, which are often missed by standard examinations.
If its effectiveness is confirmed in larger studies, this technology could provide women with a faster explanation for their symptoms, the scientists emphasize.
Affecting one in ten women in the UK, endometriosis is a painful condition where tissue similar to the lining of the womb grows outside of it.
On average, the wait for a diagnosis is up to nine years.
Symptoms can be very pronounced and varied – from heavy periods to extreme fatigue and stomach pains.
Patients often undergo numerous examinations, go for ultrasound and sometimes magnetic resonance imaging (MRI).
However, standard scans do not always detect the disease and usually show changes that occur only in advanced stages, says Dr. Tatjana Gibbons, the study’s lead researcher.
“This means that many people still have symptoms, even though they are told that the findings are normal,” he explains.
He adds that early diagnosis can help people make important decisions and plan their own lives.
‘A very long and exhausting road’
Gabriela Pearson, co-founder of the humanitarian organization Menstrual Health Project, was diagnosed with endometriosis at the age of 23, after more than a decade of worsening symptoms and a series of misdiagnoses.
The 33-year-old woman says that, “if they had heard about her earlier and had diagnosed her (endometriosis), she would be in a completely different situation today.”
Endometriosis affected her intestines, bladder and ovary and left permanent damage.
“Because of the pain and complications, I couldn’t advance in my career or go to college,” says Pearson.
“It has a knock-on effect on mental health, finances, work and fertility.”
“So I think if people were diagnosed earlier and had a better chance of an extended quality of life at a younger age, that would really help them a lot.”
Pearson was just 10 years old when her debilitating menstrual cramps began.
With every bite of food she would eat, she developed painful stomach problems.
She was told it was “because she’s a woman” and then chalked it up to irritable bowel syndrome or stress.
She went to doctors for years, until she found a general practitioner who said it was probably endometriosis.
“It’s been a very long journey and we definitely need more precision in the review,” Pearson says.
“We deserve something that’s more consistent and reliable for patients, and that’s also non-invasive.”
“I struggled with an invasive ultrasound, which was very painful,” she adds.
Doctors interpreted her ultrasound differently.
Years later, she underwent laparoscopy to get a definitive diagnosis because she felt she really needed to know what was going on.
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New findings ‘really exciting’
Although patients may be offered certain therapies, the only way to make a definitive diagnosis right now is laparoscopy, in which a small camera is inserted into the body through a small incision in the abdomen.
In the study, 19 people with confirmed or suspected endometriosis had a CT scan along with an injection of a molecular tracer called maraciclatide.
It binds to areas where new blood vessels form, which are thought to be a key part of the early development of endometriosis.
The new technique was able to accurately detect the presence or absence of endometriosis in 16 women.
She also correctly identified 14 of 17 cases of endometriosis that were later confirmed by surgery.
Gibbons says the findings are “exciting.”
This technique “offers a very promising diagnostic and follow-up tool, especially for superficial peritoneal endometriosis (which is considered an early form of the disease), which is the most common and also the most difficult to detect.”
Dr Lucy Whittaker, a gynecologist and researcher at the University of Edinburgh, who was not involved in the study, said there was a “desperate need for new non-invasive imaging techniques”.
“This is really exciting preliminary data that warrants further research,” she says.
“If they are confirmed, it gives us a real opportunity to intervene at an earlier stage and help people get an earlier diagnosis and potentially consider treatment,” adds the doctor.
The new technique could also have a role in researching how the disease changes over time, as well as how different treatment options work.
Whittaker adds that the scans and the tracer used involve radiation exposure, which should be carefully considered and compared to the risks of laparoscopy, for example.
The work, published in the Lancet journal, was led by the University of Oxford’s Nuffield Department of Women’s and Reproductive Health and the company Serac Healthcare.
Symptoms to look out for:
- severe menstrual pain that prevents you from doing normal activities
- heavy menstruation
- extreme fatigue
- pain in the lower abdomen, back and pelvic area
- pain when urinating or having a bowel movement
- pain during or after sexual intercourse
- pain or bleeding in other parts of the body, such as the chest
- difficulties with conception
- bad mood
Additional reporting: Vicki Loder
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