ИСТИНА

Relevance: Early diagnosis of endometriosis in adolescents is not developed, the clinics is polymor- phic, instrumental methods are difficult in evaluation, causing diagnostic delay up to 8-10 years in average. Objective: To characterize the pivotal clinical, instrumental, surgical and histological peculiarities of peritoneal endometriosis in adolescents to improve early diagnosis. Design: a case-control study. Methods: The study included 90 adolescent girls (13 to 17 years old) diagnosed with laparoscopically confirmed peritoneal endometriosis (PE). The comparison group consisted of 44 healthy girls of the same age with regular menses. Participants underwent clinical, hormonal, instrumental examination. In patients with PE the laparoscopic and histological picture were analyzed. Results: The risk factors for endometriosis were the family history of endometriosis and dysmenorrhea from menarche (≤0.005). Patients with PE compared to the controls were characterized with persistent dysmenorrhea, decreased daily activity, gastrointestinal symptoms, higher LH, estradiol, prolactin and Ca-125 levels (≤0.05 for each criterion). Detection by ultrasound of PE was 3.3%, MRI - 78.9%. Multivariate analysis of all MRI signs in PE in adolescents revealed as the most essential: the heterogeneity of paraovarian or parametrial tissue, the sacro-uterine ligaments thickening or nod- ular irregularity, heterogeneity of the tissue of the pouch of Douglas (≤0.05 for each criterion). Diagnostic MRI accuracy of PE reaches 74.7% (F=34.0, p<0.001) using any of the described positive signs for ligament’s or/and heterogeneity of the tissue. However, MRI data of accurate localization of foci in mild stages matched with laparoscopic picture for uterosacral ligaments and pouch of Douglas less than in half of the cases (<0.005). Adolescents with PE mostly exhibit initial rASRM stages (I and II stage in 92.2%), predominantly clear vesical (57.8%), red (43.3%) foci. Red implants correlated with a higher score rASRM (≤0.05), sheer implants were associated with pain (VAS score) (≤0.01). Endometriotic tissue was detected in 67.8% of cases, in 32.2% visual foci consisted with fibrous, adipose, muscle tissue; black lesions were more likely to be histologically verified (=0.001). Conclusion: Such indicators as family history for endometriosis, persistent dysmenorrhea from menarche, suspicion according to MRI applying detected parameters, could be suggested for use in the PE diagnostics in adolescents with a high relevance. Adolescents exhibit mild (I-II) stages of endometriosis with active implants, associated with greater pain. In third of adolescents with persistent dysmenorrhea the PE was visually confirmed in the absence of MRI predictors and histological approvement, justifying the significance of diagnostic laparoscopy.