{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T00:19:13Z","timestamp":1793751553570,"version":"4.6.1"},"reference-count":168,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Superficial peritoneal endometriosis (SPE) remains one of the most difficult endometriosis phenotypes to diagnose non-invasively, because lesions are frequently small, multifocal, and poorly detectable using conventional imaging. Diagnostic laparoscopy therefore remains the reference standard for direct visualization of superficial peritoneal lesions. However, the inconsistent relationship between visible lesion burden and pain severity, together with the multifactorial nature of chronic pelvic pain, highlights the limitations of a purely lesion-based diagnostic model. This narrative review reassesses SPE from a cautious functional and molecular perspective, focusing on clinically established evidence, emerging but incompletely validated tools, and hypothesis-generating concepts. The novelty of this review lies in its specific focus on SPE as an unresolved diagnostic phenotype and in the proposed integration of surgical diagnosis, expert imaging, pain phenotyping, empirical treatment response, and molecular research within a non-replacement framework. Materials and Methods: A narrative literature review was performed using PubMed\/MEDLINE, Scopus, Web of Science, and the Cochrane Library for English-language articles published between January 2010 and April 2026. The search focused on SPE, diagnostic laparoscopy, dynamic transvaginal ultrasound, sliding sign, chronic pelvic pain, hormonal treatment response, neuroinflammation, liquid biopsy, circulating biomarkers, epigenetics, and microbiome research. Results: Dynamic transvaginal ultrasound, sliding sign assessment, pelvic organ mobility evaluation, and tenderness-guided examination may provide indirect functional information in selected patients with suspected SPE, but they remain operator-dependent and insufficiently standardized for this phenotype. Response to hormonal therapy may support clinical reasoning, but it has low specificity and may also reflect improvement of adenomyosis, primary dysmenorrhea, ovulation-related pain, abnormal uterine bleeding, or other estrogen-sensitive conditions. Liquid biopsy and molecular biomarkers, including circulating microRNAs, extracellular vesicles, cell-free DNA, inflammatory mediators, epigenetic signatures, adipokine-related markers, and microbiome-related signals, remain investigational and require phenotype-specific validation. Conclusions: Functional and molecular stratification of suspected SPE represents a promising research direction rather than a current clinical standard. Laparoscopy remains essential when definitive diagnosis or surgical treatment is required, particularly in patients with infertility, refractory symptoms, suspicious imaging, or suspected complex disease. Future validated models may help integrate clinical phenotype, expert imaging, treatment response, pain mechanisms, and molecular profiles to support more individualized and selective diagnostic pathways.<\/jats:p>","DOI":"10.3390\/medicina62081488","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T01:43:27Z","timestamp":1785721407000},"page":"1488","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Superficial Peritoneal Endometriosis Beyond Surgical Diagnosis: A Narrative Review of Emerging Functional and Molecular Perspectives"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0670-2666","authenticated-orcid":false,"given":"Mario","family":"Palumbo","sequence":"first","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2962-6565","authenticated-orcid":false,"given":"Giuseppe","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8935-5710","authenticated-orcid":false,"given":"Dario","family":"Colacurci","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5061-8007","authenticated-orcid":false,"given":"Giorgio Maria","family":"Baldini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6071-0245","authenticated-orcid":false,"given":"Marco","family":"La Verde","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6828-1887","authenticated-orcid":false,"given":"Rafa\u0142","family":"Watrowski","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Helios Hospital M\u00fcllheim, Heliosweg 1, 79379 M\u00fcllheim, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Carone","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, \u201cF. Miulli\u201d General Regional Hospital, Acquaviva delle Fonti, 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Bifulco","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Giampaolino","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-2181","authenticated-orcid":false,"given":"Luigi","family":"Della Corte","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"F1000 Faculty Rev-529","DOI":"10.12688\/f1000research.14817.1","article-title":"Endometriosis: Advances and Controversies in Classification, Pathogenesis, Diagnosis, and Treatment","volume":"8","author":"Rolla","year":"2019","journal-title":"F1000Research"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Koninckx, P.R., Fernandes, R., Ussia, A., Schindler, L., Wattiez, A., Al-Suwaidi, S., Amro, B., Al-Maamari, B., Hakim, Z., and Tahlak, M. (2021). Pathogenesis Based Diagnosis and Treatment of Endometriosis. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.745548"},{"key":"ref_3","first-page":"349","article-title":"Endometriosis Still a Challenge","volume":"7","author":"Mehedintu","year":"2014","journal-title":"J. Med. Life"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tennfjord, M.K., Gabrielsen, R., and Tellum, T. (2021). Effect of Physical Activity and Exercise on Endometriosis-Associated Symptoms: A Systematic Review. BMC Womens Health, 21.","DOI":"10.1186\/s12905-021-01500-4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.ogc.2024.08.003","article-title":"Dysmenorrhea and Endometriosis in Adolescents","volume":"51","author":"Shim","year":"2024","journal-title":"Obstet. Gynecol. Clin. North Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"427","DOI":"10.48095\/cccg2022427","article-title":"Endometriosis in Postmenopause","volume":"87","author":"Eminger","year":"2022","journal-title":"Ceska Gynekol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1080\/08820139.2020.1764577","article-title":"Endometriosis: What Is the Influence of Immune Cells?","volume":"50","author":"Crispim","year":"2021","journal-title":"Immunol. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s11916-020-00884-6","article-title":"Endometriosis Pain Management: A Review","volume":"24","author":"Carlyle","year":"2020","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"10S","DOI":"10.1111\/j.1552-6909.1985.tb02795.x","article-title":"Endometriosis","volume":"14","author":"Garner","year":"1985","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.molmed.2025.09.002","article-title":"Endometriosis and Comorbidities: Molecular Mechanisms and Clinical Implications","volume":"32","author":"Petraglia","year":"2026","journal-title":"Trends Mol. Med."},{"key":"ref_11","first-page":"CD011031","article-title":"Laparoscopic surgery for endometriosis","volume":"10","author":"Bafort","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE Guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e062808","DOI":"10.1136\/bmjopen-2022-062808","article-title":"Is laparoscopic excision for superficial peritoneal endometriosis helpful or harmful? Protocol for a double-blinded, randomised, placebo-controlled, three-armed surgical trial","volume":"12","author":"Marschall","year":"2022","journal-title":"BMJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.fertnstert.2023.12.008","article-title":"Noninvasive Diagnostic Imaging for Endometriosis Part 1: A Systematic Review of Recent Developments in Ultrasound, Combination Imaging, and Artificial Intelligence","volume":"121","author":"Avery","year":"2024","journal-title":"Fertil. Steril."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.bpobgyn.2018.01.013","article-title":"Ultrasound Diagnosis of Endometriosis and Adenomyosis: State of the Art","volume":"51","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1111\/aogs.14099","article-title":"The #Enzian Classification: A Comprehensive Non-Invasive and Surgical Description System for Endometriosis","volume":"100","author":"Keckstein","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jmig.2020.05.003","article-title":"Negative Sliding Sign during Dynamic Ultrasonography Predicts Low Endometriosis Fertility Index at Laparoscopy","volume":"28","author":"Alfaraj","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1159\/000543075","article-title":"Advancements in Ultrasound Diagnosis of Superficial Endometriosis: Current Challenges and Emerging Techniques","volume":"90","author":"Freger","year":"2025","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/uog.24892","article-title":"Strengths and Limitations of Diagnostic Tools for Endometriosis and Relevance in Diagnostic Test Accuracy Research","volume":"60","author":"Pascoal","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1002\/uog.27602","article-title":"Clinical and Ultrasound Characteristics of Deep Endometriosis Affecting Sacral Plexus","volume":"64","author":"Bokor","year":"2024","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.fertnstert.2020.06.012","article-title":"Adolescence and Endometriosis: Symptoms, Ultrasound Signs and Early Diagnosis","volume":"114","author":"Martire","year":"2020","journal-title":"Fertil. Steril."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/uog.15990","article-title":"Sonographic Evaluation of Immobility of Normal and Endometriotic Ovary in Detection of Deep Endometriosis","volume":"49","author":"Gerges","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1093\/humrep\/den293","article-title":"Diagnostic Value of Transvaginal \u2018Tenderness-Guided\u2019 Ultrasonography for the Prediction of Location of Deep Endometriosis","volume":"23","author":"Guerriero","year":"2008","journal-title":"Hum. Reprod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1080\/14656566.2024.2425727","article-title":"Managing the Neuroinflammatory Pain of Endometriosis in Light of Chronic Pelvic Pain","volume":"25","author":"Pergolizzi","year":"2024","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.fertnstert.2023.12.035","article-title":"Transvaginal Ultrasound: A Reliable Tool for Detection and Preoperative Mapping of Pelvic Endometriosis","volume":"121","author":"Jha","year":"2024","journal-title":"Fertil. Steril."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2244877","DOI":"10.1080\/07853890.2023.2244877","article-title":"Clinicopathological Correlations of Peritoneal Endometriosis and Deep Infiltrating Endometriosis","volume":"55","author":"Qiu","year":"2023","journal-title":"Ann. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/uog.24900","article-title":"Diagnostic Accuracy of Sliding Sign for Detecting Pouch of Douglas Obliteration and Bowel Involvement in Women with Suspected Endometriosis: Systematic Review and Meta-Analysis","volume":"60","author":"Eguez","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Maple, S., Bezak, E., Chalmers, K.J., and Parange, N. (2024). Relationship Between Ultrasound Diagnosis, Symptoms and Pain Scale Score on Examination in Patients with Uterosacral Ligament Endometriosis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226901"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejogrb.2024.04.015","article-title":"Transvaginal Ultrasound with Bowel Preparation versus Transvaginal Ultrasound with Bowel Preparation and Water Contrast for Diagnosing Recto-Sigmoid Endometriosis: A Systematic Review and Meta-Analysis","volume":"297","author":"Maderuelo","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1002\/ijgo.70410","article-title":"Optimizing Endometriosis Diagnosis and Mapping: The Important Role of Advanced Transvaginal Ultrasound","volume":"172","year":"2026","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1002\/uog.24756","article-title":"Prevalence of Deep and Ovarian Endometriosis in Early Pregnancy: Ultrasound Diagnostic Study","volume":"59","author":"Bean","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1002\/j.2205-0140.2013.tb00099.x","article-title":"The \u2018Sliding Sign\u2019 in Conjunction with Sonovaginography: Is This the Optimal Approach for the Diagnosis of Pouch of Douglas Obliteration and Posterior Compartment Deep Infiltrating Endometriosis?","volume":"16","author":"Menakaya","year":"2013","journal-title":"Australas. J. Ultrasound Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1002\/jum.15800","article-title":"Ovarian Immobility at Transvaginal Ultrasound: An Important Sonographic Marker for Prediction of Need for Pelvic Sidewall Surgery in Women with Suspected Endometriosis","volume":"41","author":"Rao","year":"2022","journal-title":"J. Ultrasound Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.jmig.2022.06.014","article-title":"Ultrasound Evaluation of Retrocervical and Parametrial Deep Endometriosis on the Basis of Surgical Anatomic Landmarks","volume":"29","author":"Casarella","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/jum.16335","article-title":"The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis","volume":"43","author":"Chway","year":"2024","journal-title":"J. Ultrasound Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.ogc.2019.07.004","article-title":"Ultrasound Imaging in Endometriosis","volume":"46","author":"Moro","year":"2019","journal-title":"Obstet. Gynecol. Clin. North Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101953","DOI":"10.1016\/j.jogoh.2020.101953","article-title":"Accuracy of Transvaginal Ultrasound for Diagnosis of Deep Infiltrating Endometriosis in the Uterosacral Ligaments: Systematic Review and Meta-Analysis","volume":"50","author":"Zhou","year":"2021","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2147\/IJWH.S190326","article-title":"Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment","volume":"12","author":"Habib","year":"2020","journal-title":"Int. J. Womens Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1111\/aogs.14865","article-title":"Evaluating the Development of Endometriosis and Adenomyosis Lesions over Time: An Ultrasound Study of Symptomatic Women","volume":"103","author":"Orlov","year":"2024","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/uog.15662","article-title":"Accuracy of Transvaginal Ultrasound for Diagnosis of Deep Endometriosis in the Rectosigmoid: Systematic Review and Meta-Analysis","volume":"47","author":"Guerriero","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1002\/uog.15667","article-title":"Accuracy of Transvaginal Ultrasound for Diagnosis of Deep Endometriosis in Uterosacral Ligaments, Rectovaginal Septum, Vagina and Bladder: Systematic Review and Meta-Analysis","volume":"46","author":"Guerriero","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/uog.15955","article-title":"Systematic Approach to Sonographic Evaluation of the Pelvis in Women with Suspected Endometriosis, Including Terms, Definitions and Measurements: A Consensus Opinion from the International Deep Endometriosis Analysis (IDEA) Group","volume":"48","author":"Guerriero","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1002\/uog.27558","article-title":"Addendum to Consensus Opinion from International Deep Endometriosis Analysis (IDEA) Group: Sonographic Evaluation of the Parametrium","volume":"64","author":"Guerriero","year":"2024","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1515\/hmbci-2021-0082","article-title":"Endometriosis at All Ages: Diagnostic Ultrasound","volume":"43","author":"Heiss","year":"2022","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1210\/endrev\/bnad020","article-title":"Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics","volume":"44","author":"Marquardt","year":"2023","journal-title":"Endocr. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/uog.26310","article-title":"Natural History of Endometriosis in Pregnancy: Ultrasound Study of Morphology of Deep Endometriosis and Ovarian Endometrioma","volume":"62","author":"Bean","year":"2023","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ejogrb.2019.01.018","article-title":"The Association Between Ultrasound-Based \u2018Soft Markers\u2019 and Endometriosis Type\/Location: A Prospective Observational Study","volume":"234","author":"Reid","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1002\/uog.29288","article-title":"Addendum to Consensus Opinion from the International Deep Endometriosis Analysis (IDEA) Group: Sonographic Evaluation of Superficial Endometriosis","volume":"66","author":"Guerriero","year":"2025","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.bpobgyn.2014.04.010","article-title":"Imaging for the Evaluation of Endometriosis and Adenomyosis","volume":"28","author":"Exacoustos","year":"2014","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.fertnstert.2023.11.027","article-title":"Ultrasound Findings in Endometriosis: Avoid Hidden Surprises","volume":"121","author":"Namazi","year":"2024","journal-title":"Fertil. Steril."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jogc.2021.08.013","article-title":"Diagnosis of Endometriosis at Laparoscopy: A Validation Study Comparing Surgeon Visualization with Histologic Findings","volume":"44","author":"Gratton","year":"2022","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"30799","DOI":"10.1038\/s41598-024-81033-6","article-title":"Assessment of Ovarian Reserve Function in Patients with Adenomyosis and Ovarian Endometriosis by Three-Dimensional Transvaginal Ultrasound and Anti-M\u00fcllerian Hormone","volume":"14","author":"Yin","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jmig.2021.08.023","article-title":"Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease","volume":"29","author":"Exacoustos","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/uog.27492","article-title":"Prospective Assessment of Accuracy of Transvaginal Ultrasound Posterior Approach for Uterosacral Ligament and Torus Uterinus Deep Endometriosis","volume":"63","author":"Freger","year":"2024","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1055\/a-1300-1887","article-title":"The Association Between Gastrointestinal Symptoms and Transvaginal Ultrasound Findings in Women Referred for Endometriosis Evaluation: A Prospective Pilot Study","volume":"43","author":"Soriano","year":"2022","journal-title":"Ultraschall Med."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Jiang, S., Xu, Z., Shao, X., Liang, J., Li, M., Bai, L., and Wang, T. (2024). Diagnostic Value and Clinical Significance of Serum miR-134-5p Combined with Uterine Artery Color Doppler Ultrasound Parameters in Endometriosis. BMC Womens Health, 24.","DOI":"10.1186\/s12905-024-03372-w"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1159\/000543342","article-title":"Ultrasound in Deep Endometriosis: A Narrative Review","volume":"90","author":"Guerriero","year":"2025","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/j.fertnstert.2008.12.038","article-title":"Pelvic Endometriosis and Hydroureteronephrosis","volume":"93","author":"Carmignani","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_59","first-page":"269","article-title":"Diagnosis of Endometriosis 3rd Part\u2014Ultrasound Diagnosis of Deep Endometriosis","volume":"84","author":"Fanta","year":"2019","journal-title":"Ceska Gynekol."},{"key":"ref_60","first-page":"61","article-title":"Endometriosis in Pregnancy\u2014Diagnostics and Management","volume":"84","author":"Fanta","year":"2019","journal-title":"Ceska Gynekol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.fertnstert.2020.07.039","article-title":"Diagnosing Endometriosis in Adolescents: Ultrasound Is a Game Changer","volume":"114","author":"Pirtea","year":"2020","journal-title":"Fertil. Steril."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Mariadass, H., Chen, J.H., and Chen, K.H. (2025). The Molecular and Cellular Mechanisms of Endometriosis: From Basic Pathophysiology to Clinical Implications. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26062458"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Ol\u00e1, I.E., Mitranovici, M.I., Chiorean, D.M., Irimia, T., Crisan, A.I., Melinte, I.M., Cotru\u0219, T., Tudorache, V., Moraru, I., and Moraru, R. (2024). Endometriosis and the Role of Pro-Inflammatory and Anti-Inflammatory Cytokines in Pathophysiology: A Narrative Review of the Literature. Diagnostics, 14.","DOI":"10.3390\/diagnostics14030312"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"4844","DOI":"10.1007\/s00261-025-04870-7","article-title":"Adolescent Endometriosis: Clinical Insights and Imaging Considerations","volume":"50","author":"Lambl","year":"2025","journal-title":"Abdom. Radiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1111\/1471-0528.15917","article-title":"Deep Endometriosis Transvaginal Ultrasound in the Workup of Patients with Signs and Symptoms of Endometriosis: A Cost Analysis","volume":"126","author":"Leonardi","year":"2019","journal-title":"BJOG"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/uog.27529","article-title":"Diagnosis of superficial endometriosis on transvaginal ultrasound by visualization of peritoneum of pouch of Douglas","volume":"63","author":"Bailey","year":"2024","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.advms.2022.02.003","article-title":"Diagnostic Delay of Endometriosis in Adults and Adolescents\u2014Current State of Knowledge","volume":"67","author":"Laudanski","year":"2022","journal-title":"Adv. Med. Sci."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Kor, E., Mostafavi, S.R., Mazhin, Z.A., Dadkhah, A., Kor, A., Arvanagh, S.H., Noroozi, S.G., and Sadri, G. (2020). Relationship Between the Severity of Endometriosis Symptoms (Dysparunia, Dysmenorrhea and Chronic Pelvic Pain) and the Spread of the Disease on Ultrasound. BMC Res. Notes, 13.","DOI":"10.1186\/s13104-020-05388-5"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ejogrb.2016.02.040","article-title":"Update on the Ultrasound Diagnosis of Deep Pelvic Endometriosis","volume":"209","author":"Reid","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"8757281","DOI":"10.1155\/2020\/8757281","article-title":"Early Learning Curve in the Assessment of Deep Pelvic Endometriosis for Ultrasound and Magnetic Resonance Imaging","volume":"2020","author":"Fanta","year":"2020","journal-title":"Biomed. Res. Int."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1177\/08465371231165986","article-title":"CAR Practice Statement on Advanced Pelvic Ultrasound for Endometriosis","volume":"74","author":"Chang","year":"2023","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.jmig.2022.08.006","article-title":"Assessing Endometriosis during Routine Gynaecological Ultrasound: The Road Less Travelled","volume":"29","author":"Piessens","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"3659","DOI":"10.1016\/j.acra.2023.10.053","article-title":"Imaging of Urinary Bladder and Ureteral Endometriosis with Emphasis on Diagnostic and Therapeutic Approach","volume":"31","author":"Ray","year":"2024","journal-title":"Acad. Radiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/ajo.13322","article-title":"Awareness and Utilisation of Advanced Gynaecological Ultrasound in the Preoperative Work-Up of Women Planning Surgery for Endometriosis: A Survey of RANZCOG Fellows and Trainees","volume":"61","author":"Menakaya","year":"2021","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"114639","DOI":"10.1016\/j.ejogrb.2025.114639","article-title":"Severe Dysmenorrhea in Adolescents Need Non-Invasive Ultrasound Evaluation to Early Detect Endometriosis\/Adenomyosis","volume":"313","author":"Exacoustos","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"102760","DOI":"10.1016\/j.jogc.2024.102760","article-title":"The Development and Validation of a Patient Questionnaire Tool for the Assessment of Patient-Reported Experiences with Endometriosis Ultrasound","volume":"47","author":"Tigdi","year":"2025","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1007\/s00192-019-03963-4","article-title":"Pelvic Floor Dysfunction at Transperineal Ultrasound and Voiding Alterations in Women with Posterior Deep Endometriosis","volume":"30","author":"Mabrouk","year":"2019","journal-title":"Int. Urogynecol. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3111\/13696998.2010.549532","article-title":"Surgical Procedures and Their Cost Estimates among Women with Newly Diagnosed Endometriosis: A US Database Study","volume":"14","author":"Fuldeore","year":"2011","journal-title":"J. Med. Econ."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.wneu.2020.01.088","article-title":"Correlation Between Pain and Nerve Growth Factor Receptor Expression in Patients with Endometriosis Diagnosed by Transvaginal Color Ultrasound and Magnetic Resonance","volume":"138","author":"Mu","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1093\/biolre\/ioaf164","article-title":"Endometriosis: New Insights and Opportunities for Relief of Symptoms","volume":"113","author":"Saunders","year":"2025","journal-title":"Biol. Reprod."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s43032-019-00028-1","article-title":"Superficial Peritoneal Endometriosis: Clinical Characteristics of 203 Confirmed Cases and 1292 Endometriosis-Free Controls","volume":"27","author":"Reis","year":"2020","journal-title":"Reprod. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Warzecha, D., Za\u0142\u0119cka, J., Ma\u0144ka, G., Kiecka, M., Lipa, M., Spaczy\u0144ski, R., Piekarski, P., Banaszewska, B., Jakmiuk, A., and Issat, T. (2022). Plasma and Peritoneal Fluid Fibronectin and Collagen IV Levels as Potential Biomarkers of Endometriosis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232415669"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Daniilidis, A., Giorgiadis, G., Dalakoura, D., D\u2019Alterio, M.N., Angioni, S., and Roman, H. (2022). Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis\u2014An Overview: How, Why, and When. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122912"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Xu, X., Li, J., Lin, H., Lin, Z., and Ji, G. (2025). The Role of TGF-\u03b2 Superfamily in Endometriosis: A Systematic Review. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1638604"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ejogrb.2024.04.020","article-title":"Saliva-based microRNA diagnostic signature for the superficial peritoneal endometriosis phenotype","volume":"297","author":"Bendifallah","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/1933719116653677","article-title":"The Presence of Endometrial Cells in Peritoneal Fluid of Women with and Without Endometriosis","volume":"24","author":"ODF","year":"2017","journal-title":"Reprod. Sci."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1007\/s00404-025-08187-0","article-title":"Deep Pelvic Endometriosis: Clinical Features, Diagnosis, and Treatment\u2014A Comprehensive Review","volume":"312","author":"Abike","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"103733","DOI":"10.1016\/j.rbmo.2023.103733","article-title":"Comparison of Clinical and Ultrasound Examinations in Assessing the Parametria in Patients with Deep Infiltrating Endometriosis: A Multicentre Prospective Study","volume":"48","author":"Moro","year":"2024","journal-title":"Reprod. Biomed. Online"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jmig.2022.11.003","article-title":"Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced Stages","volume":"30","author":"Abrao","year":"2023","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Scioscia, M., Virgilio, B.A., Langian, A.S., Bernardini, T., Fattizzi, N., Neri, M., and Guerriero, S. (2020). Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge. Diagnostics, 10.","DOI":"10.3390\/diagnostics10100848"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Pedrassani, M., Guerriero, S., Pascual, M.\u00c1., Ajossa, S., Graupera, B., Pagliuca, M., Podgaec, S., Camargos, E., Vieira de Oliveira, Y., and Alc\u00e1zar, J.L. (2023). Superficial Endometriosis at Ultrasound Examination\u2014A Diagnostic Criteria Proposal. Diagnostics, 13.","DOI":"10.3390\/diagnostics13111876"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jmig.2020.04.009","article-title":"A Multicenter International Temporal and External Validation Study of the Ultrasound-Based Endometriosis Staging System","volume":"28","author":"Espada","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jmig.2020.05.020","article-title":"Peritoneal Retraction Pocket Defects and Their Important Relationship with Pelvic Pain and Endometriosis","volume":"28","author":"Carranco","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"2786","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis Is a Chronic Systemic Disease: Clinical Challenges and Novel Innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1146\/annurev-physiol-012110-142158","article-title":"Endometriosis: The Role of Neuroangiogenesis","volume":"73","author":"Asante","year":"2011","journal-title":"Annu. Rev. Physiol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1093\/biolre\/ioy212","article-title":"Ectopic Stromal Cells of Endometriosis Promote Neuroangiogenesis via Exosome Pathway","volume":"100","author":"Sun","year":"2019","journal-title":"Biol. Reprod."},{"key":"ref_97","first-page":"1033","article-title":"Angiogenesis, Lymphangiogenesis and Neurogenesis in Endometriosis","volume":"5","author":"Peters","year":"2013","journal-title":"Front. Biosci. (Elite Ed.)"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"4052","DOI":"10.4081\/ejh.2024.4052","article-title":"CCL18 Promotes Endometriosis by Increasing Endometrial Cell Migration and Neuroangiogenesis","volume":"68","author":"Peng","year":"2024","journal-title":"Eur. J. Histochem."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s00404-023-07110-9","article-title":"Mechanisms of Peripheral Sensitization in Endometriosis Patients with Peritoneal Lesions and Acyclical Pain","volume":"308","author":"Velho","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.2147\/JPR.S197667","article-title":"Research on Central Sensitization of Endometriosis-Associated Pain: A Systematic Review of the Literature","volume":"12","author":"Zheng","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e234","DOI":"10.1097\/j.pain.0000000000002351","article-title":"Central Sensitization Inventory in Endometriosis","volume":"163","author":"Orr","year":"2022","journal-title":"Pain"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Gambini, J., and Stromsnes, K. (2022). Oxidative Stress and Inflammation: From Mechanisms to Therapeutic Approaches. Biomedicines, 10.","DOI":"10.3390\/biomedicines10040753"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"7265238","DOI":"10.1155\/2017\/7265238","article-title":"Oxidative Stress and Endometriosis: A Systematic Review of the Literature","volume":"2017","author":"Scutiero","year":"2017","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Krygier, L., Jukna, P., Jarien\u0117, K., and Drejerien\u0117, E. (2024). Diagnostic Potential of Cytokine Biomarkers in Endometriosis: Challenges and Insights. Biomedicines, 12.","DOI":"10.3390\/biomedicines12122867"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Shifon, S., Tyrinova, T., Veretelnikova, T., Pasman, N., and Chernykh, E. (2025). Endometriosis as an Immune-Mediated Disease: Pathogenetic Mechanisms and Therapeutic Strategies. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1727183"},{"key":"ref_106","first-page":"e66128","article-title":"Endometriosis: A Comprehensive Exploration of Inflammatory Mechanisms and Fertility Implications","volume":"16","author":"Rathod","year":"2024","journal-title":"Cureus"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"103752","DOI":"10.1016\/j.autrev.2025.103752","article-title":"Endometriosis and Autoimmunity","volume":"24","author":"Blanco","year":"2025","journal-title":"Autoimmun. Rev."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Golinska, M., Wolyniak, M., Kulesza, P., and Kendler, W. (2025). Neuroinflammation Is Responsible for Pain in Endometriosis\u2014Targeting the JAK-STAT Pathway and Mast Cell Activation. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1621178"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s12958-025-01471-3","article-title":"Macrophages in Endometriosis: Key Roles and Emerging Therapeutic Opportunities\u2014A Narrative Review","volume":"23","author":"Wang","year":"2025","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"225","DOI":"10.2353\/ajpath.2009.080804","article-title":"Reactive Oxygen Species Controls Endometriosis Progression","volume":"175","author":"Nicco","year":"2009","journal-title":"Am. J. Pathol."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"McCallion, A., Nasirzadeh, Y., Lingegowda, H., Miller, J.E., Khalaj, K., Ahn, S., Monsanto, S.P., Bidarimath, M., Sinha, D., and Craig, A.W. (2022). Estrogen Mediates Inflammatory Role of Mast Cells in Endometriosis Pathophysiology. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.961599"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"5891","DOI":"10.7150\/ijbs.116635","article-title":"Unravelling the Intricate Link: Mast Cells and Estrogen-Induced Pain Sensitization in Endometriosis","volume":"21","author":"Wang","year":"2025","journal-title":"Int. J. Biol. Sci."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e70019","DOI":"10.1111\/aji.70019","article-title":"The Role of Mast Cells in the Development and Advancement of Endometriosis","volume":"93","author":"Makoui","year":"2025","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1080\/14728222.2017.1260548","article-title":"Targeting Mast Cells: A New Way to Treat Endometriosis","volume":"21","author":"Binda","year":"2021","journal-title":"Expert Opin. Ther. Targets"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e70278","DOI":"10.1096\/fj.202501493R","article-title":"MRGPRX2 Mediates Mast Cell-Induced Endometriosis Pain Through the Sensitization of Sensory Neurons via Histamine\/HRH1\/TRPV1 Signaling Pathway","volume":"39","author":"Mao","year":"2025","journal-title":"FASEB J."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s00109-016-1396-1","article-title":"IGF-1 Stimulates ER\u03b2 and Aromatase Expression via IGF1R\/PI3K\/AKT-Mediated Transcriptional Activation in Endometriosis","volume":"94","author":"Zhou","year":"2016","journal-title":"J. Mol. Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"e12588","DOI":"10.1002\/rmb2.12588","article-title":"Progesterone Resistance in Endometriosis: A Pathophysiological Perspective and Potential Treatment Alternatives","volume":"23","author":"Tang","year":"2024","journal-title":"Reprod. Med. Biol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"300","DOI":"10.23736\/S2724-606X.24.05631-8","article-title":"An Update on Epigenetic Mechanisms in Endometriosis","volume":"77","author":"Le","year":"2025","journal-title":"Minerva Obstet. Gynecol."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Erraji, H., El Ghanmi, A., Louanjli, N., Benahmed, M., El Mansouri, F., Zarqaoui, M., and Ghazi, B. (2025). Leveraging Epigenetic Aberrations in the Pathogenesis of Endometriosis: From DNA Methylation to Non-Coding RNAs. Front. Genet., 16.","DOI":"10.3389\/fgene.2025.1597287"},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Palumbo, M., Della Corte, L., Addeo, M., D\u2019Angelo, G., Colacurci, D., Baldini, G.M., Pellegrino, M., Giampaolino, P., and Bifulco, G. (2025). Genetic and Epigenetic Components in the Pathogenesis of Adenomyosis and Endometriosis in Adolescents. Biomedicines, 13.","DOI":"10.3390\/biomedicines13122988"},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Hoesglad-van Evert, J., Paar, P., Nan, A., and van der Molen, R. (2022). The Promise of Natural Killer Cell Therapy in Endometriosis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23105539"},{"key":"ref_122","first-page":"2596","article-title":"Role of Inflammatory Cytokines in Peripheral Nerve Injury","volume":"7","author":"Fregnan","year":"2012","journal-title":"Neural Regen. Res."},{"key":"ref_123","first-page":"e59288","article-title":"Role of Molecular Biomarkers in Endometriosis-Related Infertility: A Narrative Review of the Literature","volume":"16","author":"Koutala","year":"2024","journal-title":"Cureus"},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Ser, H.L., Au Yong, S.J., Shaffee, N.M., Mokhtar, N.M., and Ali, R.A.R. (2023). Current Updates on the Role of Microbiome in Endometriosis: A Narrative Review. Microorganisms, 11.","DOI":"10.3390\/microorganisms11020360"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s40168-025-02243-2","article-title":"Microbiota Insights in Endometriosis","volume":"13","author":"Parpex","year":"2025","journal-title":"Microbiome"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1007\/s43032-025-01985-6","article-title":"The Role of the Microbiome in Endometriosis","volume":"32","author":"Sanabani","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1530\/RAF-21-0113","article-title":"The Microbiome and Endometriosis","volume":"3","author":"Miyashira","year":"2022","journal-title":"Reprod. Fertil."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Xholli, A., Cremonini, F., Perugi, I., Londero, A.P., and Cagnacci, A. (2023). Gut Microbiota and Endometriosis: Exploring the Relationship and Therapeutic Implications. Pharmaceuticals, 16.","DOI":"10.3390\/ph16121696"},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Palumbo, M., Della Corte, L., Conte, M.R., D\u2019Angelo, G., Ascione, M., Pollio, A., Giampaolino, P., and Bifulco, G. (2026). Is Recurrent Endometriosis a Reprogrammed Disease? Molecular Persistence Beyond Surgical Clearance. Cells, 15.","DOI":"10.3390\/cells15100951"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"595","DOI":"10.2741\/1821","article-title":"Endometriosis: Harmful Survival of an Ectopic Tissue","volume":"11","author":"Garai","year":"2006","journal-title":"Front. Biosci."},{"key":"ref_131","first-page":"e92932","article-title":"Potential Changes in the Eutopic Endometrium in Endometriosis: A Narrative Review","volume":"17","author":"Makrygiannakis","year":"2025","journal-title":"Cureus"},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Camboni, A., and Marbaix, E. (2021). Ectopic Endometrium: The Pathologist\u2019s Perspective. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222010974"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11154-021-09666-w","article-title":"Hormonal Treatments for Endometriosis: The Endocrine Background","volume":"23","author":"Vannuccini","year":"2022","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/14656566.2026.2657998","article-title":"New Perspectives in Managing Chronic Pelvic Pain in Endometriosis: The Role of GnRH Antagonists Versus Dienogest","volume":"27","author":"Palumbo","year":"2026","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.1007\/s43032-025-01947-y","article-title":"Factors Affecting Hormonal Therapy Ineffectiveness and Discontinuation due to Adverse Effects in Patients with Endometriosis-Associated Pain","volume":"32","author":"Fayek","year":"2025","journal-title":"Reprod. Sci."},{"key":"ref_136","first-page":"e75590","article-title":"Management of Endometriosis-Related Pain: Comparing the Effectiveness of Hormonal Therapy, Surgical Interventions, and Complementary Therapies","volume":"16","author":"Alatawi","year":"2024","journal-title":"Cureus"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"102500","DOI":"10.1016\/j.bpobgyn.2024.102500","article-title":"Hormonal Therapies before In Vitro Fertilization in Women with Endometriosis: The Minotaur\u2019s Labyrinth and the Ariadne\u2019s Thread","volume":"95","author":"Naem","year":"2024","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"808146","DOI":"10.1155\/2015\/808146","article-title":"Abnormal Expression of Prostaglandins E2 and F2\u03b1 Receptors and Transporters in Patients with Endometriosis","volume":"2015","author":"Rakhila","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.jmig.2022.09.010","article-title":"Association Between Laparoscopic Appearance of Superficial Endometriosis, Positive Histology, and Systemic Hormone Use","volume":"29","author":"Weng","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"98","DOI":"10.5152\/jtgga.2013.52385","article-title":"Recurrence of Endometriosis: Risk Factors, Mechanisms and Biomarkers; Review of the Literature","volume":"14","year":"2013","journal-title":"J. Turk. Ger. Gynecol. Assoc."},{"key":"ref_141","first-page":"1232","article-title":"Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain","volume":"28","author":"Jarrell","year":"2009","journal-title":"J. Vis. Exp."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40814-020-00740-9","article-title":"Laparoscopic treatment of isolated superficial peritoneal endometriosis for managing chronic pelvic pain in women: Study protocol for a randomised controlled feasibility trial (ESPriT1)","volume":"7","author":"Whitaker","year":"2021","journal-title":"Pilot Feasibility Stud."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1196\/annals.1290.031","article-title":"Laparoscopic Management of Peritoneal Endometriosis, Endometriotic Cysts, and Rectovaginal Adenomyosis","volume":"997","author":"Donnez","year":"2003","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0015-0282(16)60429-6","article-title":"Laparoscopic Appearances of Peritoneal Endometriosis","volume":"51","author":"Martin","year":"1989","journal-title":"Fertil. Steril."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/uog.17415","article-title":"Expert Sonographers and Surgeons Are Needed to Manage Deep Infiltrating Endometriosis","volume":"49","author":"Exacoustos","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.jmig.2025.03.003","article-title":"Impact of Surgeon Characteristics on Endometriosis Surgery Outcomes","volume":"32","author":"Bougie","year":"2025","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/GCO.0000000000000960","article-title":"Surgical Treatment of Colorectal Endometriosis: An Updated Review","volume":"36","author":"Schneyer","year":"2024","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"6052","DOI":"10.1038\/s41598-026-36464-8","article-title":"Identification of a Circulating Immunological Signature as a Liquid Biopsy Approach for the Diagnosis of Endometriosis","volume":"16","author":"Araiz","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Lazim, N., Elias, M.H., Sutaji, Z., Abdul Karim, A.K., Abu, M.A., Ugusman, A., Syafruddin, S.E., Mokhtar, M.H., and Ahmad, M.F. (2023). Expression of HOXA10 Gene in Women with Endometriosis: A Systematic Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241612869"},{"key":"ref_150","first-page":"1135","article-title":"MicroRNAs in Endometriosis: Biological Function and Emerging Biomarker Candidates","volume":"100","author":"Bjorkman","year":"2019","journal-title":"Biol. Reprod."},{"key":"ref_151","doi-asserted-by":"crossref","unstructured":"Zygu\u0142a, A., Sankiewicz, A., Sakowicz, A., Dobrzy\u0144ska, E., Dakowicz, A., Ma\u0144ka, G., Kiecka, M., Spaczynski, R., Piekarski, P., and Banaszewska, B. (2024). Is the leptin\/BMI ratio a reliable biomarker for endometriosis?. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1359182"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"EVIDoa2400195","DOI":"10.1056\/EVIDoa2400195","article-title":"Validation of a Saliva Micro-RNA Signature for Endometriosis","volume":"4","author":"Bendifallah","year":"2025","journal-title":"NEJM Evid."},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Bendifallah, S., Suisse, S., Puchar, A., Delbos, L., Poilblanc, M., Descamps, P., Golfier, F., Jornea, L., Bouteiller, D., and Touboul, C. (2022). Salivary MicroRNA Signature for Diagnosis of Endometriosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030612"},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"Nannini, G., Cei, F., and Amedei, A. (2025). Unraveling the Contribution of Estrobolome Alterations to Endometriosis Pathogenesis. Curr. Issues Mol. Biol., 47.","DOI":"10.3390\/cimb47070502"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.fertnstert.2023.03.032","article-title":"Gut Dysbiosis-Derived \u03b2-Glucuronidase Promotes the Development of Endometriosis","volume":"120","author":"Wei","year":"2023","journal-title":"Fertil. Steril."},{"key":"ref_156","doi-asserted-by":"crossref","unstructured":"Wr\u00f3bel, M., Zuzanna, Z., O\u0142dak, \u0141., Kalicka, A., Ma\u0144ka, G., Kiecka, M., Spaczy\u0144ski, R.Z., Piekarski, P., Banaszewska, B., and Jakimiuk, A. (2023). Evaluation of Proteasome and Immunoproteasome Levels in Plasma and Peritoneal Fluid in Patients with Endometriosis. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241814363"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"4061755","DOI":"10.12998\/wjcc.v13.i20.104556","article-title":"Prediction of Genomic Biomarkers for Endometriosis Using the Transcriptomic Dataset","volume":"13","author":"Kucukakcali","year":"2025","journal-title":"World J. Clin. Cases"},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"eadd1531","DOI":"10.1126\/scitranslmed.add1531","article-title":"Fusobacterium infection facilitates the development of endometriosis through the phenotypic transition of endometrial fibroblasts","volume":"15","author":"Muraoka","year":"2023","journal-title":"Sci. Transl. Med."},{"key":"ref_159","doi-asserted-by":"crossref","unstructured":"Chiorean, D.M., Mitranovici, M.I., Toru, H.S., Cotoi, T.C., Tomu\u021b, A.N., Turdean, S.G., and Cotoi, O.S. (2023). New Insights into Genetics of Endometriosis\u2014A Comprehensive Literature Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13132265"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1186\/s12967-024-05474-3","article-title":"Proteomics Approach to Discovering Non-Invasive Diagnostic Biomarkers and Understanding the Pathogenesis of Endometriosis: A Systematic Review and Meta-Analysis","volume":"22","author":"Azeze","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_161","first-page":"17455057241248121","article-title":"Assessing the Utility of Artificial Intelligence in Endometriosis: Promises and Pitfalls","volume":"20","author":"Dungate","year":"2024","journal-title":"Womens Health"},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"114625","DOI":"10.1016\/j.ejogrb.2025.114625","article-title":"Artificial Intelligence in Endometriosis Care: A Comparative Analysis of Large Language Model and Human Specialist Responses to Endometriosis-Related Queries","volume":"313","author":"Burla","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_163","first-page":"650","article-title":"The problem with the \u2018truth\u2019: Rethinking ground truth for artificial intelligence in endometriosis diagnosis","volume":"41","author":"Deslandes","year":"2026","journal-title":"Hum. Reprod."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12978-025-02245-1","article-title":"Investigating the Role of Artificial Intelligence in the Diagnosis and Prediction of Endometriosis Using Ultrasound Images: A Systematic Review","volume":"23","author":"Esmailzadeh","year":"2026","journal-title":"Reprod. Health"},{"key":"ref_165","doi-asserted-by":"crossref","unstructured":"Zhang, B., Lv, X., Li, D., Zhang, L., Ru, Z., and Ma, Y. (2026). Diagnostic Accuracy of Machine Learning for Endometriosis: A Systematic Review and Meta-Analysis. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1735567"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1038\/s41746-022-00638-1","article-title":"Clinical Use of Artificial Intelligence in Endometriosis: A Scoping Review","volume":"5","author":"Sivajohan","year":"2022","journal-title":"npj Digit. Med."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1016\/j.jmig.2025.08.027","article-title":"Initial Results in the Automatic Visual Recognition of Endometriosis Lesions by Artificial Intelligence During Laparoscopy: A Proof-of-Concept Study","volume":"32","author":"Netter","year":"2025","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jmig.2025.05.003","article-title":"Utilizing Artificial Intelligence: Machine Learning Algorithms to Develop a Preoperative Endometriosis Prediction Model","volume":"32","author":"Snyder","year":"2025","journal-title":"J. Minim. Invasive Gynecol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1488\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T02:18:54Z","timestamp":1785723534000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":168,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081488"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081488","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]}}}