Relevance of polycystic ovarian morphology in the clinical evaluation of PCOS

项目总结。多囊卵巢综合征(PCOS)是一种复杂的内分泌疾病，其症状 并存疾病对女性一生的健康和幸福有着深远的影响。 虽然这种情况的名称暗示着卵巢形态的特殊异常，但仍存在很大争议 围绕多囊卵巢(PCO)与PCOS的诊断和临床谱的相关性。证据 PCO在健康女性中的研究使人们对PCO对PCOS状况的特异性及其存在产生了怀疑 在患有高雄激素(PCOS)和正常雄激素无排卵(NA-ANOV)的女性中， 告知疾病进展和/或治疗反应的效用。根据这些发现，我们最近 提出了重新定义PCO的新门槛。这些新标准代表着以下定义的重大变化 PCO，因为新技术的分辨率提高了。虽然这些标准预计会减少 在健康女性的假阳性诊断中，它们仍然有限。它们没有考虑已知的因素或 怀疑会影响卵巢的形态-也不能提供任何关于卵巢癌的病因或程度的洞察 多囊卵巢综合征患者卵泡发育紊乱。这个项目的目的是通过使用状态-状态来完善PCO的超声清晰度 最先进的超声成像技术和标准化的卵巢形态对比方法 患有多囊卵巢综合征和NA-ANOV的广泛女性。我们认为，定义PCO的基础是 超声检查应反映在这些情况下对有腔卵泡发育的了解。中环 提出的假设是，超声上的卵巢形态捕捉到了有腔卵泡中独特的破损。 可以告知无排卵障碍女性的临床和功能结果的发育。这个 该项目的目标是制定PCO的标准：1)与NA-ANOV相比，保持PCOS的特异性， 2)解释肥胖对卵巢形态的任何混淆影响，3)告知受损程度 卵泡生成和4)可靠地预测对体重减轻的排卵反应。代理项标记的任何实用程序 PCO(即抗苗勒氏激素)将被确定为达到或超过超声波的性能。通过 提供反映功能结果的多囊卵巢的定义，这项研究将扩大 超声在多囊卵巢综合征临床评估中的应用并为量身定制的干预带来新的方法， 解释了无排卵条件下卵泡发生紊乱的原因。这些努力旨在澄清 PCO形态的相关性与NIH最近确定的优先研究领域是一致的 多囊卵巢综合征循证方法论研讨会。

PROJECT SUMMARY. Polycystic ovary syndrome (PCOS) is a complex endocrine disorder whose symptoms and co-morbidities have far-reaching implications for the health and well-being of women across the lifespan. While the name of this condition implies a specific abnormality in ovarian morphology, substantial controversy surrounds the relevance of polycystic ovaries (PCO) to the diagnosis and clinical spectrum of PCOS. Evidence of PCO in healthy women has cast doubt upon the specificity of PCO to the condition of PCOS, and its presence in both women with hyperandrogenic (PCOS) and normoandrogenic anovulation (NA-Anov) has challenged its utility to inform progression of the disease and/or response to treatment. In line with these findings, we recently proposed new thresholds to redefine PCO. These new criteria represented a major change in the definition of PCO owing to the improved resolution of new technology. While these criteria are expected to reduce the number of false positive diagnoses in healthy women, they are still limited. They do not account for factors known or suspected to influence ovarian morphology – nor do they provide any insight into the etiology or degree of disordered folliculogenesis in PCOS. This project aims to refine the sonographic definition of PCO by using state- of-the-art ultrasound imaging technology and standardized approaches to contrast ovarian morphology across a broad spectrum of women with PCOS and NA-Anov. We believe that the basis for defining PCO on ultrasonography should reflect an understanding of antral follicle development in these conditions. The central hypothesis proposed is that ovarian morphology on ultrasonography captures unique disruptions in antral follicle development that can inform both clinical and functional outcomes in women with anovulatory disorders. The goals of this project are to develop criteria for PCO that: 1) maintain specificity for PCOS compared to NA-Anov, 2) account for any confounding effect of adiposity on ovarian morphology, 3) inform on the degree of impaired folliculogenesis and 4) reliably predict the ovulatory response to weight loss. Any utility of surrogate markers of PCO (i.e. anti-Müllerian hormone) to match or exceed the performance of ultrasound will be determined. By providing definitions for PCO that reflect functional outcomes, this research will expand the role of ultrasonography in the clinical evaluation of PCOS and usher new approaches for tailored interventions that account for the spectrum of disordered folliculogenesis across anovulatory conditions. These efforts to clarify the relevance of PCO morphology are consistent with prioritized areas of research identified by the recent NIH Evidence-Based Methodology Workshop on PCOS.