Endometriosis is a common gynecological pathology, with an incidence of nearly 10% in patients of reproductive age, and is still underdiagnosed. A thorough and well-spread diagnostic study of endometriosis based on epigenetic factor dysregulation can highlight potential areas for improvement. To quantify the potential and utility of non-invasive tools in the early diagnosis of endometriosis, an overview of current knowledge on epigenetic factors, based on DNA and RNA, is presented. Among these tools, it is important to highlight the role of miRNAs (microRNAs), cfDNA (cell-free DNA), and rRNAs (ribosomal RNAs), which are small molecules involved in endometriosis and numerous other pathologies. To evaluate their potential and utility in endometriosis, a salivary miRNA diagnostic test was conducted, the cfDNA methylation patterns of fragmented DNA circulating in bodily fluids (e.g., plasma) were analyzed, and cervical and uterine microbiomes were profiled for bacterial rRNA in patients with clinical suspicion of incipient endometriosis. Specific molecular profiles associated with endometriosis were analyzed. The first profile, a 109-miRNA saliva signature, was validated as a product of miRNA biomarkers and artificial intelligence modeling. In addition, peripheral blood cfDNA methylation biomarkers were identified by investigating nine genes in a molecular signature that requires validation. A profile was also obtained from cervical swabs and uterine washes, including molecular analysis of 16S rRNA amplicon sequencing to evaluate alterations in the cervical bacterial community. This review aims to optimize the integration of a non-invasive diagnostic tool for early endometriosis diagnosis. Genetic biomarkers can be correlated with clinical factors to improve diagnostic accuracy. Of the assessed diagnostic tools, salivary miRNA tests, a peripheral blood cfDNA methylation biomarker, and a microbiome rRNA signature may be useful for early diagnosis of endometriosis, as well as, implicitly, therapeutic attitude and follow-up.

Background and Objectives: Radiomics and artificial intelligence (AI) offer emerging quantitative tools for enhancing the diagnostic evaluation of testicular cancer. Conventional imaging—ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT)—remains central to management but has limited ability to characterize tumor subtypes, detect occult nodal disease, or differentiate necrosis, teratoma, and viable tumor in post-chemotherapy residual masses. This systematic review summarizes current advances in radiomics and AI for both primary tumors and retroperitoneal disease. Materials and Methods: A systematic search of PubMed, Scopus, and Web of Science identified studies applying radiomics or AI to testicular tumors, retroperitoneal lymph nodes and post-chemotherapy residual masses. Eligible studies included quantitative imaging analyses performed on ultrasound, MRI, and CT, with optional integration of clinical or molecular biomarkers. Eighteen studies met inclusion criteria and were evaluated with respect to methodological design, diagnostic performance, and translational readiness. Results: Across modalities, radiomics demonstrated encouraging discriminatory capacity, with accuracies of 74–82% for ultrasound, 80.7–97.9% for MRI, and 71.7–85.3% for CT. CT-based radiomics for post-chemotherapy residual masses showed moderate ability to distinguish necrosis/fibrosis, teratoma, and viable germ-cell tumor, though heterogeneous methodologies and limited external validation constrained generalizability. The strongest performance was observed in multimodal approaches: integrating radiomics with clinical variables or circulating microRNAs improved accuracy by up to 12% and 15%, respectively, mirroring gains reported in other oncologic radiomics applications. Persisting variability in segmentation practices, acquisition protocols, feature extraction, and machine-learning methods highlights ongoing barriers to reproducibility. Conclusions: Radiomics and AI-enhanced frameworks represent promising adjuncts for improving the noninvasive evaluation of testicular cancer, particularly when combined with clinical or molecular biomarkers. Future progress will depend on standardized imaging protocols, harmonized radiomics pipelines, and multicenter prospective validation. With continued methodological refinement and clinical integration, radiomics may support more precise risk stratification and reduce unnecessary interventions in testicular cancer.

Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral ligament involvement, and pouch of Douglas obliteration. Material and Methods: A comprehensive literature search of PubMed, Scopus, and Web of Science was performed for studies published between 2015 and 2025. Eligible studies assessed the accuracy of TVUS for posterior compartment DIE using laparoscopy and histology as reference standards. Data on sensitivity, specificity, and overall diagnostic accuracy were extracted or derived. The study’s quality was evaluated using the QUADAS-2 tool. Results: Thirty eligible studies were included. The mean sensitivities and specificities reported in the included studies reached 83.05% and 90.53% for rectosigmoid disease, 78.07% and 90.49% for uterosacral ligament involvement, and 79.58% and 89.75% for pouch of Douglas obliteration, respectively. Adjunctive techniques such as gel sonovaginography, rectal water contrast, or saline instillation into the pouch of Douglas were described, but their use was inconsistent. Marked heterogeneity in patient preparation, scanning protocols, and reporting limited comparability across studies. Despite this, TVUS demonstrated diagnostic performance within a similar range to that reported for MRI in prior systematic reviews, with the advantages of lower cost, accessibility, and integration into routine gynecological practice. Conclusions: TVUS is consistently reported as a reliable and cost-effective imaging modality and, in line with international guidelines, should be considered the first-line option for posterior compartment DIE, though further standardization of scanning and reporting protocols is needed to optimize reproducibility and clinical utility.

Background/Objectives: Excisional treatment is effective for cervical intraepithelial neoplasia grade 2 or 3 (CIN2–3), but residual or recurrent high-grade disease remains clinically important. This focused systematic review evaluated post-treatment high-risk human papillomavirus (hrHPV) testing as a test of cure and compared it with cytology and resection-margin status. Methods: PubMed/MEDLINE was searched and supplemented by structured citation checking and targeted verification, with supplementary Embase and CENTRAL searches conducted during peer review; the review was not prospectively registered. Mixed-grade cohorts were retained only when a high-grade subgroup was extractable or for supportive qualitative evidence. Results: Fifteen primary studies enrolled 21,932 treated women, of whom 18,992 contributed to endpoint-specific analyses. Explicit CIN2+/CIN3+/HSIL+ event rates were 1.9–6.8% in most studies, with 11.8% in one earlier intensively verified cohort; higher rates in other reports reflected any-grade CIN or composite outcomes and were not treated as CIN2+. In the subset reporting directly comparable accuracy measures, hrHPV testing was generally more sensitive than cytology and negative predictive values were 98.0–100%. These values require caution because recurrence prevalence was low and histological verification was incomplete in several cohorts. Five studies were judged at low, eight at unclear, and two at high overall risk of bias for their diagnostic-accuracy contributions. Conclusions: The evidence supports hrHPV-based risk stratification and reduced-intensity surveillance after a negative test, but not unqualified return to routine population screening. Standardised prospective studies with uniform CIN2+ endpoints and complete verification remain needed.

Background/Objectives: Skene’s gland malignancies are extremely rare tumors of the female paraurethral region, known almost exclusively from case reports and small case series. Their diagnosis is often delayed because symptoms are nonspecific and may mimic benign periurethral disorders, urethral diverticula, primary urethral carcinoma or anterior vaginal wall tumors. This narrative review focuses on the role of imaging, particularly pelvic magnetic resonance imaging (MRI), in the diagnosis, differential diagnosis, staging and treatment planning of Skene’s gland malignancies, distinguishing evidence from confirmed Skene’s gland cases from evidence extrapolated from female urethral carcinoma. Methods: PubMed/MEDLINE, Scopus and Web of Science were searched on 27 September 2026 (publication years 2015–2026) and supplemented by reference-list screening; an explicit case definition was applied. Results: Of 191 records (93 after de-duplication), 17 reports of Skene’s gland malignancy were included (15 case reports or series and 2 systematic reviews); fewer than thirty cases have been published overall. Patients were mostly postmenopausal (median age about 70 years, range 45–91), presenting with an asymptomatic periurethral nodule, hematuria or vaginal bleeding, or lower urinary tract symptoms; no uniform staging system has been applied. Most tumors were prostatic-type adenocarcinomas treated by local excision alone; radiotherapy, chemotherapy or androgen deprivation were used mainly for nodal, metastatic or recurrent disease. After examination, ultrasonography can detect and characterize a paraurethral mass, whereas MRI best defines tumor epicenter, urethral, periurethral and anterior vaginal wall involvement and regional spread, and should precede cystourethroscopy and biopsy; CT and PET/CT are complementary for systemic staging. No single immunohistochemical marker establishes Skene’s gland origin. Conclusions: MRI is central to localizing and staging suspected Skene’s gland malignancy and thus to guiding biopsy and the choice between local excision and radical surgery, but most imaging recommendations are extrapolated from female urethral carcinoma and require validation in pooled multicenter data.

Background: Adolescent endometriosis remains underrecognized, although symptoms often begin after menarche and diagnosis may be delayed for years. Severe dysmenorrhea, chronic or acyclic pelvic pain, school absenteeism, and impaired functioning should not be normalized. This narrative review synthesizes evidence on adolescent and early-onset endometriosis, focusing on early recognition, non-invasive assessment, individualized care, and function-preserving follow-up. Methods: A structured narrative review search supported by PubMed/MEDLINE was updated on 9 August 2026, focused mainly on the last decade, with selected older studies included when relevant. Adolescent-specific evidence was prioritized; adult or mixed-age data were used only when applicable to diagnosis, imaging, treatment safety, or pathophysiology. Evidence was synthesized descriptively; no meta-analysis, formal risk-of-bias assessment, or formal evidence grading was performed. Results: The synthesis included 58 unique publications. Direct adolescent evidence supports early suspicion in severe dysmenorrhea, refractory or acyclic pain, functional impairment, family history, and obstructive Müllerian anomalies. Imaging may identify endometriomas, deep endometriosis, adhesions, or adenomyosis-related features, but normal imaging does not exclude superficial disease. Biomarkers remain investigational in adolescents. Hormonal treatment is primarily supported for pain, bleeding, and functional outcomes. Conclusions: Early recognition, timely referral, expert imaging when appropriate, individualized treatment, and follow-up centered on functional impact may reduce symptom burden in adolescents. Hormonal suppression is a clinically plausible strategy for symptom control and preservation of functioning, but it is not a proven disease-modifying or fertility-preserving intervention in adolescents.