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Arezzo F, Cormio G, La Forgia D, Kawosha AA, Mongelli M, Putino C, Silvestris E, Oreste D, Lombardi C, Cazzato G, Cicinelli E, Loizzi V. The Application of Sonovaginography for Implementing Ultrasound Assessment of Endometriosis and Other Gynaecological Diseases. Diagnostics (Basel) 2022; 12:diagnostics12040820. [PMID: 35453868 PMCID: PMC9032141 DOI: 10.3390/diagnostics12040820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
Sonovaginography is a way of assessing gynaecological diseases that can be described as cheap yet accurate and non-invasive. It consists of distention of the vagina with ultrasound gel or saline solution while performing transvaginal sonography to clearly visualize and assess a host of local cervical, as well as any vaginal, disorders. With endometriosis being a steadily growing gynaecological pathology affecting 8-15% of women of fertile age, transvaginal sonography (TVS) can be considered as one of the most accurate and comprehensive imaging techniques in its diagnosis. Nevertheless, the accuracy may vary depending on scan sites. The purpose of this narrative review is to assess the performance of sonovaginography in detecting endometriosis in those sites where TVS has a low sensitivity.
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Affiliation(s)
- Francesca Arezzo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (C.P.); (C.L.); (E.C.)
- Correspondence: ; Tel.: +39-3274961788
| | - Gennaro Cormio
- Obstetrics and Gynecology Unit, Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.L.)
| | - Daniele La Forgia
- SSD Radiodiagnostica Senologica, IRCCS Istituto Tumori “Giovanni Paolo II”, Via Orazio Flacco 65, 70124 Bari, Italy;
| | - Adam Abdulwakil Kawosha
- Department of General Medicine, Universitatea Medicina si Farmacie Grigore T Popa, Strada Universitatii 16, 700115 Iasi, Romania;
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (C.P.); (C.L.); (E.C.)
| | - Carmela Putino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (C.P.); (C.L.); (E.C.)
| | - Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Via Orazio Flacco 65, 70124 Bari, Italy;
| | - Donato Oreste
- SSD Radiologia Diagnostica, IRCCS Istituto Tumori “Giovanni Paolo II”, Via Orazio Flacco 65, 70124 Bari, Italy;
| | - Claudio Lombardi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (C.P.); (C.L.); (E.C.)
| | - Gerardo Cazzato
- Pathology Section, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (C.P.); (C.L.); (E.C.)
| | - Vera Loizzi
- Obstetrics and Gynecology Unit, Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.L.)
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Barra F, Leone Roberti Maggiore U, Evangelisti G, Scala C, Alessandri F, Vellone VG, Stabilini C, Ferrero S. A prospective study comparing rectal water contrast-transvaginal ultrasonography with sonovaginography for the diagnosis of deep posterior endometriosis. Acta Obstet Gynecol Scand 2021; 100:1700-1711. [PMID: 34096037 PMCID: PMC8457128 DOI: 10.1111/aogs.14209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Preoperative assessment of deep endometriotic (DE) nodules is necessary to inform patients about the possible treatments and provide informed consent in case of surgery. This study aims to investigate the diagnostic performance of rectal water-contrast transvaginal ultrasonography (RWC-TVS) and sonovaginography (SVG) in women with suspicion of posterior DE. MATERIAL AND METHODS This prospective comparative study (NCT04296760) enrolled women with clinical suspicion of DE at our institution (Piazza della Vittoria 14 SRL, Genoa, Italy). Exclusion criteria were previous diagnosis of DE by imaging techniques or laparoscopy. All patients underwent RWC-TVS and SVG, independently performed by two gynecological sonologists blinded to the other technique's results. Patients underwent laparoscopic surgery within the following three months; imaging findings were compared with surgical and histological results. RESULTS In 208 of 281 (74.0%) patients included, posterior DE was surgically confirmed in rectosigmoid (n = 88), vagina (n = 21), rectovaginal septum (n = 34) and uterosacral ligaments (n = 156). RWC-TVS and SVG demonstrated similar sensitivity (SE; 93.8% vs 89.4%; p = 0.210) and specificity (SP; 86.3% vs 79.4%; p = 0.481) in diagnosing posterior DE. Specifically, both examinations had similar accuracy in detecting nodules of uterosacral ligaments (p = 0.779), vagina (p = 0.688) and rectovaginal septum (p = 0.824). RWC-TVS had higher SE (95.2% vs 82.0%; p = 0.003) and similar SP (99.5% vs 98.5%; p = 0.500) in diagnosing rectosigmoid endometriosis and estimated better infiltration of intestinal submucosa (p = 0.039), and distance between these nodules and anal verge (p < 0.001); only RWC-TVS allowed the estimation of bowel lumen stenosis. A similar proportion of discomfort was experienced during both examinations (p = 0.191), although a statistically higher mean visual analog score was reported during RWC-TVS (p < 0.001). CONCLUSIONS Although RWC-TVS and SVG have similar accuracy in the diagnosis of DE, RWC-TVS performed better in assessment of the characteristics of rectosigmoid endometriosis.
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Affiliation(s)
- Fabio Barra
- Academic Unit of Obstetrics and GynecologyIRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of GenoaGenoaItaly
- Piazza della Vittoria 14 SRLGenoaItaly
| | | | - Giulio Evangelisti
- Academic Unit of Obstetrics and GynecologyIRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of GenoaGenoaItaly
| | - Carolina Scala
- Division of Obstetrics and GynecologyGaslini InstituteGenoaItaly
| | - Franco Alessandri
- Unit of Obstetrics and GynecologyIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic SciencesIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Cesare Stabilini
- Department of Surgical and Diagnostic SciencesIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Simone Ferrero
- Academic Unit of Obstetrics and GynecologyIRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of GenoaGenoaItaly
- Piazza della Vittoria 14 SRLGenoaItaly
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Ferrero S, Barra F, Scala C, Condous G. Ultrasonography for bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2021; 71:38-50. [DOI: 10.1016/j.bpobgyn.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023]
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Biscaldi E, Barra F, Ferrero S. Magnetic Resonance Enema in Rectosigmoid Endometriosis. Magn Reson Imaging Clin N Am 2020; 28:89-104. [DOI: 10.1016/j.mric.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Update on the ultrasound diagnosis of deep pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol 2017; 209:50-54. [DOI: 10.1016/j.ejogrb.2016.02.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/20/2016] [Accepted: 02/29/2016] [Indexed: 11/16/2022]
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Menakaya U, Reid S, Infante F, Condous G. The 'sliding sign' in conjunction with sonovaginography: is this the optimal approach for the diagnosis of Pouch of Douglas obliteration and posterior compartment deep infiltrating endometriosis? Australas J Ultrasound Med 2013; 16:118-123. [PMID: 28191185 PMCID: PMC5029996 DOI: 10.1002/j.2205-0140.2013.tb00099.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Endometriosis is a chronic peritoneal disease that may progress as a deep infiltrating lesion involving the posterior compartment of the pelvis. Efforts to improve pre-operative knowledge of the location and extent of these lesions have resulted in the development of Transvaginal ultrasound (TVS) as the first-line imaging modality for extra-ovarian endometriosis. However, various techniques of TVS have been described in the literature for this purpose. Methods: In this review we will detail the evolution of TVS as the primary imaging modality in the pre-operative diagnosis of posterior compartment deep infiltrating endometriosis (DIE). We will also discuss the potential of an emerging new real-time diagnostic ultrasound-based technique known as the 'sliding sign' in combination with office gel sonovaginography for the pre-operative diagnosis of Pouch of Douglas obliteration and posterior compartment DIE. Conclusion: Implementation of the new real-time dynamic, reproducible and simple 'sliding sign' in conjunction with SVG has the potential to challenge the current concept that traditional laparoscopy is the 'gold standard' modality for the diagnosis of women with posterior compartment DIE.
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Affiliation(s)
- Uche Menakaya
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University of Sydney Kingswood New South Wales Australia
| | - Shannon Reid
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University of Sydney Kingswood New South Wales Australia
| | - Fernando Infante
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University of Sydney Kingswood New South Wales Australia
| | - George Condous
- Acute GynaecologyEarly Pregnancy and Advanced Endosurgery UnitNepean Medical SchoolNepean HospitalUniversity of SydneyKingswoodNew South WalesAustralia; OMNI GynaecologicalCare Centre for Women's Ultrasound and Early Pregnancy St LeonardsSydneyNew South WalesAustralia
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