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Maderuelo S, Satorres E, Arrufat T, Lourenço M, Novillo-Del Álamo B, Guerriero S, Alcazar JL. 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. Eur J Obstet Gynecol Reprod Biol 2024; 297:233-240. [PMID: 38696910 DOI: 10.1016/j.ejogrb.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/11/2024] [Indexed: 05/04/2024]
Abstract
Transvaginal ultrasound is effective in diagnosing endometriosis involving the rectosigmoid bowel. Some authors suggest enhanced detection of rectosigmoid involvement with bowel preparation. Conversely, conflicting views argue that bowel preparation may not improve diagnostic precision, yielding similar results to rectal water contrast. No existing meta-analysis compares these approaches. Our study aims to conduct a meta-analysis to evaluate the diagnostic performance of transvaginal ultrasound with bowel preparation, with and without rectal water contrast. Studies published between 2000 and 2023 were searched in PubMed, Scopus, Cochrane and Web of Science. From 561 citations, we selected nine studies to include in this meta-analysis. The study quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2). The mean prevalence of endometriosis rectosigmoid was 43.6% (range 17,56-76,66%) in the group with bowel preparation and 64,80% (50,0-83,60%) for the group with bowel preparation and rectal water contrast. Pooled sensitivity and specificity were 93% and 94% for bowel preparation and 92% and 95% and for bowel preparation with water contrast. We conclude that, there was no significant difference between performing transvaginal ultrasound with intestinal preparation with and without water contrast. In clinical practice, the absence of a significant difference between these methods should be taken into account when making recommendations.
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Affiliation(s)
- Sara Maderuelo
- Department of Obstetrics and Gynecology, University Hospital La Fe, Valencia, Spain
| | - Elena Satorres
- Department of Obstetrics and Gynecology, University Hospital La Fe, Valencia, Spain
| | - Teresa Arrufat
- Department of Obstetrics and Gynecology, University Hospital Castelló, Castelló de la Plana, Spain
| | - Mariana Lourenço
- Department of Obstetrics and Gynecology, Vila Franca de Xira Hospital, Lisbon, Portugal
| | | | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria - Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain.
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Neme GL, Guimarães CTS, Dantas PP, Santana DDB, Yamauchi FI, Filho HML, Bittencourt LK, Pereira RMA, Mattos LA. Postoperative Imaging of Endometriosis. Radiographics 2024; 44:e230159. [PMID: 38512726 DOI: 10.1148/rg.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Glaucy L Neme
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Patricia P Dantas
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Daniel D B Santana
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Fernando I Yamauchi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Hilton M Leão Filho
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leonardo K Bittencourt
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Ricardo M A Pereira
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leandro A Mattos
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
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Avery JC, Deslandes A, Freger SM, Leonardi M, Lo G, Carneiro G, Condous G, Hull ML. Noninvasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging, and artificial intelligence. Fertil Steril 2024; 121:164-188. [PMID: 38101562 DOI: 10.1016/j.fertnstert.2023.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Endometriosis affects 1 in 9 women and those assigned female at birth. However, it takes 6.4 years to diagnose using the conventional standard of laparoscopy. Noninvasive imaging enables a timelier diagnosis, reducing diagnostic delay as well as the risk and expense of surgery. This review updates the exponentially increasing literature exploring the diagnostic value of endometriosis specialist transvaginal ultrasound (eTVUS), combinations of eTVUS and specialist magnetic resonance imaging, and artificial intelligence. Concentrating on literature that emerged after the publication of the IDEA consensus in 2016, we identified 6192 publications and reviewed 49 studies focused on diagnosing endometriosis using emerging imaging techniques. The diagnostic performance of eTVUS continues to improve but there are still limitations. eTVUS reliably detects ovarian endometriomas, shows high specificity for deep endometriosis and should be considered diagnostic. However, a negative scan cannot preclude endometriosis as eTVUS shows moderate sensitivity scores for deep endometriosis, with the sonographic evaluation of superficial endometriosis still in its infancy. The fast-growing area of artificial intelligence in endometriosis detection is still evolving, but shows great promise, particularly in the area of combined multimodal techniques. We finalize our commentary by exploring the implications of practice change for surgeons, sonographers, radiologists, and fertility specialists. Direct benefits for endometriosis patients include reduced diagnostic delay, better access to targeted therapeutics, higher quality operative procedures, and improved fertility treatment plans.
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Affiliation(s)
- Jodie C Avery
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Alison Deslandes
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Shay M Freger
- Department of Obstetrics and Gynecology McMaster University, Hamilton, ON, Canada
| | - Mathew Leonardi
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Obstetrics and Gynecology McMaster University, Hamilton, ON, Canada
| | - Glen Lo
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Gustavo Carneiro
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Centre for Vision, Speech and Signal Processing (CVSSP), School of Computer Science and Electronic Engineering, University of Surrey, Guildford, United Kingdom
| | - G Condous
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Gynaecology Department, Omni Ultrasound and Gynaecological Care, Sydney, New South Wales, Australia
| | - Mary Louise Hull
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Gynaecology Department, Embrace Fertility, Adelaide, South Australia, Australia
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Al-Arnawoot B, Chang S, Duigenan S, Kielar AZ, Leonardi M. CAR Practice Statement on Advanced Pelvic Ultrasound for Endometriosis. Can Assoc Radiol J 2023; 74:643-649. [PMID: 37042803 DOI: 10.1177/08465371231165986] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. This practice statement provides an overview of the state of the art of advanced pelvic ultrasound in the diagnosis and mapping of pelvic endometriosis. While acknowledging that advanced pelvic ultrasound in some practices falls within the scope of clinical colleagues rather than imaging departments, the statement seeks to guide radiologists interested in implementing these techniques into their practice for patients referred for evaluation and diagnosis of endometriosis. The statement covers indications, some components of the ultrasound assessment and technique, reporting, and recommendations for starting an ultrasound endometriosis evaluation program.
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Affiliation(s)
- Basma Al-Arnawoot
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Silvia Chang
- Department of Medical Imaging, University of British Columbia, Vancouver, BC, Canada
| | - Shauna Duigenan
- Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ania Z Kielar
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Mathew Leonardi
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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5
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Aas-Eng MK, Lieng M, Dauser B, Diep LM, Leonardi M, Condous G, Hudelist G. Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:933-939. [PMID: 34182605 DOI: 10.1002/uog.23728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the agreement of measurements of the three diameters of rectosigmoid deep endometriosis (DE) lesions between presurgical evaluation using transvaginal sonography (TVS) and postsurgical specimen measurement (PSM). METHODS This was a prospective observational multicenter study including symptomatic women undergoing surgical treatment for DE involving the rectosigmoid, by either discoid or segmental resection, from April 2017 to December 2019. TVS was performed presurgically to evaluate lesion size (craniocaudal-midsagittal length, anteroposterior thickness and transverse diameter), in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement, and was compared with PSM. The agreement of lesion dimensions between the two methods was assessed by Bland-Altman plots and limits of agreement and additionally by the intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. Systematic and proportional bias was assessed using the paired t-test. RESULTS A total of 207 consecutive women were eligible for inclusion. Forty-one women were excluded, leaving 166 women for final analysis. A total of 123 segmental resections and 46 discoid resections were performed (both procedures were performed in three women). The mean difference between TVS and PSM was 0.90 (95% CI, 0.85-0.95) mm for lesion length measurements, 1.03 (95% CI, 0.98-1.09) mm for lesion thickness measurements and 0.84 (95% CI, 0.79-0.89) mm for transverse diameter measurements. Bland-Altman analysis demonstrated good agreement between the two methods for measurements of lesion length. Furthermore, there was good reliability and correlation between TVS and PSM for lesion length measurements, as demonstrated by an ICC of 0.82 (95% CI, 0.75-0.87) and Pearson's correlation coefficient of 0.72 (95% CI, 0.62-0.80), moderate-to-good reliability and correlation for lesion thickness measurements, with an ICC of 0.76 (95% CI, 0.67-0.82) and Pearson's correlation coefficient of 0.61 (95% CI, 0.51-0.70), and poor-to-moderate reliability and correlation for transverse diameter measurements, with an ICC of 0.58 (95% CI, 0.39-0.71) and Pearson's correlation coefficient of 0.46 (95% CI, 0.33-0.58). CONCLUSION Preoperative TVS determines accurately rectosigmoid DE lesion length. TVS can thereby contribute to optimal planning of surgical treatment options in women with rectosigmoid DE. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M K Aas-Eng
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M Lieng
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - B Dauser
- Department of Surgery, Hospital St John of God, Vienna, Austria
| | - L M Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - M Leonardi
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - G Hudelist
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
- Scientific Endometriosis Foundation (SEF, Stiftung Endometriose Forschung), Westerstede, Germany
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6
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Ros C, Rius M, Abrao MS, deGuirior C, Martínez-Zamora MÁ, Gracia M, Carmona F. Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:335-341. [PMID: 32349172 DOI: 10.1002/uog.22058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To analyze the effect of bowel preparation prior to transvaginal ultrasound (TVS) examination on the detection of bowel involvement and the description of rectosigmoid nodules of deep infiltrating endometriosis (DIE), and to evaluate patient tolerance of bowel preparation. METHODS This was a prospective study of paired data obtained between September 2015 and March 2016 from a cohort of women referred, on suspicion of DIE but without surgical criteria, to the endometriosis unit of a tertiary university hospital. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by two TVS examinations: the first was performed without bowel preparation and the second was done after the patient had followed a 3-day low-residue diet and received two 250-mL enemas, one the night before TVS and the second 1-3 h before the examination. The presence of adhesions, number and size of rectosigmoid nodules, deepest layer of the rectum affected, percentage of the circumference of the bowel affected and distance from the most caudal part of the bowel nodule to the anal verge were determined. Patient tolerance to bowel preparation was assessed using a 5-point Likert scale, in which 1 represented 'very well tolerated' and 5 represented 'very poorly tolerated'. RESULTS The mean ± SD age of the 110 patients included in the study was 36.8 ± 5.07 years. As many as 55% of those identified during the first examination (TVS alone) as having adhesions were identified at the second examination (TVS with prior bowel preparation) as having rectosigmoid nodules, and 22 additional nodules were observed on TVS following bowel preparation. These newly detected rectosigmoid nodules, initially assessed mainly as adhesions, were smaller and more superficial compared with the nodules detected on TVS alone, or located in the anterior sigmoid wall. Patient tolerance overall to bowel preparation scored a mean of 1.81 on the 5-point Likert scale. CONCLUSIONS Bowel preparation is well tolerated by patients. When bowel preparation is performed before TVS, the detection of small and superficial nodules and those in the anterior sigmoid wall is improved, allowing more detailed description of these nodules in patients with suspected endometriosis. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M S Abrao
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, São Paulo University, São Paulo, Brazil
- Gynecologic Division, BP - A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
| | - C deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Á Martínez-Zamora
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Deslandes A, Parange N, Childs JT, Osborne B, Bezak E. Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery: A Systematic Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1477-1490. [PMID: 32083336 DOI: 10.1002/jum.15246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
Endometriosis is a common gynecologic condition affecting as many as 1 per 10 women. Transvaginal ultrasound (TVUS) has become a frontline tool in the diagnosis of deep infiltrating endometriosis (DIE) before surgery. The primary aim of this review was to determine the accuracy of TVUS for DIE. The secondary aim was to determine accuracy specifically when a sonographer performed the TVUS examination. A systematic review was performed, searching literature by following a population, intervention, comparator, and outcome outline. MEDLINE, Embase, Emcare, and Google Scholar were searched in July 2018 and in November 2019. Including "sonographer" in the search terms yielded no results, so our terms were expanded. Two hundred and four articles were returned from the searches, and 35 were ultimately included in the final review. Analysis of the returned articles revealed the TVUS is a valuable diagnostic tool for DIE before surgery. Sensitivities ranged from 78.5% to 85.3%, specificities from 46.1% to 92.5%, and accuracies from 75.7% to 97%. Most authors reported site-specific sensitivities and specificities, which varied greatly between locations. Site-specific sensitivities ranged from 10% to 88.9% (uterosacral ligaments), 20% to 100% (bladder), 33.3% to 98.1% (rectosigmoid colon), and 31% to 98.7% (pouch of Douglas). Site-specific specificities ranged from 75% to 99.6% (uterosacral ligaments), 96.4% to 100% (bladder), 86% to 100% (rectosigmoid colon), and 90% to 100% (pouch of Douglas). Transvaginal ultrasound is an accurate tool in the diagnosis of DIE; however, limited data exist as to whether this technique is accurate when performed by sonographers. More evidence surrounding the reliability between operators is also needed.
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Affiliation(s)
- Alison Deslandes
- Specialist Imaging Partners, Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - Nayana Parange
- University of South Australia, Adelaide, South Australia, Australia
| | - Jessie T Childs
- University of South Australia, Adelaide, South Australia, Australia
| | - Brooke Osborne
- University of South Australia, Adelaide, South Australia, Australia
| | - Eva Bezak
- University of South Australia, Adelaide, South Australia, Australia
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8
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Barra F, Biscaldi E, Scala C, Laganà AS, Vellone VG, Stabilini C, Ghezzi F, Ferrero S. A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis. Diagnostics (Basel) 2020; 10:diagnostics10040252. [PMID: 32344709 PMCID: PMC7236009 DOI: 10.3390/diagnostics10040252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 12/14/2022] Open
Abstract
(1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2–59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.
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Affiliation(s)
- Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16132 Genoa, Italy
| | - Ennio Biscaldi
- Department of Radiology, Galliera Hospital, 16142, Genoa, Italy;
| | - Carolina Scala
- Unit of Obstetrics and Gynecology, Gaslini Institute, 16147 Genova, Italy;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (A.S.L.); (F.G.)
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic Sciences, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (V.G.V.); (C.S.)
| | - Cesare Stabilini
- Department of Surgical and Diagnostic Sciences, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (V.G.V.); (C.S.)
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (A.S.L.); (F.G.)
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-34-7721-1682
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