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Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024; 311:e232191. [PMID: 38591980 PMCID: PMC11070694 DOI: 10.1148/radiol.232191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Endometriosis is a prevalent and potentially debilitating condition that mostly affects individuals of reproductive age, and often has a substantial diagnostic delay. US is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis. Other than the visualization of an endometrioma, sonologists frequently do not appreciate endometriosis on routine transvaginal US images. Given a substantial body of literature describing techniques to depict endometriosis at US, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis. The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus. This statement defines the targeted screening population, describes techniques for augmenting pelvic US, establishes direct and indirect observations for endometriosis at US, creates an observational grading and reporting system, and makes recommendations for additional imaging and patient management. The panel recommends transvaginal US of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis. These additional techniques can be performed in 5 minutes or less and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients.
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Affiliation(s)
| | | | - Luciana Chamié
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Shuchi Rodgers
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Rosanne M. Kho
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Mindy M. Horrow
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Phyllis Glanc
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Myra Feldman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Yvette Groszmann
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Zaraq Khan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Steven L. Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Liina Poder
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Tatnai L. Burnett
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Eric M. Hu
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Susan Egan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Wendaline VanBuren
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
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Stone J, Abu-Rustum RS, Bromley B, Fuchs KM, Anton T, Cooper T, Minton KK, Dashe J, Lee W, Platt LD, Porche LM, Norton ME, Benacerraf BR, Abuhamad AZ. Curriculum and Competency Assessment Program for Training Maternal-Fetal Medicine Fellows in the Performance of the Detailed Obstetric Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2925-2932. [PMID: 36073175 DOI: 10.1002/jum.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reem S Abu-Rustum
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karin M Fuchs
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York, USA
| | - Tracy Anton
- Department of Obstetrics and Gynecology, University of California at San Diego, San Diego, California, USA
| | - Therese Cooper
- American Institute of Ultrasound in Medicine, Laurel, Maryland, USA
| | | | - Jodi Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Lawrence D Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lea M Porche
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Beryl R Benacerraf
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Pascoal E, Wessels JM, Aas-Eng MK, Abrao MS, Condous G, Jurkovic D, Espada M, Exacoustos C, Ferrero S, Guerriero S, Hudelist G, Malzoni M, Reid S, Tang S, Tomassetti C, Singh SS, Van den Bosch T, Leonardi M. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:309-327. [PMID: 35229963 DOI: 10.1002/uog.24892] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Pascoal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J M Wessels
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- AIMA Laboratories Inc., Hamilton, Canada
| | - M K Aas-Eng
- Department of Gynecology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M S Abrao
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - D Jurkovic
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Espada
- Department of Obstetrics and Gynaecology, Blue Mountains ANZAC Memorial Hospital, Katoomba, Australia
- Sydney Medical School, Sydney, Australia
| | - C Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Cagliari, Italy
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, St John of God Hospital, Vienna, Austria
- Scientific Endometriosis Foundation (SEF), Westerstede, Germany
| | - M Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - S Reid
- Department of Obstetrics and Gynaecology, Western Sydney University, Sydney, Australia
| | - S Tang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - S S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - M Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Sydney Medical School, Sydney, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Deslandes A, Parange N, Childs JT, Osborne B, Panuccio C, Croft A, Bezak E. How long does a transvaginal ultrasound examination for endometriosis take in comparison to a routine transvaginal ultrasound examination? Australas J Ultrasound Med 2022; 25:20-27. [PMID: 35251899 PMCID: PMC8873621 DOI: 10.1002/ajum.12288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
INTRODUCTION This study aimed to determine the additional time needed to perform an endometriosis transvaginal ultrasound (eTVUS) compared to routine transvaginal ultrasound (rTVUS). METHODS A retrospective case-control study was performed. The study group included 199 eTVUS performed between September 2019 and September 2020. The control group comprised 105 consecutive rTVUS studies performed in the same time period. The time stamps on the ultrasound images of all cases in both groups were reviewed to determine the time taken to perform each study. Mean, median, minimum and maximum scan times for both groups were calculated as was percentage difference between scan times. A two-tailed, unpaired t-test of the normalised data and a Mann-Whitney U test assessing time difference of scans between two groups were performed with P value <0.05 considered statistically significant. RESULTS Performing eTVUS took significantly longer than rTVUS with increases in the mean (8.4 vs 13.8 min, 64%), median (7 vs 12 min, 71%), minimum (4 vs 7 min, 75%) and maximum (19 vs 42 min, 121%) scan times. The Mann-Whitney U test indicated a statistically significant difference in the median scan times (5.0, CI 4.0-6.0), P < 0.001. An independent t-test of the normalised data revealed a significantly larger mean scan time for eTVUS than rTVUS, Mean = 9.05 95%CI [13.17-4.94], t(302) = 4.327, P < 0.001. R 2 = 0.583. CONCLUSION Endometriosis transvaginal ultrasound added an average 5.4 min to rTVUS, which is statistically significant. For ultrasound departments wanting to offer this technique, doubling the scan time allocated to perform a transvaginal ultrasound (TVUS) is suggested.
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Affiliation(s)
- Alison Deslandes
- Specialist Imaging PartnersNorth AdelaideSouth Australia5006Australia
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Nayana Parange
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Jessie T. Childs
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Brooke Osborne
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Catrina Panuccio
- Specialist Imaging PartnersNorth AdelaideSouth Australia5006Australia
| | - Anthea Croft
- Specialist Imaging PartnersNorth AdelaideSouth Australia5006Australia
| | - Eva Bezak
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
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Ong J, Leonardi M, Espada M, Stamatopoulos N, Georgousopoulou E, Condous G. Ureter Visualization With Transvaginal Ultrasound: A Learning Curve Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2365-2372. [PMID: 32472967 DOI: 10.1002/jum.15345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. METHODS We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. RESULTS A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. CONCLUSIONS Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competency-based medical education model in learning US for identifying the ureters.
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Affiliation(s)
- Jozarino Ong
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Mathew Leonardi
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Mercedes Espada
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Nicole Stamatopoulos
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | | | - George Condous
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
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6
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Leonardi M, Ong J, Espada M, Stamatopoulos N, Georgousopoulou E, Hudelist G, Condous G. One-Size-Fits-All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2295-2303. [PMID: 32412170 DOI: 10.1002/jum.15337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate whether gynecologic surgical trainees (fellows) can become competent in the real-time classification of the pouch of Douglas (POD) obliteration state and direct visualization of bowel deep endometriosis (DE) during a program with a prespecified number of transvaginal ultrasound (TVUS) examinations. METHODS We performed a prospective study between December 2017 and December 2018. Three fellows (F1-F3) performed 50 scans each, which were all supervised by an expert sonologist, who performed the reference standard TVUS examination. The fellows performed a focused TVUS examination to assess the bowel and POD state, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's official classifications. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. RESULTS A total of 150 examinations were performed on 145 patients. Twenty-six (17.9%) patients had a diagnosis of bowel DE, and 34 (23.4%) were classified as having a negative sliding sign by the reference standard. The overall accuracy of the presence/absence of bowel DE was 90% (range, 82%-94%). The overall accuracy of POD state classification was 93% (range, 90%-96%). The cumulative summation test for the learning curve for bowel DE showed that F1 did not reach competency by 50 scans, whereas F2 and F3 required 21 and 25 scans, respectively. For POD obliteration, F2 did not reach competency, whereas F1 and F3 required 40 and 22 scans. CONCLUSIONS Not all trainees can reach competency for TVUS evaluations of POD obliteration and bowel DE in a predefined number of scans.
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Affiliation(s)
- Mathew Leonardi
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Jozarino Ong
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Mercedes Espada
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Nicole Stamatopoulos
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Ekavi Georgousopoulou
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Gernot Hudelist
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
| | - George Condous
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
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7
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Leonardi M, Martins WP, Espada M, Georgousopoulou E, Condous G. Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:928-933. [PMID: 32198902 DOI: 10.1002/uog.22023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. METHODS This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. RESULTS During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001). CONCLUSIONS We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Leonardi
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, Australia
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
| | - M Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, Australia
| | - E Georgousopoulou
- School of Medicine, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, Australia
- OMNI Ultrasound and Gynaecological Care, St Leonards, NSW, Australia
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8
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Leonardi M, Espada M, Kho RM, Magrina JF, Millischer AE, Savelli L, Condous G. Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment. Diagnostics (Basel) 2020; 10:E771. [PMID: 33007875 PMCID: PMC7650710 DOI: 10.3390/diagnostics10100771] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023] Open
Abstract
We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.
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Affiliation(s)
- Mathew Leonardi
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.E.); (G.C.)
- Nepean Clinical School, University of Sydney, Sydney, NSW 2747, Australia
- Endometriosis Clinic, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8N3Z5, Canada
| | - Mercedes Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.E.); (G.C.)
- Nepean Clinical School, University of Sydney, Sydney, NSW 2747, Australia
| | - Rosanne M. Kho
- Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Javier F. Magrina
- Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Anne-Elodie Millischer
- IMPC Radiology Bachaumont Paris and Radiodiagnostics Department, Hôpital Necker, 75015 Paris, France;
| | - Luca Savelli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, 40126 Bologna, Italy;
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.E.); (G.C.)
- Nepean Clinical School, University of Sydney, Sydney, NSW 2747, Australia
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9
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Leonardi M, Robledo KP, Goldstein SR, Benacerraf BR, Condous G. International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:324-328. [PMID: 32112585 DOI: 10.1002/uog.21996] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 06/10/2023]
Affiliation(s)
- M Leonardi
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - K P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S R Goldstein
- Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA
| | | | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
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10
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Leonardi M, Reid S, Lu C, Condous G. Prevalence of Deep Endometriosis and Rectouterine Pouch Obliteration in the Presence of Normal Ovaries. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1211-1216. [PMID: 32682707 DOI: 10.1016/j.jogc.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE It is well-established that there is a strong association between ovarian endometriomas (OE) and deep endometriosis (DE) and rectouterine pouch (RP) obliteration. We aimed to determine the prevalence of DE and RP obliteration in the presence of normal ovaries. METHODS We conducted a multicentre retrospective cohort study from January 2009 to December 2017 using a prospective multicentre data registry. Participants included patients with signs and/or symptoms of endometriosis who underwent excisional laparoscopic surgery at one of eight hospitals. The primary outcome was the prevalence of DE and RP obliteration, which was compared between women with normal ovaries (i.e., no OE) and women with ovaries containing OE. Secondary outcomes evaluated included rates of DE by anatomic site between women with and without OE. RESULTS The ovaries did not contain an OE in 319 of 410 patients (77.8%). The prevalence of DE and RP obliteration in this cohort was 25.4% and 9.7% (81 and 31 patients), respectively; whereas, in patients with OE, DE and RP obliteration prevalence was 68.1% and 60.4% (62 and 55 patients), respectively (P < 0.001 for both DE and RP obliteration). The uterosacral ligaments were the most common site for DE (right: 47/319 [14.7%]; left: 42/319 [13.2%]). CONCLUSIONS In patients who visited a tertiary care centre with endometriosis without ovarian involvement, 1 in 4 had DE and 1 in 10 had RP obliteration. These prevalence rates should encourage knowledge and skills dissemination to improve non-invasive imaging diagnosis overall. In patients with symptoms or signs suggestive of endometriosis, a basic pelvic ultrasound that ends at evaluation for OE should not be regarded as reassuring.
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Affiliation(s)
- Mathew Leonardi
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, Australia; Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
| | - Shannon Reid
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, Australia; Sydney Medical School Nepean, University of Sydney, Sydney, Australia; Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia
| | - Chuan Lu
- Department of Computer Sciences, Aberystwyth University, Aberystwyth, UK
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, Australia; Sydney Medical School Nepean, University of Sydney, Sydney, Australia; OMNI Gynaecological Ultrasound and Care, St. Leonards, Australia
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11
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Espada M, Leonardi M, Condous G. Lack of preoperative predictors of surgical complications in patients undergoing endometriosis surgery may be due to lack of adequate preoperative imaging. Acta Obstet Gynecol Scand 2019; 99:429-430. [PMID: 31729759 DOI: 10.1111/aogs.13772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mercedes Espada
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood and Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - Mathew Leonardi
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood and Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - George Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood and Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
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12
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Leonardi M, Martin E, Reid S, Blanchette G, Condous G. Deep endometriosis transvaginal ultrasound in the workup of patients with signs and symptoms of endometriosis: a cost analysis. BJOG 2019; 126:1499-1506. [DOI: 10.1111/1471-0528.15917] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 12/01/2022]
Affiliation(s)
- M Leonardi
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney, Nepean Hospital Sydney NSW Australia
| | - E Martin
- School of Public Health and Social Work Institute of Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Qld Australia
| | - S Reid
- Department of Obstetrics and Gynaecology Liverpool Hospital Liverpool NSW Australia
| | - G Blanchette
- Department of Obstetrics and Gynaecology Nepean Hospital Penrith NSW Australia
| | - G Condous
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney, Nepean Hospital Sydney NSW Australia
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13
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Revels JW, Dey CB, Aggarwal A, London SS, Katz D, Menias C, Moshiri M. More Than Just 2 Layers: A Comprehensive Multimodality Imaging Review of Endometrial Abnormalities. Curr Probl Diagn Radiol 2019; 49:431-446. [PMID: 31307863 DOI: 10.1067/j.cpradiol.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/06/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
Endometrial abnormalities develop in female patients of all ages. Symptoms related to endometrial pathologies are among the most common causes of gynecologist office visits, with the radiologists playing an important role in endometrial evaluation. In some instances, the radiologist may be the first physician to note endometrial pathology. In this article, we will provide a comprehensive review of radiologic modalities utilized in the evaluation of the endometrium, as well as the imaging appearance of various endometrial disease processes.
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Affiliation(s)
| | - Courtney B Dey
- Department of Radiology, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA
| | - Abhi Aggarwal
- Department of Radiology, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA
| | - Sean S London
- Department of Radiology, University of Washington, Seattle, WA
| | - Douglas Katz
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | | | - Mariam Moshiri
- Department of Radiology, University of Washington, Seattle, WA
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14
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Déclaration commune CAR/SOGC en matière d’échographie du pelvis féminin. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S24-S28. [DOI: 10.1016/j.jogc.2019.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Introduction of a student tutor-based basic obstetrical ultrasound screening in undergraduate medical education. Arch Gynecol Obstet 2019; 300:59-66. [PMID: 31044300 DOI: 10.1007/s00404-019-05161-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND While there is an increasing interest in incorporating ultrasound in undergraduate medical education and the use of student tutors in conveying this medical skill to assist faculty members, little is known about undergraduate ultrasound teaching in obstetrics and gynecology. METHODS After a 3 week training of the student tutors, the student tutors joined an undergraduate ultrasound educational program to teach practical round students. After being certified, the student tutors organized a pre-test, gave a presentation about ultrasound, and then supervised the hands on ultrasound course under faculty staff supervision for round students. Finally, the practical round students had to answer a post-test with image recognition. The practical round students had to evaluate the course using a Likert scale. RESULTS 111 students joined this ultrasound course. The objective theoretical and practical multiple-choice questions' (MCQ) test showed a statistically significant improvement (50 vs. 90%, p < 0.05). The practical round students expressed a high acceptance (Likert 1.7) and subjective medical skill learning (Likert 1.8). The students also positively graded the student tutors (Likert 1.3). CONCLUSION Student tutor-based undergraduate obstetrical and gynecological ultrasound course is a useful method to teach a medical skill and is well accepted by students.
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Brennan O, Oh S, Necas M. The value of surveying the kidneys during pelvic ultrasound examinations. Australas J Ultrasound Med 2019; 22:118-128. [PMID: 34760548 PMCID: PMC8411717 DOI: 10.1002/ajum.12122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound. METHOD We examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women. RESULTS In total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys). CONCLUSION Indiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence-based and represents a low-yield examination with extremely low rate of incidental findings of clinical significance.
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Affiliation(s)
| | - Sheila Oh
- Department of UltrasoundWaikato HospitalHamiltonNew Zealand
| | - Martin Necas
- Department of UltrasoundWaikato HospitalHamiltonNew Zealand
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Abstract
Endometriosis is a common disease of reproductive-age women that is often first encountered with ultrasound. Therefore, familiarity with the variety of manifestations of endometriosis is important for appropriate diagnosis and management. The aim of this article is to review the spectrum of appearance of pelvic endometriosis and to discuss potential mimics on ultrasound. Given that magnetic resonance imaging is an important problem-solving tool in female pelvic imaging, magnetic resonance imaging correlation is also provided.
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Ko Y, Chung J, Lee SR, Kim SH, Chae H, Kang BM. Thick "Swiss Cheese" Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions. J Menopausal Med 2019; 25:158-163. [PMID: 32307941 PMCID: PMC6952701 DOI: 10.6118/jmm.19015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women. Methods We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance. Results We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions. Conclusions Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.
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Affiliation(s)
- Yuri Ko
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinha Chung
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heedong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Moon Kang
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Andres MP, Borrelli GM, Ribeiro J, Baracat EC, Abrão MS, Kho RM. Transvaginal Ultrasound for the Diagnosis of Adenomyosis: Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2018; 25:257-264. [DOI: 10.1016/j.jmig.2017.08.653] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 01/09/2023]
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Abuhamad A, Minton KK, Benson CB, Chudleigh T, Crites L, Doubilet PM, Driggers R, Lee W, Mann KV, Perez JJ, Rose NC, Simpson LL, Tabor A, Benacerraf BR. Obstetric and Gynecologic Ultrasound Curriculum and Competency Assessment in Residency Training Programs: Consensus Report. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:19-50. [PMID: 29297610 DOI: 10.1002/jum.14519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at, or close to, 75% for each, and obtaining a set of 5 ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the task force expects that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum and the competency assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology.
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Affiliation(s)
- Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | | | - Carol B Benson
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Trish Chudleigh
- Department of Ultrasound, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Lori Crites
- Ultrasound Education, Obstetrics and Gynecology Residency Program, Doctors Hospital OhioHealth, Columbus, OH
| | - Peter M Doubilet
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Rita Driggers
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Division of Women's and Fetal Imaging, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Karen V Mann
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James J Perez
- Ultrasound Education, Obstetrics and Gynecology Residency Program, Doctors Hospital OhioHealth, Columbus, OH
| | - Nancy C Rose
- Reproductive Genetics, Intermountain Healthcare, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Lynn L Simpson
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Ann Tabor
- Department of Obstetrics, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Beryl R Benacerraf
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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Abuhamad A, Minton KK, Benson CB, Chudleigh T, Crites L, Doubilet PM, Driggers R, Lee W, Mann KV, Perez JJ, Rose NC, Simpson LL, Tabor A, Benacerraf BR. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: consensus report. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:150-155. [PMID: 29297616 DOI: 10.1002/uog.18967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multi-Society Task Force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency-assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at or close to 75% for each, and obtaining a set of five ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the Task Force expects that the criteria set forth in this document will evolve with time. The Task Force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency-assessment process. Incorporating this training curriculum and the competency-assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - K K Minton
- American Institute of Ultrasound in Medicine, Laurel, MD, USA
| | - C B Benson
- Department of Radiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - T Chudleigh
- Department of Ultrasound, Cambridge University Hospitals, Cambridge, UK
| | - L Crites
- Ultrasound Education, Obstetrics and Gynecology Residency Program, Doctors Hospital OhioHealth, Columbus, OH, USA
| | - P M Doubilet
- Department of Radiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - R Driggers
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Washington, DC, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Division of Women's and Fetal Imaging, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K V Mann
- Division of Medical Education, Dalhousie University, Nova Scotia, Canada
| | - J J Perez
- Ultrasound Education, Obstetrics and Gynecology Residency Program, Doctors Hospital OhioHealth, Columbus, OH, USA
| | - N C Rose
- Reproductive Genetics, Intermountain Healthcare, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - L L Simpson
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - A Tabor
- Department of Obstetrics, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - B R Benacerraf
- Department of Radiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
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Rosenlund IM, Leivseth L, Nilsen I, Førde OH, Revhaug A. Extent, regional variation and impact of gynecologist payment models in routine pelvic examinations: a nationwide cross-sectional study. BMC WOMENS HEALTH 2017; 17:114. [PMID: 29162106 PMCID: PMC5697055 DOI: 10.1186/s12905-017-0471-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022]
Abstract
Background Based on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women. The aims of this study was to quantify the extent of routine pelvic examinations within specialized health care in Norway, to assess if the use of these services differs across hospital referral regions and to assess if the use of colposcopy and ultrasound differs with gynecologists’ payment models. Methods Nationwide cross-sectional study including all women aged 18 years and older in Norway in the years 2014–16 (2,038,747). Data was extracted from the Norwegian Patient Registry and Statistics Norway. The main outcome measures were 1. The number of appointments per 1000 women with a primary diagnosis of “Encounter for gynecological examination without complaint, suspected or reported diagnosis.” 2. The age-standardized number of these appointments per 1000 women in the 21 different hospital referral regions of Norway. 3. The use of colposcopy and ultrasound in routine pelvic examinations, provided by gynecologists with fixed salaries and gynecologists paid by a fee-for-service model. Results Annually 22.2 out of every 1000 women in Norway had a routine pelvic examination, with variation across regions from 6.6 to 43.9 per 1000. Gynecologists with fixed salaries performed colposcopy in 1.6% and ultrasound in 74.5% of appointments. Corresponding numbers for fee-for-service gynecologists were 49.2% and 96.2%, respectively. Conclusions Routine pelvic examinations are widely performed in Norway. The variation across regions is extensive. Our results strongly indicate that fee-for-service payments for gynecologists skyrocket the use of colposcopy and increase the use of ultrasound in pelvic examinations of asymptomatic women. Electronic supplementary material The online version of this article (10.1186/s12905-017-0471-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Ingard Nilsen
- Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway
| | - Olav Helge Førde
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Arthur Revhaug
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
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Paliulyte V, Drasutiene GS, Ramasauskaite D, Bartkeviciene D, Zakareviciene J, Kurmanavicius J. Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study. Obstet Gynecol Int 2017; 2017:6739345. [PMID: 28555159 PMCID: PMC5438840 DOI: 10.1155/2017/6739345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/13/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To examine the uterine involution period after uncomplicated delivery in primiparous and multiparous women. METHODS Longitudinal prospective study. Repeated parameters were measured and endometrial contents and diastolic notch were observed. Measurements of primiparous and multiparous women were carried out after labour on the 1st, 3rd, 10th, 30th, 42nd, and 60th postpartum days. The analysis was performed using SPSS version 21. RESULTS The median uterus parameters are bigger in multiparous group in physiological puerperium, but the decreasing trend is the same. The endometrial cavity on the 10th day was significantly wider in multiparous women and mainly echo-negative view of the uterine cavity was observed. The evaluation of the uterine angle deviation changes from an extremely retroverted position to a more anteverted position. RI of the uterine artery in both groups was low immediately after labour and significantly increased one month postpartum. Notching of the uterine artery undergoes changes, but diastolic notch does not appear in all postpartum women even after two months following labour. CONCLUSIONS The puerperium period after normal vaginal delivery depends on parity. The trend of involution in primiparous and multiparous women follows a similar pattern, yet, it lasts longer in the multiparous women. Ultrasound of uterine is certainly a useful tool after labour and may be important in facilitating an early detection of postpartum uterine complications.
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Affiliation(s)
- V. Paliulyte
- Clinic of Obstetrics and Gynaecology of Vilnius University, Centre of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - G. S. Drasutiene
- Clinic of Obstetrics and Gynaecology of Vilnius University, Centre of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - D. Ramasauskaite
- Clinic of Obstetrics and Gynaecology of Vilnius University, Centre of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - D. Bartkeviciene
- Clinic of Obstetrics and Gynaecology of Vilnius University, Centre of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - J. Zakareviciene
- Clinic of Obstetrics and Gynaecology of Vilnius University, Centre of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - J. Kurmanavicius
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
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Wylomanski S, Winer N. [Role of ultrasound in elective abortions]. ACTA ACUST UNITED AC 2016; 45:1477-1489. [PMID: 27814980 DOI: 10.1016/j.jgyn.2016.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022]
Abstract
Ultrasound plays a fundamental role in the management of elective abortions. Although it can improve the quality of post-abortion care, it must not be an obstacle to abortion access. We thus studied the role of ultrasound in pregnancy dating and possible alternatives and analyzed the literature to determine the role of ultrasound in post-abortion follow-up. During an ultrasound scan, the date of conception is estimated by measurement of the crown-rump length (CRL), defined by Robinson, or of the biparietal diameter (BPD), as defined by the French Center for Fetal Ultrasound (CFEF) after 11 weeks of gestation (Robinson and CFEF curves) (grade B). Updated curves have been developed in the INTERGROWTH study. In the context of abortion, the literature recommends the application of a safety margin of 5 days, especially when the CRL and/or BPD measurement indicates a term close to 14 weeks (that is equal or below 80 and 27mm, respectively) (best practice agreement). Accordingly, with the ultrasound measurement reliable to±5 days when its performance meets the relevant criteria, an abortion can take place when the CRL measurement is less than 90mm or the BPD less than 30mm (INTERGROWTH curves) (best practice agreement). While a dating ultrasound should be encouraged, its absence is not an obstacle to scheduling an abortion for women who report that they know the date of their last menstrual period and/or of the at-risk sexual relations and for whom a clinical examination by a healthcare professional is possible (best practice agreement). In cases of intrauterine pregnancy of uncertain viability or of a pregnancy of unknown location, without any particular symptoms, the patient must be able to have a transvaginal ultrasound to increase the precision of the diagnosis (grade B). Various reviews of the literature on post-abortion follow-up indicate that the routine use of ultrasound during instrumental abortions should be avoided (best practice agreement). If it becomes clear immediately after the procedure that the endometrial thickness exceeds 8mm, immediate reaspiration is necessary. Ultrasound examination of the endometrium several days after an instrumental elective abortion does not appear to be relevant (grade B). An analysis of the literature similarly shows that routine ultrasound scans after medical abortions should be avoided. If a transvaginal ultrasound is performed after a medical abortion, it should take place at least two weeks afterwards (best practice agreement). The only aim of an ultrasound examination during follow-up should be to determine whether a gestational sac is present (best practice agreement). Finally, if an ultrasound is performed at any point during pre- or post-abortion care, a report should be drafted, specifying any potential gynecologic abnormalities found, but its absence must not delay the scheduling of the abortion (best practice agreement).
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Affiliation(s)
- S Wylomanski
- Service de gynécologie-obstétrique, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
| | - N Winer
- Service de gynécologie-obstétrique, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Wildenberg JC, Yam BL, Langer JE, Jones LP. US of the Nongravid Cervix with Multimodality Imaging Correlation: Normal Appearance, Pathologic Conditions, and Diagnostic Pitfalls. Radiographics 2016; 36:596-617. [DOI: 10.1148/rg.2016150155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
PURPOSE To determine patient preferences for use of a chaperone during transvaginal sonography. MATERIALS AND METHODS Informed consent was waived for this IRB-exempt, HIPAA-compliant, retrospective review of prospectively acquired quality improvement survey data. Willing unique consecutive adult patients (n = 155) scheduled to undergo a transvaginal pelvic ultrasound between March 1, 2015 and August 15, 2015 completed a survey before and after the ultrasound examination assessing their opinions regarding the need for a chaperone. Surveys were collected from three outpatient centers (n = 35/center) and an inpatient center (n = 50) in the same health system. Respondent opinions were compared with Chi-Square test or Fisher's Exact test. RESULTS Most respondents (78% [121/155]) had previously undergone a transvaginal pelvic ultrasound. Respondents were significantly more likely to prefer a chaperone if their sonographer was male than if their sonographer was female (pre-ultrasound: 46% [69/155] vs. 12% [19/155], p < 0.0001; post-ultrasound: 43% [66/155] vs. 6% [10/155], p < 0.0001). The fraction of respondents who said they would be somewhat or substantially reassured by a chaperone if their sonographer was female was similar to the fraction of respondents who said they would be somewhat or substantially embarrassed by presence of a female chaperone (pre-ultrasound: 12% [19/155] vs. 6% [9/155], p = 0.07; post-ultrasound: 6% [10/155] vs. 7% [11/155], p = 0.82; respectively). CONCLUSION Approximately half of adult women scheduled to undergo transvaginal pelvic sonography prefer that a chaperone be present if their sonographer is male, but in general do not feel it is necessary if their sonographer is female. These opinions do not change after performance of a transvaginal pelvic ultrasound.
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