Objectives To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of rectosigmoid endometriosis in patients with clinical suspicion of deep infiltrating endometriosis (DIE), comparing enhanced (E-TVS) and non-enhanced approaches. Methods 97% (95%CI,[95][96][97][98] 33.0 (95%CI,, respectively. Significant heterogeneity was found for sensitivity (I 2 , 90.8%; Cochran Q, 195.2; P < 0.001) and specificity (I 2 , 76.8%; Cochran Q, 77.7; P < 0.001). We did not find statistical differences between

Objective To review the diagnostic accuracy of transvaginal ultrasound (TVS) CI,[76][77][78][79][80][81][82][83][84][85] 4.3 (95% CI,, respectively. We did not observe differences among the three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity of all three methods (I 2 range, 60.6-95.0 Results Our extended search identified a total of 184 citations, among which we examined the full text of 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration were 82% (95% CI, 76-87%), 81% (95%

ObjectiveTo compare the diagnostic performance of six different approaches for assessing myometrial infiltration using ultrasound in women with carcinoma of the corpus uteri.MethodsMyometrial infiltration was assessed by two-dimensional (2D) transvaginal or transrectal ultrasound in 169 consecutive women with well (G1) or moderately (G2) differentiated endometrioid type endometrial carcinoma. In 74 of these women three-dimensional (3D) ultrasound was also performed. Six different techniques for myometrial infiltration assessment were evaluated. The impression of examiner and Karlsson's criteria were assessed prospectively. Endometrial thickness, tumor/uterine 3D volume ratio, tumor distance to myometrial serosa (TDS), and van Holsbeke's subjective model were assessed retrospectively. All subjects underwent surgical staging within 1 week after ultrasound evaluation. Definitive histopathological data regarding myometrial infiltration was used as gold standard. Sensitivity and specificity for all approaches were calculated and compared using McNemar test.ResultsThe impression of examiner and subjective model performed similarly (sensitivity 79.5% and 80.5%, respectively; specificity 89.6% and 90.3%, respectively). Both methods had significantly better sensitivity than Karlsson's criteria (sensitivity 31.8%, p<0.05) and endometrial thickness (sensitivity 47.7%, p<0.05), and better specificity than tumor/uterine volume ratio (specificity 28.3%, p<0.05) and TDS (specificity 41.5%, p<0.05).ConclusionSubjective impression seems to be the best approach for assessing myometrial infiltration in G1 or G2 endometrioid type endometrial cancer by transvaginal or transrectal ultrasound. The use of mathematical models and other objective 2D and 3D measurement techniques do not improve diagnostic performance.

Background/Aims: We aimed at performing a systematic review to determine the diagnostic accuracy of three-dimensional (3D) hysterosalpingo-contrast-sonography (HyCoSy) for detecting tubal occlusion. Methods: A systematic review in Medline database search from January 1989 to October 2015 to identify relevant studies evaluating 3D-HyCoSy. Eligibility criteria were studies assessing the role of 3D-HyCoSy for diagnosing tubal occlusion in infertile women. Index test was 3D-HyCoSy. Reference standard was laparoscopy with dye test or X-ray hysterosalpingography. Quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity for the method were estimated. Results: A total number of 88 papers were identified. After exclusions, nine studies were ultimately included. Pooled estimated sensitivity was 98% (95% CI 91-100) with a moderate heterogeneity (I²: 64.8%, 95% CI 39.6-89.9; and Cochran Q 22.7, p < 0.001). Pooled estimated specificity was 90% (95% CI 83-95) with significant heterogeneity (I²: 80.3%, 95% CI 68.1-92.5; and Cochran Q 40.6, p < 0.001). Positive likelihood ratio was 10.3 (95% CI 5.6-18.7) and negative likelihood ratio was 0.02 (95% CI 0.00-0.21). Conclusion: 3D-HyCoSy is an accurate test for diagnosing tubal occlusion in women with infertility.

Objectives: To investigate the prevalence and locations of pelvic adhesions following previous Caesarean section (CS), to identify risk factors for their formation and symptoms associated with their presence. Methods: This was a prospective observational study of women with history of one or more previous CS who attended for a gynecological ultrasound examination. In all women both transvaginal and transabdominal scans were performed in order to identify the presence of pelvic adhesions. Past medical and surgical history was recorded and a structured questionnaire was used to enquire about any history of pelvic pain and urinary symptoms. Results: A total of 308 women were recruited into the study. On ultrasound examination 139/308 (45.1%, 95% CI 39.7-50.7) women had evidence of adhesions within the pelvis. Adhesions in the vesico-uterine pouch were the most common and they were found in a total of 79/308 (25.6%, women. In women with no other surgery other than Caesarean section(s) (n = 220), increasing number of CS (OR 3.4, 95% CI 2.1-5.5) and a post operative wound infection (OR 11.7, 95% CI 3.5-39.5) increased the likelihood of adhesions in the anterior pelvic compartment. There was a significant association between presence of anterior compartment adhesions and chronic pelvic pain. Multivariate logistic regression analysis selected anterior abdominal wall adhesions (OR 2.4, 95% CI 1.6-3.7) and any adhesions on scan (OR 2.6, 95% CI 1.2-5.7) as independently predictive of chronic pelvic pain. Conclusions: Pelvic adhesions are present in more than a third of women with a history of previous CS and they are associated with chronic pelvic pain. Objectives: To evaluate the diagnostic accuracy of transvaginal ultrasound (TVUS) in the preoperative detection of deep endometriosis, using the pathologic and/or surgical data as a reference standard. Methods: An extensive search was performed in Medline (Pubmed) and ISI Web of Knowledge from January 1990 to March 2015. In order to obtain more robust data, we decided to exclude studies with less than 50 patients. Quality was assessed using QUADAS-2 tool. Results: Our extended search identified a total of 378 citations but we finally examined the full text of the 18 articles including 2510 patients. With respect to the bladder location, TVUS overall pooled estimated sensitivity was 0.75 (95%CI, 0.43-1.00) with an I 2 of 0% and a Cochran Q of 1,88 and specificity was 0.99 (95%CI, 0.90-1.00) with an I 2 of 0% and a Cochran Q of 0.07. With respect to the recto-sigmoid location, pooled estimated sensitivity was 0.87 (0.81-0.93) with an I 2 of 7.61% and a Cochran Q of 18.4 and specificity was 0.96 (0.92-1.00) with an I 2 of 0% and a Cochran Q of 3.02. With respect to the uterosacral ligament location, pooled estimated sensitivity was 0.55 (0.49-0.60) with an I 2 of 93.1% and a Cochran Q of 116.09 and specificity was 0.90 (0.83-0.97) with an I 2 of 0% and a Cochran Q of 2.54. With respect to the vaginal location, estimated sensitivity was 0.65 (0.61-0.79) with an I 2 of 0% and a ...