Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta‐analysis

Abstract

Objective To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of endometriosis in the uterosacral ligaments (USL), rectovaginal septum (RVS), vagina and bladder in patients with clinical suspicion of deep infiltrating endometriosis (DIE). Methods An extensive search was performed in MED-

Transvaginal sonography in the diagnosis of deep infiltrating endometriosis: A review

“…A separate systemic review by Guerriero et al of the diagnostic accuracy of TVUS in the preoperative detection of nonbowel endometriosis included 11 studies that focused on the detection of endometriosis in the uterosacral ligament (USL), rectovaginal septum (RVS), vagina, and bladder in patients with clinical suspicion of DIE. 15 Figure 7 illustrates bladder wall endometriosis. According to Guerriero's analysis, the sensitivities and specificities of TVUS in the detection of endometriosis involving the USL, RSV, vagina, and bladder were 53% and 93%, 49% and 98%, 58% and 96%, and 62% and 100%, respectively.…”

The Role of Biomarkers in the Early Diagnosis of Endometriosis

“…A metanalysis of CA-125 performance in this setting revealed that the sensitivity of this marker ranges from 4-100% with a specificity of 38-100% [13]. Indeed much like in ovarian cancer where this biomarker is used, it is thought that it may be best utilised when used as part of a biomarker panel, with the sensitivity of this marker improving to 74-94% with a specificity of 55-75% when combined with VEGF, Annexin V and sICAM1 [7]. However, while promising these results need to be ratified according to age and ethnicity of female cohorts, both of which are known to influence CA-125 values.…”

“…Historically, the pathophysiology of endometriosis has been explained by Sampsons theory of retrograde menstruation secondary to fallopian tube reflux, [7]. While this has formed much of the basis of endometrial research and understanding the fact that a paucity of diagnostic techniques for this condition exist remains evident.…”

“…While this has formed much of the basis of endometrial research and understanding the fact that a paucity of diagnostic techniques for this condition exist remains evident. Indeed even after several decades of research the gold standard remains laparoscopy which incurs great cosmetic, psychological and physical harm but can identify all types of endometriosis [7]. However even this gold standard has potential flaws with visual diagnosis of endometriosis by this process proving to be suboptimal.…”

To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

“…Endometriosis is a benign gynecological disorder characterized by the presence and growth of endometriumlike tissue in sites outside the uterine cavity, primarily on the pelvic peritoneum and ovaries (Giudice & Kao, 2004; Bulun, 2009). It affects 5-10% of women of reproductive age and the main clinical features are chronic pelvic pain and infertility (Gupta et al , 2008; de Ziegler et al , 2010; Carneiro et al , 2010).…”