Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis

Hudelist, Gernot; Oberwinkler, K. H.; Singer, CF; Tuttlies, F; Rauter, G.; Ritter, Olga Maria Schimidt; Keckstein, J.

doi:10.1093/humrep/dep013

Cited by 146 publications

(154 citation statements)

References 25 publications

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“…This is the case with DIE, as symptoms are not specific [2,3]. Bimanual pelvicgynaecologic examination may suggest the presence of DIE by the identification of tender nodules and fibrosis in the cul de sac, but it has poor accuracy in determining the extent of disease [3,36]. The current gold standard for a definitive diagnosis of endometriosis remains surgical evaluation with histological confirmation, even if deep retroperitoneal localisations have been missed on laparoscopy.…”

Section: Deep Infiltrating Endometriosis Diagnostic Imaging and Implimentioning

confidence: 99%

“…6) An increase in the amount of ultrasonographic gel inside the probe's cover can also improve visualisation of the vaginal walls and posterior and anterior fornix [52]. The low reported accuracy of transvaginal sonography in detecting vaginal endometriosis [36,47] confirms that digital gynaecological examination could be a better alternative to transvaginal sonography. In the recto-vaginal septum, nodules replacing the normal hyperechoic aspect of the tissue between the vagina and the rectum are present below the horizontal plane passing through the lower border of the posterior lip of the cervix [47].…”

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

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Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

204

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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Section: Deep Infiltrating Endometriosis Diagnostic Imaging and Implimentioning

confidence: 99%

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

204

143

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“…To detect DIE extension into the pelvis, use of magnetic resonance imaging (MRI) (7)(8)(9)(10)(11)(12) and transvaginal sonography (TVS) (6,(13)(14)(15)(16)(17)(18) have been described. The MRI provides accurate information about lesions located on the upper level of the sigmoid, but for pelvic disease TVS is equally accurate and is considered the first and most widely used diagnostic tool (6,(18)(19)(20).…”

mentioning

confidence: 99%

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Exacoustòs

Malzoni²,

Giovanni³

et al. 2014

Fertility and Sterility

129

143

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Objective: To assess the accuracy of transvaginal sonography (TVS) in defining size and location of deep infiltrating endometriosis (DIE) with laparoscopic/histologic confirmation. Design: Prospective observational study. Setting: University hospital. Patient(s): One hundred four women with suspected DIE on the basis of TVS. Intervention(s): Patients with DIE underwent TVS evaluation before laparoscopic surgery. An accurate mapping of the extent of the disease was recorded during TVS and at laparoscopy. This new mapping system was developed to assess the extent of endometriosis by measuring the size and depth of the lesions at the various pelvic locations. Main Outcome Measure(s): Surgical and histologic confirmation of the ultrasonographic data to evaluate the presence and location of DIE and creation of a new mapping methodology for detecting DIE by TVS. Result(s): Depending on the different location of the lesions, the accuracy of TVS ranged from 76%-97%. The lowest sensitivity (59%) and accuracy (76%) were obtained for TVS in the diagnosis of vaginal endometriosis, whereas the greatest accuracy (97%) was shown in detecting bladder lesions and Douglas obliteration. Conclusion(s):This new ultrasound mapping system is accurate for detecting the extent of DIE and may be useful for preoperative planning and intraoperative management of symptomatic patients with DIE. (Fertil Steril Ò

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“…Reid et al [12] obtained a sensitivity of 83% and a specificity of 97% in the detection of the obstruction of the pouch of Douglas, the results being similar to ours. The diagnosis of ovarian endometriomas through SVG with gel had a sensitivity of 95.5%, smaller than the one obtained by using the TVS by Hudelist et al [13], which communicated a sensitivity of 98% in the detection of these lesions. These results determined us to consider TVS to be superior to SVG in diagnosing ovarian endometriosis.…”

Section: Resultsmentioning

confidence: 61%

Diagnosis of endometriotic lesions by sonovaginography with ultrasound gel

et al. 2016

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Aims: The aim of the study was to evaluate the diagnostic ability of sonovaginography (SVG) with ultrasound gel in patients with endometriosis. Material and methods: We conducted a multicentre prospective study, which included 193 patients with symptoms highly suggestive for endometriosis. All patients were investigated by transvaginal sonography and SVG with gel and afterwards underwent laparoscopic surgery. For each category of endometriotic lesions investigated, we calculated and compared the sensitivity, specificity, positive predictive value and negative predictive value of the imagisticinvestigations used. Results: In the case of endometriotic lesions of the uterosacral ligaments, SVG with gel had a sensitivity of 78.5% and a specificity of 96% (p=ns). The lesions of the vagina and rectovaginal septum were diagnosed with a sensitivity of 79%, respectively 94% (p=ns), obtaining a specificity of 99%, respectively of 97% (p=0.007). The lesions of the Douglas pouch were identified with a sensitivity of 81% (p=0.015), and those of the rectosigmoid with a 94% sensitivity (p=0.010). We obtained lower sensitivity (67%) in detecting the lesions of the urinary bladder (p=ns). Conclusions: SGV with ultrasound gel represents a useful investigation tool for the evaluation of endometriotic lesions in the posterior pelvic compartment.

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Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis

Cited by 146 publications

References 25 publications

Imaging for the evaluation of endometriosis and adenomyosis

Imaging for the evaluation of endometriosis and adenomyosis

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Diagnosis of endometriotic lesions by sonovaginography with ultrasound gel

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