Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis

Abrão, Maurício Simões; Gonçalves, Maynara Santana; Dias, João; Podgaec, Sérgio; Chamié, Luciana Pardini; Blasbalg, Roberto

doi:10.1093/humrep/dem187

Cited by 437 publications

(407 citation statements)

References 25 publications

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“…These results are similar to those of Guerriero et al (7), who indicated a specificity of 92% and a sensitivity of 67%, but lower than those of Abrao et al (26) and Bazot et al (5,9,(27)(28)(29). On the contrary our results are superior in terms of sensitivity compared with the data reported by Grasso et al (30) (33.3% sensitivity).…”

Section: Mri and Tg-tvus Had A Similar Diagnostic Accuracy And Good Isupporting

confidence: 90%

MRI and “Tenderness Guided” transvaginal ultrasonography in the diagnosis of recto‐sigmoid endometriosis

Saba

Guerriero

Sulcis

et al. 2011

Magnetic Resonance Imaging

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Purpose: To compare the diagnostic accuracy of MRI and ''tenderness-guided'' transvaginal ultrasonography (tg-TVUS) in the identification of recto-sigmoid endometriosis. Materials and Methods:Institutional Review Board approval for this study was obtained, and written informed consent was given by all patients. This study is compliant with the STARD (Standards for Reporting of Diagnostic Accuracy) method. Fifty-nine patients (mean age, 33 years; range, 21-44 years) with clinical suspicion of deep pelvic endometriosis were prospectively enrolled. They underwent tg-TVUS and MRI before surgery. The characteristics of the MRI signal were analyzed. Mapping of recto-sigmoid endometriosis was performed and tg-TVUS and MR imaging results were compared with surgical and pathological findings. Sensitivity, specificity, and the positive and negative likelihood ratio (LRþ and LRÀ) were calculated. Inter-technique concordance was assessed using the Cohen statistic, and receiver operating characteristic (ROC) curves were obtained. Logistic regression analysis was performed.Results: The prevalence of recto-sigmoid endometriosis was 51%. The specificity, sensitivity, and LRþ and LRÀ were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg-TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter-technique concordance using the Cohen statistic indicated a kappa value of 0.658 (6 0.098 SD). According to the logistic regression equation obtained, the use of both tg-TVUS and MRI allows optimal diagnostic performance.Conclusion: MRI and tg-TVUS show similar results in the identification of recto-sigmoid endometriosis. The Cohen kappa value suggests that these methods may have complementary roles in the identification of recto-sigmoid endometriosis, depending on the site affected.

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Section: Mri and Tg-tvus Had A Similar Diagnostic Accuracy And Good Isupporting

confidence: 90%

MRI and “Tenderness Guided” transvaginal ultrasonography in the diagnosis of recto‐sigmoid endometriosis

Saba

Guerriero

Sulcis

et al. 2011

Magnetic Resonance Imaging

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“…, 24 , 25 In the past decade, several studies have compared different imaging modalities for a role in the pre‐operative diagnosis of extra‐ovarian endometriosis. Abrao, et al compared TVS and MRI for the detection of recto‐sigmoid DIE and found that TVS had a sensitivity, specificity, and accuracy of 98%, 100%, and 99%, respectively, compared to MRI's sensitivity, specificity, and accuracy of 83%, 98%, and 90% 13 . Although MRI may have slightly higher sensitivity for uterosaccral disease, TVS performs similarly to MRI in the diagnosis of intestinal endometriosis 14 .…”

Section: Evolution Of Transvaginal Scan For Diagnosis Of Extra‐ovariamentioning

confidence: 99%

The ‘sliding sign’ in conjunction with sonovaginography: is this the optimal approach for the diagnosis of Pouch of Douglas obliteration and posterior compartment deep infiltrating endometriosis?

Menakaya

Reid

Infante

et al. 2013

Australas J Ultrason Med

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Introduction: Endometriosis is a chronic peritoneal disease that may progress as a deep infiltrating lesion involving the posterior compartment of the pelvis. Efforts to improve pre‐operative knowledge of the location and extent of these lesions have resulted in the development of Transvaginal ultrasound (TVS) as the first‐line imaging modality for extra‐ovarian endometriosis. However, various techniques of TVS have been described in the literature for this purpose. Methods: In this review we will detail the evolution of TVS as the primary imaging modality in the pre‐operative diagnosis of posterior compartment deep infiltrating endometriosis (DIE). We will also discuss the potential of an emerging new real‐time diagnostic ultrasound‐based technique known as the ‘sliding sign’ in combination with office gel sonovaginography for the pre‐operative diagnosis of Pouch of Douglas obliteration and posterior compartment DIE. Conclusion: Implementation of the new real‐time dynamic, reproducible and simple ‘sliding sign’ in conjunction with SVG has the potential to challenge the current concept that traditional laparoscopy is the ‘gold standard’ modality for the diagnosis of women with posterior compartment DIE.

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“…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). Close communication between the radiologist or sonographer and the clinician is useful to provide the patient with accurate and adequate information regarding the extent of the disease and to plan the best possible management, whether medical, surgical, or both.…”

mentioning

confidence: 99%

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Exacoustòs

Malzoni²,

Giovanni³

et al. 2014

Fertility and Sterility

128

140

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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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Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis

Abstract: TVUS had better sensitivity, specificity, PPV, NPV and accuracy in cases of deep retrocervical and rectosigmoid endometriosis when compared with MRI and digital vaginal examination, confirming that it is an important preoperative examination for the definition of surgical strategies.

Cited by 437 publications

References 25 publications

MRI and “Tenderness Guided” transvaginal ultrasonography in the diagnosis of recto‐sigmoid endometriosis

MRI and “Tenderness Guided” transvaginal ultrasonography in the diagnosis of recto‐sigmoid endometriosis

The ‘sliding sign’ in conjunction with sonovaginography: is this the optimal approach for the diagnosis of Pouch of Douglas obliteration and posterior compartment deep infiltrating endometriosis?

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

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