Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery

Abstract

Endometriosis is a common gynecologic condition affecting as many as 1 per 10 women. Transvaginal ultrasound (TVUS) has become a frontline tool in the diagnosis of deep infiltrating endometriosis (DIE) before surgery. The primary aim of this review was to determine the accuracy of TVUS for DIE. The secondary aim was to determine accuracy specifically when a sonographer performed the TVUS examination. A systematic review was performed, searching literature by following a population, intervention, comparator, and outcome outline. MEDLINE, Embase, Emcare, and Google Scholar were searched in July 2018 and in November 2019. Including “sonographer” in the search terms yielded no results, so our terms were expanded. Two hundred and four articles were returned from the searches, and 35 were ultimately included in the final review. Analysis of the returned articles revealed the TVUS is a valuable diagnostic tool for DIE before surgery. Sensitivities ranged from 78.5% to 85.3%, specificities from 46.1% to 92.5%, and accuracies from 75.7% to 97%. Most authors reported site‐specific sensitivities and specificities, which varied greatly between locations. Site‐specific sensitivities ranged from 10% to 88.9% (uterosacral ligaments), 20% to 100% (bladder), 33.3% to 98.1% (rectosigmoid colon), and 31% to 98.7% (pouch of Douglas). Site‐specific specificities ranged from 75% to 99.6% (uterosacral ligaments), 96.4% to 100% (bladder), 86% to 100% (rectosigmoid colon), and 90% to 100% (pouch of Douglas). Transvaginal ultrasound is an accurate tool in the diagnosis of DIE; however, limited data exist as to whether this technique is accurate when performed by sonographers. More evidence surrounding the reliability between operators is also needed.

Accuracy of Transvaginal Ultrasound Compared to Cystoscopy in the Diagnosis of Bladder Endometriosis Nodules

“…However, the sensitivity of the technique was lower (<50%) and depended on the size of the nodule and on some technical aspects (empty bladder). 15 In this study, TVUS was very accurate in predicting which cystoscopic findings would or would not be normal. Therefore, in patients with suspicion of partial involvement of the muscular layer by TVUS, cystoscopy could be avoided.…”

“…4,[9][10][11][12] Transvaginal ultrasound (TVUS) can visualize isoechoic and hypoechoic nodule thickening of the bladder wall, with occasional protrusion into the lumen. 13 Although the specificity and accuracy of TVUS for BE reported in the literature are high among experienced operators, 14,15 there is no strong evidence about the best diagnostic approach. When an endometriotic nodule is diagnosed by TVUS, cystoscopy is usually performed to assess the grade of infiltration and ureteral meatus involvement and to determine the etiology of the nodule in case of suspicion of malignancy.…”

Intraoperative Ultrasound for Bowel Deep Infiltrating Endometriosis

“…The need for accurate tools to detect diameters and the depth of invasion in DIE bowel lesions has been widely discussed in the literature: in referral centers, the preoperative detection rate of rectal nodules with TVUS is extremely high 6,7 . An ideal description of a bowel nodule must include the craniocaudad diameter and the depth of invasion together with the level of the lesion from the anal verge and stenosis of the bowel lumen: this information is really important when counseling patients and planning the surgical approach.…”

Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge

“…However, the evaluation should include the anterior and posterior pelvic compartments to assess the mobility of pelvic organs [ 7 , 8 , 9 , 10 ] and to improve the assessment of endometriosis, as suggested by the International Deep Endometriosis Analysis (IDEA) consensus [ 11 ]. The use of a systematic ultrasound approach can enhance the detection of different endometriosis locations within the pelvis [ 12 , 13 , 14 ], with a detection rate that is similar to that of magnetic resonance [ 15 , 16 ].…”

“…Colonic endometriosis is not a rare condition. It affects 37% of women with severe endometriosis [ 13 ], and its correct diagnosis is essential for the proper planning of treatment [ 15 , 48 , 50 , 51 ]. Recently, the ultrasound detection rate of endometriosis foci of the bowels has increased, exhibiting both high sensitivity and specificity [ 46 , 52 ].…”