Deep endometriosis: Can surgical complexity and associated risk factors be evaluated with transvaginal sonography and classification systems?

Aas-Eng, Mee Kristine; Keckstein, J; Condous, G.; Abrão, Maurício Simões; Hudelist, Gernot

doi:10.1016/j.ejogrb.2022.07.011

Cited by 2 publications

(5 citation statements)

References 25 publications

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“…For the same reasons, this bilateral anatomical region demands a dedicated, technically prepared, and usually multidisciplinary surgical team. Parametrium involvement has been reported as an independent risk factor for intraand postoperative complications: longer operating times, hospital stays, and increased intraoperative and postoperative morbidity have been observed to be associated with PE [6,10,12,14,22,29].…”

Section: Discussionmentioning

confidence: 99%

“…Transvaginal sonography (TVS) is the first-line diagnostic tool for DIE [2,4,14,15], and its diagnostic accuracy and reliability have been well documented [4,14,16]. However, considering the complexity of endometriosis and that TVS is firmly operator-dependent, adequate protocols are required to achieve appropriate diagnostic accuracy [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, considering the complexity of endometriosis and that TVS is firmly operator-dependent, adequate protocols are required to achieve appropriate diagnostic accuracy [4]. In 2016, the International Deep Endometriosis Analysis (IDEA) group recognized the importance of a dedicated standardized protocol to overcome this limit [14,17,18]. A systematic 4-step approach to describe and examine the pelvis with TVS was developed to accurately map the disease by assessing the anatomic structures and their dynamic features [4,17,18].…”

Section: Introductionmentioning

confidence: 99%

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Transvaginal Sonography for the Preoperative Assessment of Parametrial Deep Infiltrating Endometriosis: A Diagnostic Accuracy Study

Garzon,

Laganà,

Guerriero

et al. 2024

Gynecol Obstet Invest

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Objective: To evaluate the diagnostic accuracy for parametria endometriosis (PE) of transvaginal sonography (TVS) performed following a systematic approach for the assessment of the lateral parametria. Design: Diagnostic accuracy study based on a prospective observational design Participants: All consecutive patients who underwent laparoscopic surgery for endometriosis between January 2016 and December 2020. Setting: Endometriosis referral hospital Methods: We prospectively collected clinical, imaging, and surgical data of all consecutive patients who underwent laparoscopic surgery for endometriosis between January 2016 and December 2020. A standardized technique with a systematic approach for the assessment of the lateral parametria following specific anatomic landmarks was used for the TVS. The diagnostic accuracy for PE of TVS was assessed using the intraoperative and pathologic diagnosis of PE as the gold standard. Results: In 476 patients who underwent surgery, PE was identified in 114 out of 476 patients (23.95%): 91 left and 54 right PE out of 476 surgical procedures were identified (19.12% vs. 11.34%; p=0.001); bilateral involvement in 27.19% (31/114 patients) cases. The sensitivity of TVS for PE was 90.74% (79.70%-96.92%, 95% CI) for the right side and 87.91% (79.40%-93.81%, 95% CI) for the left side. The specificity was almost identical for both sides (98.58% vs. 98.18%). For the right parametrium, the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 63.82 (28.70-141.90, 95% CI) and 0.09 (0.04-0.22, 95% CI), respectively. On the left parametrium, the PLR and NLR were 48.35 (23.12-101.4, 95% CI) and 0.12 (0.07-0.21, 95% CI), respectively. The diagnostic accuracy for right and left PE was 97.69% (95.90%-98.84%, 95%CI) and 96.22% (94.04%-97.74%, 95% CI), respectively. Limitations: The principal limit is the high dependence of TVS on the operator experience. Therefore, although a standardized approach following precise definitions of anatomical landmarks was used, we cannot conclude that the observed accuracy of TVS for PE is the same for all sonographers. In this regard, the learning curve was not assessed. In the case of negative TVS for parametrial involvement with an absent intraoperative suspect, a complete dissection of the parametrium was not performed to avoid surgical complications; therefore, cases of minor PE may be missed, underestimating false negatives. Conclusions: TVS performed following a systematic approach for assessing the lateral parametria seems to have good diagnostic accuracy for PE with large changes in posttest probability of parametrial involvement based on the TVS evaluation. Considering the clinical and surgical implications of PE, further studies implementing a standardized approach for assessing the parametrium by TVS are recommended to confirm our observations and implement a standardized protocol in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transvaginal Sonography for the Preoperative Assessment of Parametrial Deep Infiltrating Endometriosis: A Diagnostic Accuracy Study

Garzon,

Laganà,

Guerriero

et al. 2024

Gynecol Obstet Invest

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“…However, such deep lesions can be seen with three‐dimensional transvaginal sonography (3DTVS) in the anterior pelvic compartment, in the cul‐de‐sac, the rectosigmoid, uterosacral ligaments, and other places in the region. This has been demonstrated in multiple reports 2–12 . Given a report suggesting the inaccuracy of this imaging modality, 13 the pathologic verification represented in these studies of sonographic identification of DIE, can be considered as contrasting evidence.…”

Section: Introductionmentioning

confidence: 98%

“…This has been demonstrated in multiple reports. [2][3][4][5][6][7][8][9][10][11][12] Given a report suggesting the inaccuracy of this imaging modality, 13 the pathologic verification represented in these studies of sonographic identification of DIE, can be considered as contrasting evidence. A comparison of ultrasound and magnetic resonance imaging for the detection of DIE states that ultrasound is superior.…”

Section: Introductionmentioning

confidence: 99%

The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series

Fernandez,

Levine,

Shashoua

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo investigate the value of the sonographic identification of deep infiltrating endometriosis (DIE) in women presenting with complaints suggestive of DIE. Sonography findings were correlated with subsequent surgical exploration, and histologic verification.MethodsA retrospective observational case series was investigated to document the ability of the use of sonography to accurately detect the presence of deep infiltrating endometriosis. The clinical observations were performed consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for observational studies. Recognizing the real‐world office setting for this may introduce the importance of the practical clinical aspects of diagnostic procedures in general.ResultsThree‐dimensional transvaginal sonography was able to accurately identify deep invasive endometriosis in 92% of the 100 women subjectively complaining of the associated symptoms of endometriosis, who underwent sonography, surgical exploration, and pathologic analysis. Additional sonographic evidence of pelvic pathology was found during the course of this investigation, perhaps complementing other means for diagnosing endometriosis.ConclusionThree‐dimensional transvaginal sonography is a diagnostic tool that can effectively identify deep infiltrating endometriosis, which may otherwise go undetected and untreated. These findings should encourage the use of sonography for the detection of this subtype of endometriosis.

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Deep endometriosis: Can surgical complexity and associated risk factors be evaluated with transvaginal sonography and classification systems?

Cited by 2 publications

References 25 publications

Transvaginal Sonography for the Preoperative Assessment of Parametrial Deep Infiltrating Endometriosis: A Diagnostic Accuracy Study

Transvaginal Sonography for the Preoperative Assessment of Parametrial Deep Infiltrating Endometriosis: A Diagnostic Accuracy Study

The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series

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