Evaluation of Uterosacral Ligament Involvement in Deep Endometriosis by Transvaginal Ultrasonography

Abstract

This study was designed to conclude the ultrasonic characteristics of uterosacral ligament (USL) lesions involved by endometriosis and evaluated the value of transvaginal sonography (TVS) in diagnosing USL involvement in deep infiltrating endometriosis (DIE). A total of one hundred and eighteen patients with DIE were included in the study and underwent surgery. All these patients were evaluated by transvaginal ultrasound examination by one trained examiner. The gold standard for diagnosis was surgery and histopathology. 85 patients with USL endometriosis were confirmed by surgical pathology. 84 patients were diagnosed USL endometriosis by TVS and 81 of which were confirmed by the gold standard. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TVS for diagnosing USL endometriosis were 95.3, 90.9, 96.4, 88.2, and 94.1%, respectively. According to the ultrasound characteristics of USL endometriosis, we summarized four types: Type I. thickened and stiff lesions, Type II. local nodules, Type III. irregular striped lesions, and Type IV. mixed lesions. The conclusion of the study was that TVS was a convenient, accurate and first-line diagnostic technique for USL endometriosis and the USL lesions could be summarized into four types according to the ultrasound morphological changes.

Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis

“…The 10 studies included a total of 1188 women with a median of 91.5 per study (range 23 to 317) ( Pascual et al , 2010 ; Hudelist et al , 2011 ; Fiaschetti et al , 2012 ; Bazot et al , 2013 ; Holland et al , 2013 ; Manganaro et al , 2013 ; Tammaa et al , 2015 ; Menakaya et al , 2016 ; Alborzi et al , 2018 ; Zhang et al , 2019 ). Of the 10 studies, seven were conducted in Europe, one in Asia, one in Australia and one in the Middle East.…”

“…A total of nine studies assessed USL DE (1150 participants) ( Hudelist et al , 2011 ; Fiaschetti et al , 2012 ; Bazot et al , 2013 ; Holland et al , 2013 ; Manganaro et al , 2013 ; Tammaa et al , 2015 ; Menakaya et al , 2016 ; Alborzi et al , 2018 ; Zhang et al , 2019 ), of which seven studies assessed TVS (1085 women), of which five studies used two-dimensional (2D) TVS (568 participants) ( Hudelist et al , 2011 ; Fiaschetti et al , 2012 ; Holland et al , 2013 ; Tammaa et al , 2015 ; Zhang et al , 2019 ), one used SVG ( Menakaya et al , 2016 ) and one used TVS with BP ( Alborzi et al , 2018 ). A total of four studies assessed MRI (440 women with 521 examinations included in the analysis due to two studies comparing more than one MRI technique with each woman), of which all four studies used 2D MRI ( Fiaschetti et al , 2012 ; Bazot et al , 2013 ; Manganaro et al , 2013 ; Alborzi et al , 2018 ), one used three-dimensional (3D) MRI ( Bazot et al , 2013 ) and two studies used MRI with gel ( Fiaschetti et al , 2012 ; Manganaro et al , 2013 ).…”

“…Six studies were considered to be low risk for patient selection bias ( Pascual et al , 2010 ; Hudelist et al , 2011 ; Holland et al , 2013 ; Tammaa et al , 2015 ; Menakaya et al , 2016 ; Alborzi et al , 2018 ), three were high risk ( Fiaschetti et al , 2012 ; Bazot et al , 2013 ; Manganaro et al , 2013 ) and one was unclear ( Zhang et al , 2019 ). With reference to the index test domain, seven studies were assessed to be low risk ( Pascual et al , 2010 ; Hudelist et al , 2011 ; Bazot et al , 2013 ; Holland et al , 2013 ; Tammaa et al , 2015 ; Menakaya et al , 2016 ; Zhang et al , 2019 ) and three were high risk ( Holland et al , 2013 ; Menakaya et al , 2016 ; Alborzi et al , 2018 ). Aside from Zhang et al (2019) which was unclear, the remaining nine studies were considered high risk of bias for the reference standard domain as surgeons were not blinded to the preoperative imaging results.…”

Transvaginal US of Endometriosis: Looking Beyond the Endometrioma with a Dedicated Protocol

“…Pooled sensitivity and specificity values of 71% and 93%, respectively, were reported in the Alborzi et al study (13). However, in a recent study (50) with experienced TVS operators, a sensitivity of 95%, specificity of 91%, and accuracy of 94% were reported.…”

“…Symptoms include dyspareunia in addition to dysmenorrhea, and chronic pelvic pain. A normal USL can be visualized when it is outlined by a small amount of free fluid (24,50). At TVS, a normal USL is hyperechoic in contrast to the retrocervical hypoechoic nodular or linear thickening that occurs with DIE of the USL (Fig 10).…”