Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Abstract

Objectives To review the accuracy of different imaging modalities for the detection of rectosigmoid deep endometriosis (DE) in women with clinical suspicion of endometriosis, and to determine the optimal modality. Methods A search was conducted using PubMed, MEDLINE, Scopus, EMBASE and Google Scholar to identify studies using imaging to evaluate women with suspected DE, published from inception to May 2020. Studies were considered eligible if they were prospective and used any imaging modality to assess preoperatively for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical diagnosis as the reference standard. Eligibility was restricted to studies including at least 10 affected and 10 unaffected women. The QUADAS‐2 tool was used to assess the quality of the included studies. Mixed‐effects diagnostic meta‐analysis was used to determine the overall pooled sensitivity and specificity of each imaging modality for rectal/rectosigmoid DE, which were used to calculate the likelihood ratio of a positive (LR+) and negative (LR–) test and diagnostic odds ratio (DOR). Results Of the 1979 records identified, 30 studies (3374 women) were included in the analysis. The overall pooled sensitivity and specificity, LR+, LR– and DOR for the detection of rectal/rectosigmoid DE using transvaginal sonography (TVS) were, respectively, 89% (95% CI, 83–92%), 97% (95% CI, 95–98%), 30.8 (95% CI, 17.6–54.1), 0.12 (95% CI, 0.08–0.17) and 264 (95% CI, 113–614). For magnetic resonance imaging (MRI), the respective values were 86% (95% CI, 79–91%), 96% (95% CI, 94–97%), 21.0 (95% CI, 13.4–33.1), 0.15 (95% CI, 0.09–0.23) and 144 (95% CI, 70–297). For computed tomography, the respective values were 93% (95% CI, 84–97%), 95% (95% CI, 81–99%), 20.3 (95% CI, 4.3–94.9), 0.07 (95% CI, 0.03–0.19) and 280 (95% CI, 28–2826). For rectal endoscopic sonography (RES), the respective values were 92% (95% CI, 87–95%), 98% (95% CI, 96–99%), 37.1 (95% CI, 21.1–65.4), 0.08 (95% CI, 0.05–0.14) and 455 (95% CI, 196–1054). There was significant heterogeneity and the studies were considered methodologically poor according to the QUADAS‐2 tool. Conclusions The sensitivity of TVS for the detection of rectal/rectosigmoid DE seems to be slightly better than that of MRI, although RES was superior to both. The specificity of both TVS and MRI was excellent. As TVS is simpler, faster and more readily available than the other methods, we believe that it should be the first‐line diagnostic tool for women with suspected DE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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

“…This study is one of a series of subgroups of the larger systematic review protocol. The protocol and following methodology, whilst standard for systematic reviews and meta-analyses, were used in a previously published study ( Gerges et al , 2021 ).…”

“…and M.L. as per QUADAS-2 ( Whiting et al , 2011 ; Gerges et al , 2021 ). The four domains evaluated were: patient selection; index text; reference standard; and flow and timing (only risk of bias).…”

The #Enzian classification: A comprehensive non‐invasive and surgical description system for endometriosis

“…This raises several questions when analyzing the predictive value, when used in terms of symptoms, response to surgical treatment, postoperative pregnancy rate, symptom recurrence, and disease relapse 3 . High accuracy in diagnosis of DE through non‐invasive methods, such as magnetic resonance imaging (MRI) and transvaginal sonography (TVS), has been demonstrated 4 , 5 …”

Impact of Uterine Adenomyosis on Pregnancy Outcomes in Women Undergoing In Vitro Fertilization Treated With a Long-Term Pituitary Downregulation Protocol

“…In addition, adenomyosis in our study was diagnosed by transvaginal ultrasound (TVS) examination, which has limited specificity. Other studies have showed that the sensitivity of MRI is higher than that of ultrasonic examination in the diagnosis of adenomyosis, so there may be some misdiagnosis in our study (23). Future studies should include the size of the uterus which was indeed an important factor influencing IVF outcomes (19).…”