Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign

Reid, S.; Lü, Chuan; Casikar, I.; Reid, Gary C.; Abbott, Jason; Cario, Gregory M.; Chou, Danny; Kowalski, David; Cooper, Michael; Condous, G.

doi:10.1002/uog.12305

Cited by 145 publications

(189 citation statements)

References 27 publications

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“…The rectum, sigmoid, and rectovaginal septum are often considered together, and the Douglas obliteration was described as an indirect sign of DIE (26). Other studies (17,20) reported a lower accuracy compared with our results, probably due to a retrospective analysis of the TVS findings (17) or to the small number of patients (20).…”

Section: Discussioncontrasting

confidence: 76%

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Exacoustòs

Malzoni²,

Giovanni³

et al. 2014

Fertility and Sterility

134

143

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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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Section: Discussioncontrasting

confidence: 76%

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Exacoustòs

Malzoni²,

Giovanni³

et al. 2014

Fertility and Sterility

134

143

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“…In our analysis of data from 100 women who underwent laparoscopic surgery for diagnosis and surgical treatment of endometriosis, this new technique gave an accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 93.0%, 83.3%, 97.1%, 92.6%, 93.2%, 29.2 and 0.17, respectively when using the ‘sliding sign’ ultrasound technique to predict POD obliteration 27 . We have recently demonstrated the high reproducibility of the ‘sliding sign’, both intra‐ and inter‐observer, in a recent publication 36 .…”

Section: Evolution Of Sonovaginographymentioning

confidence: 93%

“…Recent findings from our Endogynaecology unit suggest that in women undergoing laparoscopy for chronic pelvic pain, uterine retroversion vs. anteversion is significantly associated with the presence vs. absence of POD obliteration at laparoscopy, respectively ( P = 0. 0015) 27 (Figure 1). …”

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

confidence: 99%

“…The new real‐time dynamic ultrasound based ‘sliding sign’ can predict POD obliteration 27 . In order to assess the real‐time ultrasound‐based ‘sliding sign, gentle pressure is placed against the cervix with the transvaginal probe to establish whether the anterior rectum glided freely across the posterior aspect of the cervix (retro‐cervical region) and posterior vaginal wall.…”

Section: Evolution Of Sonovaginographymentioning

confidence: 99%

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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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“…Nodules (arrows) located below the level of a virtual line (red line) passing through the insertion of the uterosacral ligaments on the cervix are considered to be located in the lower rectum, which are more difficult to be surgically resected compared with upper rectum or recto-sigmoid junction lesions. woman's lower anterior abdominal wall to ballot the uterus between the palpating hand and transvaginal probe to determine whether the recto sigmoid glides freely over the posterior aspect of the upper uterus or fundus [38,39].…”

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

207

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign

Cited by 145 publications

References 27 publications

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Ultrasound mapping system for the surgical management of deep infiltrating 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?

Imaging for the evaluation of endometriosis and adenomyosis

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