Prospective diagnostic test accuracy of transvaginal ultrasound posterior approach for uterosacral ligament and torus uterinus deep endometriosis

Abstract

ObjectiveTo determine the diagnostic test accuracy of transvaginal ultrasound (TVS) using a standardized technique for the diagnosis of deep endometriosis (DE) of the uterosacral ligaments (USLs) and adjacent torus uterinus (TU).MethodsThis was a prospective diagnostic test accuracy study conducted at the McMaster University Medical Center Tertiary Endometriosis Clinic. Consecutive participants were enrolled if they successfully underwent TVS and surgery with our team from August 10, 2020 – October 31, 2021. The index test was TVS using a standardized posterior approach performed and interpreted by an expert‐trained sonologist. The reference standard included direct surgical visualization through laparoscopy by the same person who performed and interpreted the ultrasound scans. The reference standard included direct surgical visualization through laparoscopy. Accuracy, sensitivity, specificity, positive and negative predictive values (PPV/NPV), and positive and negative likelihood ratios (LR+/LR‐) were calculated for the posterior TVS approach for each location using the reference standard.ResultsFifty‐four consecutive participants were included upon completion of laparoscopy and histological assessment. The prevalence of DE for the left USL, right USL, and TU were 42.6%, 22.2%, and 14.8%, respectively. The diagnostic performance of TVS based on surgical visualization as a reference for the left USL, right USL, and TU were as follows: Accuracy 92.6%, 94.4%, and 100%; Sensitivity 82.6%, 75.0%, and 100%; Specificity 100%, 100%, 100%; PPV 100%, 100%, 100%; NPV 88.6%, 93.3%, 100%; respectively.ConclusionWe observed high diagnostic test accuracy of the examined standardized TVS technique for assessing DE of USLs and TU. More studies evaluating this technique should be performed, particularly with less trained observers, before considering this technique as the standard approach.This article is protected by copyright. All rights reserved.

Systematic, noninvasive endometriosis diagnosis in transvaginal sonography by the Swiss Society of Ultrasound in Medicine

“…This article presents a new, comprehensive, and systematic approach by the Swiss Society of Ultrasound in Medicine (SGUM) (SWISS Gynecologic Ultrasound Guideline, 3 rd edition, in press) to explore the entire female true (lesser) pelvis in five compartments for endometriotic lesions using TVS. It is based on the 2016 IDEA Consensus (IDEA 2016) [8], including subsequent extensions [11,12], refinements [6,13], and validations [4,14]. It highlights the five sites most commonly affected by DE (sacrouterine ligaments (SUL) 53 %, bowel 23 %, vagina 16 %, bladder 6 %, and ureters 2 %) [15].…”

“…The SULs are preferably found topographically and not morphologically [14]. In a transverse plane, they directly connect caudally to the CALs as a bright, echogenic stripe in the dorsal peritoneum that extends laterally from the cervix.…”