Staging of Pelvic Endometriosis: Role of Sonographic Appearance in Determining Extension of Disease and Modulating Surgical Approach

Exacoustòs, C.; Zupi, Errico; Carusotti, C.; Rinaldo, D.; Marconi, Daniela; Lanzi, G; Arduini, Domenico

doi:10.1016/s1074-3804(05)60266-6

Cited by 71 publications

(53 citation statements)

References 11 publications

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“…Therefore, in women who are infertile or have chronic pelvic pain, and in the absence of ovarian endometriomas, it is important to look for sonographic signs of adhesions. Only a few studies have attempted to assess the ability of transvaginal sonographic examination to detect the presence of pelvic adhesions in women with pelvic endometriosis, and to assess their severity [32][33][34][35].…”

Section: Ultrasound Evaluationmentioning

confidence: 99%

“…In this case, adhesions can be suspected. Sometimes, in the presence of pelvic fluid, fine septa (adhesions) can be seen between the ovary, the endometrioma, the uterus, or the peritoneum of the POD [33,35]. Endometrioma are usually fixed posteriorly to the uterus, in the POD.…”

Section: Ultrasound Evaluationmentioning

confidence: 99%

“…endometrioma, hydrosalpinx) in women with a history of chronic pelvic pain correlated with the presence or absence of endometriosis and adhesions at laparoscopy. Preoperative transvaginal and transrectal ultrasound have also been used to predict Stage 3 and 4 endometriosis (including pelvic adhesions) at laparoscopy, with a sensitivity and specificity of 86% and 82%, respectively, for Stage 3 and 76% and 91%, respectively, for Stage 4 disease [35]. Guerriero et al [32] used a technique of applying pressure between the uterus and ovary, and found that a combination of three features are suggestive of ovarian adhesions: blurring of the ovarian margin; the inability to mobilise the ovary on palpation (fixation); and an increased distance from the probe.…”

Section: Ultrasound Evaluationmentioning

confidence: 99%

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Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

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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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Section: Ultrasound Evaluationmentioning

confidence: 99%

Section: Ultrasound Evaluationmentioning

confidence: 99%

Section: Ultrasound Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

Self Cite

207

143

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“…To detect DIE extension into the pelvis, use of magnetic resonance imaging (MRI) (7)(8)(9)(10)(11)(12) and transvaginal sonography (TVS) (6,(13)(14)(15)(16)(17)(18) have been described. The MRI provides accurate information about lesions located on the upper level of the sigmoid, but for pelvic disease TVS is equally accurate and is considered the first and most widely used diagnostic tool (6,(18)(19)(20).…”

mentioning

confidence: 99%

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Exacoustòs

Malzoni²,

Giovanni³

et al. 2014

Fertility and Sterility

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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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“…Results are extremely variable. One study found ultrasound staging of pelvic endometriosis to agree with laparoscopic staging in 82% of cases [168]. I have found no studies reporting the diagnostic performance of CT for the diagnosis of peritoneal endometriosis.…”

Section: Endometriosismentioning

confidence: 99%

Imaging in gynecology

Valentin

2006

Best Practice & Research Clinical Obstetrics & Gynaecol

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This chapter summarizes the diagnostic performance (sensitivity, specificity, positive and negative likelihood ratios) of ultrasound, computer tomography, and magnetic resonance imaging in the diagnosis of various gynecological diseases and tumors. Positron emission tomography is not discussed. Imaging in infertility, in the diagnosis of Mullerian duct anomalies and in gynecological oncology (staging of gynecological cancers, diagnosis of recurrence of gynecological cancer, diagnosis of trophoblastic tumors) is not dealt with.Ultrasound is the first line imaging method for discrimination between viable intrauterine pregnancy, miscarriage and tubal pregnancy in women with bleeding and/or pain in early pregnancy, for discrimination between benign and malignant adnexal masses and for making a specific diagnosis in adnexal tumors (e.g., dermoid cyst, endometrioma, hemaorrhagic corpus luteum, ectetera), for diagnosing intracavitary uterine pathology in women with bleeding problems, and for confirming or refuting pelvic pathology in women with pelvic pain. Magnetic resonance imaging may have a role as a secondary test in the diagnosis of adenomyosis, 'deep endometriosis' (e.g., endometriosis in the rectovaginal septum or in the utero-sacral ligaments), and in the diagnosis of extremely rare types of ectopic pregnancy (e.g., in the spleen, liver or retroperitoneum).

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Staging of Pelvic Endometriosis: Role of Sonographic Appearance in Determining Extension of Disease and Modulating Surgical Approach

Cited by 71 publications

References 11 publications

Imaging for the evaluation of endometriosis and adenomyosis

Imaging for the evaluation of endometriosis and adenomyosis

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Imaging in gynecology

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