To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: Ultrasound “sliding sign,” transvaginal ultrasound direct visualization or both?

Reid, S.; Espada, Mercedes; Lü, Chuan; Condous, G.

doi:10.1111/aogs.13425

Cited by 13 publications

(31 citation statements)

References 12 publications

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“…Several findings associated with the presence of DE have been investigated previously, but there has been no direct evaluation of the role of simple soft markers in screening patients for RS endometriosis. The sliding sign is one such example; Reid et al . investigated the optimal US screening method for rectal/RS‐DE, but examined the sliding sign in association with its direct visualization at US.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

Guerriero

Ajossa

Pascual

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives The aim of this study was to evaluate the use of ultrasound (US) soft markers as a first‐line imaging tool to raise suspicion of rectosigmoid (RS) involvement in women suspected of having deep endometriosis. Methods We included in this prospective observational study all patients with clinical suspicion of deep endometriosis who underwent diagnostic transvaginal US evaluation at our unit from January 2016 to February 2017. Several US soft markers were evaluated for prediction of RS involvement (presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesion of the ovary to the uterus (reduced ovarian mobility), presence of ‘kissing ovaries’ (KO) and absence of the ‘sliding sign’), using as the gold standard expert US examination for the presence of RS endometriosis. Results Included were 333 patients with clinical suspicion of deep endometriosis. Of these, 106 had an US diagnosis of RS endometriosis by an expert. The only significant variables found in the prediction model were absence of the sliding sign (odds ratio (OR), 13.95; 95% CI, 7.7–25.3), presence of KO (OR, 22.5; 95% CI, 4.1–124.0) and the interaction between these two variables (OR, 0.03; 95% CI, 0.004–0.28). Regarding their interaction, RS endometriosis was present when KO was absent and the sliding sign was present in 10% (19/190) of cases, when both KO and the sliding sign were present in 71.4% (5/7) of cases, when both KO and the sliding sign were absent in 60.8% (76/125) of cases and when KO was present and the sliding sign was absent in 54.5% (6/11) of cases. Thus, when the sliding sign was absent and/or KO was present, transvaginal US showed a specificity of 75% (95% CI, 69–80%) and a sensitivity of 82% (95% CI, 73–88%). Conclusions US findings of absence of the sliding sign and/or presence of KO in patients with clinical suspicion of endometriosis should raise suspicion of RS involvement and indicate referral for expert US examination, with a low rate of false‐negative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 99%

Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

Guerriero

Ajossa

Pascual

et al. 2020

Ultrasound in Obstet & Gyne

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“…Bowel.-Overall, the intestines are involved in 5%-12% of women with endometriosis and in 10% of patients with DIE (18,38,44). The rectum and rectosigmoid junction account for 70%-93% of intestinal lesions and reflect a severe form of disease (11,21,44). Bowel DIE is commonly associated with other pelvic sites of involvement, with only 29% of bowel DIE cases reported to be isolated to the bowel (18).…”

Section: Component 2: Search For Diementioning

confidence: 99%

“…POD obliteration can be predicted by performing a sliding sign assessment (6,52). Adding sliding sign assessment to TVS also increases accuracy in the detection of rectosigmoid and rectal DIE (44). POD obliteration is associated with a threefold increased risk of bowel involvement and can obscure DIE lesions at laparoscopy (51).…”

Section: Component 3: Assessment Of the Sliding Signmentioning

confidence: 99%

“…It is important to note that although a negative sliding sign is associated with increased bowel involvement, it is not specific for bowel DIE. The sliding sign can be negative in the absence of rectal DIE and positive in cases with rectal DIE (11,44). The sliding sign assessment is essentially a test for adhesions, which can be caused by superficial endometriosis, inflammation, or prior pelvic surgery.…”

Section: Component 3: Assessment Of the Sliding Signmentioning

confidence: 99%

“…The sliding sign assessment is essentially a test for adhesions, which can be caused by superficial endometriosis, inflammation, or prior pelvic surgery. However, the most common cause of POD obliteration is rectal and rectosigmoid DIE (44). A negative sliding sign is predictive of rectal DIE, with a reported accuracy of 93%, and it should prompt an amplified search for bowel DIE in the posterior compartment (53).…”

Section: Component 3: Assessment Of the Sliding Signmentioning

confidence: 99%

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

et al. 2019

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■ List the four components of a US examination that is optimized for evaluation of pelvic endometriosis. ■ Identify the anatomic locations and TVS findings of the various manifestations of endometriosis. ■ Discuss the value of US in the management of endometriosis, including the unique features of US, performed as an extension of the physical examination, that enable acquisition of information that is not easily addressed with other imaging modalities.

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OC15.07: Ultrasonographic “soft” markers for the detection of rectosigmoid endometriosis

Guerriero

Ajossa

Pascual

et al. 2018

Ultrasound in Obstet & Gyne

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Objectives: To assess the value of nodule's volume and location for predicting type of resection during surgery in women with DIE involving the rectosigmoid. Methods: Retrospective analysis of prospectively collected data from 76 consecutive women (mean age: 33.8-year old) who underwent enhanced transvaginal ultrasound for assessing DIE involving the rectosigmoid prior to surgery. DIE nodule's volume and distance to the anal verge were estimated. All women underwent laparoscopy and bowel surgery. The type of surgery (complete resection with termino-terminal anastomosis (T-T), discoid resection or shaving) was correlated with ultrasound measurements. Results: Sixty women underwent shaving surgery, four women underwent discoid resection and twelve women underwent complete resection with T-T. Median nodule's volume was significantly higher in women with complete resection and T-T as compared with women discoid resection or shaving surgery (4.8 cm 3 versus 1.6 cm 3 , p < 0.001). There were no differences for nodule distance to the anal verge. A volume > 2.3 cm 3 had a sensitivity of 100%, specificity of 75%, PPV of 43% and NPV of 100% for identifying women with complete resection ad T-T. Conclusions: Nodule volume estimation by enhanced transvaginal ultrasound in women with DIE involving the rectosigmoid might be useful for predicting the type of resection during surgery. OC15.05 Prevalence of deep infiltrating endometriosis in patients with endometriotic ovarian cyst

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To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: Ultrasound “sliding sign,” transvaginal ultrasound direct visualization or both?

Abstract: The combination of the TVS "sliding sign" and direct visualization of the bowel during TVS appears to provide the most accurate assessment for the identification of rectal/rectosigmoid DE preoperatively.

Cited by 13 publications

References 12 publications

Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

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

OC15.07: Ultrasonographic “soft” markers for the detection of rectosigmoid endometriosis

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