Transvaginal ultrasound <i>vs</i> magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta‐analysis

Guerriero, S.; Saba, Luca; Pascual, M.; Ajossa, Silvia; Rodríguez, I.; Mais, Valerio; Alcázar, Juan Luis

doi:10.1002/uog.18961

Cited by 167 publications

(138 citation statements)

References 32 publications

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“…Over the last decade, transvaginal ultrasonography (TVS) has become a fundamental diagnostic tool for the disease. Several authors report that, in expert hands, this technique is highly accurate, and a targeted endometriosis scan performed by an experienced expert clinician is expected to have higher predictive accuracy compared with routine pelvic ultrasound examination.…”

Section: Introductionmentioning

confidence: 99%

Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program

Guerriero

Pascual

Ajossa

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE).Methods Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE. ResultsThe trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE. ConclusionsThe suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE.

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Section: Introductionmentioning

confidence: 99%

Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program

Guerriero

Pascual

Ajossa

et al. 2019

Ultrasound in Obstet & Gyne

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“…Using this technology is far better than suddenly confronting this condition in the operating room, which possibly best would involve other related surgical specialties. The essential surgical approach to consider for treatment and the decision making that is often involved can be improved on with 3D US visualization before the surgical procedure is performed . The borders of the endometriotic lesion are best identified with 3D US because of the clarity of the image that results and the ability to manipulate the image subsequent to its capture, identifying the depth of invasion.…”

Section: Deeply Invasive Endometriosismentioning

confidence: 99%

“…The essential surgical approach to consider for treatment and the decision making that is often involved can be improved on with 3D US visualization before the surgical procedure is performed. 3,4 The borders of the endometriotic lesion are best identified with 3D US because of the clarity of the image that results and the ability to manipulate the image subsequent to its capture, identifying the depth of invasion. It has become recognized that multiple surgical specialties should be included on the surgical team that ideally surgically treats this condition, and all should be well prepared from viewing the imaging studies to perform the necessary surgical procedures.…”

Section: Deeply Invasive Endometriosismentioning

confidence: 99%

Clinical Value of 3‐Dimensional Ultrasound in Gynecology

Levine

Fernández

Miller

et al. 2018

J of Ultrasound Medicine

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“…A dedicated operator with specific knowledge is expected to have high predictive accuracy in the diagnosis of rectosigmoid (RS) deep endometriosis (DE). Due to the high sensitivity and specificity reported (> 90%), the detection rate of RS endometriosis by expert ultrasonographic (US) evaluation should be considered a gold standard comparable to laparoscopy.…”

Section: Introductionmentioning

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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Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta‐analysis

Cited by 167 publications

References 32 publications

Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program

Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program

Clinical Value of 3‐Dimensional Ultrasound in Gynecology

Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

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