Accuracy of sonography for non‐invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study

Montanari, Eliana; Bokor, Attila; Szabó, Gábor; Kondo, William; Trippia, Carlos Henrique; Malzoni, Mario; Giovanni, A. Di; Tinneberg, Hans‐Rudolf; Oberstein, A; Rocha, Rodrigo; Leonardi, Mathew; Condous, G.; Alsalem, Hanan; Keckstein, J; Hudelist, G

doi:10.1002/uog.24833

Cited by 37 publications

(40 citation statements)

References 22 publications

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“…Superficial peritoneal endometriosis may be the only entity which cannot be reliably diagnosed by any imaging method [18]. A recently published prospective, multicentre study including 745 patients undergoing TVS and surgery found excellent sensitivities for DE and ovarian endometriosis [19]. But none of the analyzed anatomical sites reached a 100% detection rate.…”

Section: Ultrasonography Does Not Allow the Definite Exclusion Of End...mentioning

confidence: 99%

“…Recently, a prospective, multicentre study including 745 patients undergoing TVS in combination with the #Enzian classification and surgery [19] documented sensitivities for the detection of DE ranging from 50% (#Enzian compartment FI-other intestinal locations) to 95% (#Enzian A), specificities from 86% (#Enzian T left) to 99% (#Enzian FI) and 100% (#Enzian FB-urinary bladder, FU-ureters and FO-other extragenital locations) with positive predictive values of 90% (#Enzian T right) to 100% (#Enzian FO), negative predictive values of 74% (#Enzian B left) to 99% (#Enzian FB and FU) and accuracies of 88% (#Enzian B right) to 99% (#Enzian FB). These data support that DE can be accurately evaluated using TVS in combination with the #Enzian classification (Table 1 and Figs.…”

Section: Classification Of the Extent Of Findings Should Be Done Acco...mentioning

confidence: 99%

“…The authors advocate for using of TVS as a primary tool to evaluate women with suspected endometriosis and to stratify these patients into low-and high-risk patients based on the results of TVS-based preoperative assessment. A nearly complete Table 1 The accuracy of sonographic classification (#Enzian(u)) of endometriosis compared with the result of surgical classification #Enzian(s) (retrospective study by di Giovanni A. et al [54] and prospective study of Montanari E. [19]) O = ovary; T = adhesions of the adnexa; A = vagina, rectovaginal septum, torus uteri; B = USL, parametrium; C = rectum; FB = bladder; FI = intestinal above the rectosigmoid (> 16 cm from the anus); FU = ureteral obstruction; FO = other lesions *For #Enzian compartment T, it was not possible to calculate sensitivities and specificities, as there were too few cases without any lesion during TVS or surgery di Giovanni et non-invasive diagnosis of endometriosis opens up new perspectives for conservative and surgical treatment. Using the #Enzian classification, also in the context of sonographic assessment, provides clinicians with a uniform "language" for a comprehensive and easily reproducible description of endometriosis.…”

Section: Conclusion and Perspectivementioning

confidence: 99%

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Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis

Keckstein

Hoopmann

Merz³

et al. 2022

Arch Gynecol Obstet

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Gynecological ultrasonography plays a central role in the management of endometriosis. The rapid technical development as well as the currently increasing evidence for non-invasive diagnostic methods require an updated compilation of recommendations for the use of ultrasound in the management of endometriosis. The present work aims to highlight the accuracy of sonography for diagnosing and classifying endometriosis and will formulate the present list of key messages and recommendations. This paper aims to demonstrate the accuracy of TVS in the diagnosis and classification of endometriosis and to discuss the clinical applications and consequences of TVS findings for indication, surgical planning and assessment of associated risk factors. (1) Sophisticated ultrasound is the primary imaging modality recommended for suspected endometriosis. The examination procedure should be performed according to the IDEA Consensus. (2) Surgical intervention to confirm the diagnosis alone is not recommended. A preoperative imaging procedure with TVS and/or MRI is strongly recommended. (3) Ultrasound examination does not allow the definitive exclusion of endometriosis. (4) The examination is primarily transvaginal and should always be combined with a speculum and a bimanual examination. (5) Additional transabdominal ultrasonography may enhance the accuracy of the examination in case of extra pelvic disease, extensive findings or limited transvaginal access. (6) Sonographic assessment of both kidneys is mandatory when deep endometriosis (DE) and endometrioma are suspected. (7) Endometriomas are well defined by sonographic criteria. When evaluating the ovaries, the use of IOTA criteria is recommended. (8) The description of sonographic findings of deep endometriosis should be systematically recorded and performed using IDEA terminology. (9) Adenomyosis uteri has sonographically well-defined criteria (MUSA) that allow for detection with high sensitivity and specificity. MRI is not superior to differentiated skilled ultrasonography. (10) Classification of the extent of findings should be done according to the #Enzian classification. The current data situation proves the best possible prediction of the intraoperative situs of endometriosis (exclusive peritoneum) for the non-invasive application of the #Enzian classification. (11) Transvaginal sonographic examination by an experienced examiner is not inferior to MRI diagnostics regarding sensitivity and specificity in the prediction of the extent of deep endometriosis. (12) The major advantage of non-invasive imaging and classification of endometriosis is the differentiated planning or possible avoidance of surgical interventions. The recommendations represent the opinion of experts in the field of non-invasive and invasive diagnostics as well as therapy of endometriosis. They were developed with the participation of the following national and international societies: DEGUM, ÖGUM, SGUM, SEF, AGEM/DGGG, and EEL.

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Section: Ultrasonography Does Not Allow the Definite Exclusion Of End...mentioning

confidence: 99%

Section: Classification Of the Extent Of Findings Should Be Done Acco...mentioning

confidence: 99%

Section: Conclusion and Perspectivementioning

confidence: 99%

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Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis

Keckstein

Hoopmann

Merz³

et al. 2022

Arch Gynecol Obstet

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“…The accuracy of TVUS is well established for diagnosing endometrioma of the ovary. In a recent multicentre prospective study involving over 700 women, Montanari et al [26 ▪▪ ] showed TVUS had a sensitivity of 90%, specificity of 97%, positive-predictive value (PPV) of 94% and negative-predictive value (NPV) of 95% in predicting ovarian disease. In a prospective study of 120 patients, where two experienced surgeons who were blinded to the ultrasound findings reviewed laparoscopy videos, Goncalves et al [18 ▪ ] showed TVUS demonstrated no significant difference in sensitivity and specificity compared with laparoscopy for endometrioma (95 and 95% for TVUS vs. 79 and 87% for laparoscopy).…”

Section: Ovariesmentioning

confidence: 99%

Effectiveness of ultrasound for endometriosis diagnosis

Chen-Dixon

Uzuner

Mak

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewEndometriosis is a chronic benign gynaecological condition characterized by pelvic pain, subfertility and delay in diagnosis. There is an emerging philosophical shift from gold standard histopathological diagnosis through laparoscopy to establishing diagnosis through noninvasive imaging.Recent findingsThe ENZIAN classification system was updated in 2021 to be suitable for both diagnostic imaging and laparoscopy. The accuracy of transvaginal ultrasound (TVUS) in diagnosing endometriosis varies depending on location of the lesion. A recent international pilot study found that when ultrasound is performed in accordance with the IDEA consensus, a higher detection of deep endometriosis is seen, with an overall sensitivity of 88% and specificity of 79% compared with direct surgical visualization.SummaryAlthough ultrasound can detect adenomyosis, deep endometriosis and endometriomas, it is not possible to reliably detect superficial endometriosis. In the instance of a negative ultrasound with persistence of symptoms despite medical therapy, laparoscopy should be considered for diagnosis and treatment.

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“…The maneuver consisted of gentle pushing of the probe combined with abdominal palpation with the free hand. When the ovaries are medially located and fixed (kissing ovaries), there is a high probability of underlying endometriosis 34 .…”

Section: Ovariesmentioning

confidence: 99%

Imaging diagnosis of endometriosis

Chamié¹

2022

JMEXFRI

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Endometrosis is a common gynecologic disease that affects women of reproductive age and commonly causes pelvic pain and infertility. The most common types are superficial peritoneal implants, ovarian endometriotic cysts (endometriomas), and deep-infiltrating subperitoneal lesions. Diagnosis is often delayed, and up to 65% of women are initially misdiagnosed. Imaging methods play a pivotal role in patient counseling and clinical management of the disease, and have been replacing diagnostic laparoscopy in specialized centers worldwide. Comprehensive imaging mapping is required for adequate surgical planning and to assist fertility doctors in determining the appropriate treatment options. Transvaginal ultrasound (TVU) is the first-line imaging modality and is a widely available tool that enables accurate diagnosis of endometriosis when a dedicated protocol is used. TVU is the best imaging method to investigate multiple bowel lesions and small peritoneal implants. Magnetic resonance imaging (MRI) is an excellent multiplanar method for evaluating the pelvic cavity and extrapelvic sites in endometriosis. It is the method of choice to differentiate ovarian cysts and investigate endometriosis affecting the ureters, pelvic nerves, pelvic floor, and diaphragm. This In-Depth Review describes the imaging protocol and findings of TVU and MRI to investigate endometriosis.

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Accuracy of sonography for non‐invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study

Cited by 37 publications

References 22 publications

Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis

Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis

Effectiveness of ultrasound for endometriosis diagnosis

Imaging diagnosis of endometriosis

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