Can Enhanced Techniques Improve the Diagnostic Accuracy of Transvaginal Sonography and Magnetic Resonance Imaging for Rectosigmoid Endometriosis? A Systematic Review and Meta-analysis

Pereira, Ana Maria Gomes; Brizon, Valéria Silva Cândido; Carvas, Nelson; Carvalho, Mariana de Sousa Ribeiro de; Cuvero, Estevan Matheus; Buehler, Anna Maria; Pereira, Tiago; Lopes, Reginaldo Guedes Coelho

doi:10.1016/j.jogc.2019.07.016

Cited by 19 publications

(26 citation statements)

References 24 publications

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“…Moura et al 56 performed a meta-analysis of studies comparing MRI and TVS in the diagnosis of rectosigmoid DE in the same population and found that both modalities had similar sensitivity, specificity and AUC of, respectively, 90%/96%/0.95 for TVS and 90%/96%/0.90 for MRI. This was similar to the findings of the more recent meta-analysis by Pereira et al 8 on MRI and TVS for the detection of rectosigmoid DE, including comparisons between enhanced techniques, with a sensitivity and specificity of, respectively, 80%/94% for MRI and 82%/94% for TVS. The limitation of the latter two meta-analyses is the small number of included studies, being eight and 11, respectively, although they were both well-conducted and confirmed the high diagnostic accuracy of both TVS and MRI.…”

Section: Interpretation Of Resultssupporting

confidence: 89%

“…These include, but are not limited to, transvaginal sonography (TVS), rectal endoscopic sonography (RES), magnetic resonance imaging (MRI) and computed tomography (CT). Although TVS and MRI have been shown to be comparable with regard to diagnostic accuracy [6][7][8] , any differences being in cost and expertise needed, laparoscopy remains the gold standard for the diagnosis of endometriosis 2 . In 2016, the International Deep Endometriosis Analysis (IDEA) group published a consensus statement to standardize the terms, definitions and sonographic evaluation of the pelvis in women with suspected endometriosis and, in particular, identified five locations for examination, namely the bladder, rectovaginal septum, posterior vaginal fornix, uterosacral ligaments/torus uterinus and rectum/rectosigmoid/sigmoid 9 .…”

Section: Introductionmentioning

confidence: 99%

“…There have been a number of systematic reviews assessing separately the accuracy of TVS 7,10,11 and MRI 12 for the detection of DE, including those of Guerriero et al 10 and Pereira et al 8 , in which head-to-head analyses of MRI and TVS were performed to assess the accuracy of TVS for the detection of rectosigmoid DE, as well as the most recent Cochrane systematic review, by Nisenblat et al 13 , in 2016, which compared multiple imaging technologies.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Gerges

Leonardi

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To review the accuracy of different imaging modalities for the detection of rectosigmoid deep endometriosis (DE) in women with clinical suspicion of endometriosis, and to determine the optimal modality. Methods A search was conducted using PubMed, MEDLINE, Scopus, EMBASE and Google Scholar to identify studies using imaging to evaluate women with suspected DE, published from inception to May 2020. Studies were considered eligible if they were prospective and used any imaging modality to assess preoperatively for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical diagnosis as the reference standard. Eligibility was restricted to studies including at least 10 affected and 10 unaffected women. The QUADAS‐2 tool was used to assess the quality of the included studies. Mixed‐effects diagnostic meta‐analysis was used to determine the overall pooled sensitivity and specificity of each imaging modality for rectal/rectosigmoid DE, which were used to calculate the likelihood ratio of a positive (LR+) and negative (LR–) test and diagnostic odds ratio (DOR). Results Of the 1979 records identified, 30 studies (3374 women) were included in the analysis. The overall pooled sensitivity and specificity, LR+, LR– and DOR for the detection of rectal/rectosigmoid DE using transvaginal sonography (TVS) were, respectively, 89% (95% CI, 83–92%), 97% (95% CI, 95–98%), 30.8 (95% CI, 17.6–54.1), 0.12 (95% CI, 0.08–0.17) and 264 (95% CI, 113–614). For magnetic resonance imaging (MRI), the respective values were 86% (95% CI, 79–91%), 96% (95% CI, 94–97%), 21.0 (95% CI, 13.4–33.1), 0.15 (95% CI, 0.09–0.23) and 144 (95% CI, 70–297). For computed tomography, the respective values were 93% (95% CI, 84–97%), 95% (95% CI, 81–99%), 20.3 (95% CI, 4.3–94.9), 0.07 (95% CI, 0.03–0.19) and 280 (95% CI, 28–2826). For rectal endoscopic sonography (RES), the respective values were 92% (95% CI, 87–95%), 98% (95% CI, 96–99%), 37.1 (95% CI, 21.1–65.4), 0.08 (95% CI, 0.05–0.14) and 455 (95% CI, 196–1054). There was significant heterogeneity and the studies were considered methodologically poor according to the QUADAS‐2 tool. Conclusions The sensitivity of TVS for the detection of rectal/rectosigmoid DE seems to be slightly better than that of MRI, although RES was superior to both. The specificity of both TVS and MRI was excellent. As TVS is simpler, faster and more readily available than the other methods, we believe that it should be the first‐line diagnostic tool for women with suspected DE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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Section: Interpretation Of Resultssupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Gerges

Leonardi

et al. 2021

Ultrasound in Obstet & Gyne

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“…Several meta-analyses have recently been published on this topic [ 43 , 57 , 58 , 59 , 60 ]. According to Guerriero et al [ 58 ], MRI and TVS have a similar diagnostic performance in the assessment of DIE of the rectosigmoid, uterosacral ligaments, and RVS.…”

Section: Resultsmentioning

confidence: 99%

Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis—An Overview: How, Why, and When

et al. 2022

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Endometriosis is a common gynaecological disease, causing symptoms such as pelvic pain and infertility. Accurate diagnosis and assessment are often challenging. Transvaginal ultrasound (TVS), along with magnetic resonance imaging (MRI), are the most common imaging modalities. In this narrative review, we present the evidence behind the role of TVS in the diagnosis and assessment of endometriosis. We recognize three forms of endometriosis: Ovarian endometriomas (OMAs) can be adequately assessed by transvaginal ultrasound. Superficial peritoneal endometriosis (SUP) is challenging to diagnose by either imaging modality. TVS, in the hands of appropriately trained clinicians, appears to be non-inferior to MRI in the diagnosis and assessment of deep infiltrating endometriosis (DIE). The IDEA consensus standardized the terminology and offered a structured approach in the assessment of endometriosis by ultrasound. TVS can be used in the non-invasive staging of endometriosis using the available classification systems (rASRM, #ENZIAN). Given its satisfactory overall diagnostic accuracy, wide availability, and low cost, it should be considered as the first-line imaging modality in the diagnosis and assessment of endometriosis. Modifications to the original ultrasound technique can be employed on a case-by-case basis. Improved training and future advances in ultrasound technology are likely to further increase its diagnostic performance.

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“…In addition, we did not use bowel preparation prior to TVS in this study. However, there is no consensus on the use of bowel preparation to enhance TVS evaluation of rectosigmoid DE lesions [31][32][33] . Bowel preparation is more invasive and requires more resources, particularly outside a study setting.…”

Section: Discussionmentioning

confidence: 99%

Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis

Aas-Eng

Lieng

Dauser

et al. 2021

Ultrasound in Obstet & Gyne

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Can Enhanced Techniques Improve the Diagnostic Accuracy of Transvaginal Sonography and Magnetic Resonance Imaging for Rectosigmoid Endometriosis? A Systematic Review and Meta-analysis

Cited by 19 publications

References 24 publications

Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis—An Overview: How, Why, and When

Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis

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