Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‑analysis of diagnostic accuracy studies

Abstract

Visual inspection via laparoscopy is considered the gold standard for the diagnosis of deep infiltrating endometriosis. Laparoscopy is an invasive procedure; therefore, it would be beneficial to patients if accurate non-invasive modalities were available for the diagnosis of deep infiltrating endometriosis. The purpose of the current review and meta-analysis was to assess the diagnostic accuracy of clinical examination, transvaginal ultrasound (TVUS), transrectal ultrasound (TRUS) and MRI as alternative methods for diagnosis of deep infiltrating endometriosis. A systematic search of the Medline, Scopus, Embase and Cochrane library databases, between their inception and September 2019, was performed. The quality of trials was assessed using the quality assessment of diagnostic accuracy studies-2 tool. Meta-analyses were conducted to obtain the pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio for each of the three imaging modalities and clinical examination. A total of 30 studies with 4,565 participants were included in the review. Physical examination had a pooled sensitivity of 71% and a specificity of 69%, with an average diagnostic accuracy [area under the curve (AUC) = 0.76]. TVUS had a pooled sensitivity of 76% and a specificity of 94%, with higher diagnostic accuracy than physical examination (AUC = 0.92). TRUS had a pooled sensitivity of 91% and a specificity of 80% with an AUC of 0.93. MRI had a pooled sensitivity of 82% and a specificity of 87% with higher diagnostic accuracy than physical examination (AUC = 0.91). All the imaging modalities had good clinical utility, as indicated by the Fagan plot. The present analysis demonstrates that the imaging modalities TVUS, TRUS and MRI may be highly useful alternatives to laparoscopy for diagnosis of deep infiltrating endometriosis and that these techniques have a high sensitivity and specificity.

The experiences of endometriosis patients with diagnosis and treatment in New Zealand

“…Transvaginal ultrasound can be an effective diagnostic tool for ovarian endometriosis, with a sensitivity of 93% and 96% specificity ( 36 ), and deep infiltrating endometriosis, with a sensitivity of 76% and 94% specificity ( 37 ). Unlike abdominal ultrasound, transvaginal ultrasound experiences were consistently negative throughout the cohort, who found the experience painful at best and traumatizing at worst.…”

Transvaginal Ultrasound vs. Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis

“…TVS’ diagnostic accuracy was examined in 21 investigations, with sensitivity and specificity of 76% (95% CI (confidence interval), 67–83%) and 94%, respectively (95% CI, 88–97%). The diagnostic accuracy of MRI was examined in 13 trials, with sensitivity and specificity of 82% (95% CI, 70–90%) and 87%, respectively (95% CI, 78–92%) [ 59 ].…”

Vault Endometriosis: Detailed Step-by-Step Laparoscopic Surgical Management Technique

“…Some of the review articles have documented the role of imaging in the pre-operative diagnosis, but no definite features suggestive of vault endometriosis has been specified. 11 , 12 …”

“…Imaging of the abdomen-pelvis region (magnetic resonance imaging [MRI], abdominal ultrasound, transvaginal ultrasound) may be tried for supportive evidence, but usually, there are no specific findings related to vault endometriosis. 11 , 12 However, few findings on imaging may be still suggestive of vault endometriosis or associated other endometriotic lesions. Abdominal and transvaginal ultrasound is the first imaging of choice in a suspected case of vault endometriosis as it may help in the assessment of site, size, approximate depth of nodule if present, and findings of ovarian endometrioma.…”