Correlation between ultrasound findings and laparoscopy in prediction of deep infiltrating endometriosis (DIE)

Pattanasri, Melinda; Ades, Alex; Nanayakkara, Pav

doi:10.1111/ajo.13242

Cited by 10 publications

(4 citation statements)

References 11 publications

(22 reference statements)

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“…Recently the role of USG as a non-invasive instrument in endometriosis has shown promising results [14]. The present work demonstrates high concordance between TV scan and laparoscopic ndings as per #Enzian classi cation.…”

Section: Discussionsupporting

confidence: 70%

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

Bindra

Nori²,

Mohanty³

et al. 2022

Arch Gynecol Obstet

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Purpose: The objective of this study was to evaluate and compare the diagnostic performance of ultrasonography (USG) assessment using structured reporting with intraoperative laparoscopic assessment in deep in ltrating endometriosis (DIE) using the recent update of the #ENZIAN classi cation.Methods: This was a retrospective study conducted in Tertiary Multi-disciplinary Endometriosis Care Hospital over a period of 8 months which included 50 patients who underwent a planned laparoscopic endometriosis excisional surgery after a dedicated USG assessment using International Deep Endometriosis Analysis (IDEA) protocol and #Enzian score (updated Enzian classi cation), between Feb 2021 to Sept 2021 at Apollo Hospitals, Hyderabad. The pre-operative USG ndings were reported in a structured reporting format and intraoperative ndings were classi ed using the standard #ENZIAN classi cation. No prospective interventions were done. A review of pre-operative ultrasound and laparoscopic ndings as per the #Enzian.Results: Sensitivity and the negative predictive value of ultrasound were 86% and 84.2% for peritoneal lesions, 97% and 93.3 % for left ovarian lesions, 93% and 91.6% for right ovarian lesions, 91% and 84% for left tubal lesions, 90% and 86.3 % for right tubal lesions, 93% and 75 % for uterosacral ligaments, 93.3 % and 97% for rectal lesions and sensitivity and negative predictive values were 100 % for rectovaginal lesions, adenomyosis, and ureteric lesions as con rmed on laparoscopy.Conclusion: Dynamic ultrasound assessment with a structured report based on IDEA protocol and #ENZIAN score is accurate for mapping of pelvic endometriosis in all forms, and it correlates with laparoscopic ndings, thus helps surgeon for better planning and providing a road map for surgeons. From a clinical perspective, a uniform and shared reporting system across imaging and therapeutic modalities will simplify communication, improving patient management by conservative or surgical treatments, avoiding multiple repeat surgeries, and improving quality of treatment.

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Section: Discussionsupporting

confidence: 70%

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

Bindra

Nori²,

Mohanty³

et al. 2022

Arch Gynecol Obstet

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“…TVS was found to detect more single OEs than laparoscopy, while the latter found more multiple OEs than the former. According to the present findings, the most common extraovarian sites for DIE, found on both TVS and laparoscopy, were the uterosacral ligament (USL) in PPC and the bladder base in APC; these findings are comparable to those of previous studies (19).…”

Section: Discussionsupporting

confidence: 91%

Diagnostic Accuracy of Transvaginal Sonography for Deeply Infiltrating Endometriosis and Pouch of Douglas Obliteration in the Presence or Absence of Ovarian Endometrioma

et al. 2023

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Background: Endometriosis is one of the most common gynecological diseases worldwide. Significant attention has been drawn to this multiorgan and often painful disorder. Objectives: This study aimed to examine the accuracy of transvaginal sonography (TVS) in the diagnosis of deeply infiltrating endometriosis (DIE) with respect to the presence or absence of ovarian endometrioma (OE). Patients and Methods: This cross-sectional study was performed on all patients undergoing TVS before gynecological laparoscopy. With pathological confirmation as the standard reference, the diagnostic accuracy of TVS for DIE and pouch of Douglas (POD) obliteration was compared with that of laparoscopy in the anterior and posterior pelvic compartments with respect to the presence or absence of OE. Agreement between TVS and laparoscopy was evaluated for each case, and Cohen’s kappa statistic was measured for each site of involvement. Moreover, sensitivity, specificity, negative and positive predictive values, and likelihood ratios of TVS were calculated, with laparoscopy as the reference test. Results: A total of 110 patients, with a mean age of 37.20 ± 7.16 years, were recruited in this study. The accuracy, sensitivity, and negative predictive value of TVS for the diagnosis of DIE and POD obliteration were estimated at 89.5%, 58.3%, and 88.9% in the anterior pelvic compartment and 93.3%, 92%, and 70.6% in the posterior pelvic compartment, respectively. Nevertheless, TVS showed lower sensitivity for detecting pelvic adhesions and peritoneal cysts compared to laparoscopy. The presence of OE did not significantly increase the accuracy of TVS for the diagnosis of DIE or POD obliteration (P > 0.05). Conclusion: The present study showed that TVS is an adequately accurate and non-invasive diagnostic tool for the detection and mapping of DIE and POD obliteration, regardless of the presence of OE. TVS may waive the need for exploratory laparoscopy in DIE or at least facilitate precise pre-procedural DIE mapping.

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“…Our sensitivity and specificity were high at 82.5% and 98.4% respectively similar to previously published results [9,16,33,35]. Other investigators reported lower sensitivity and specificity [28,31,32,36,37]. In our series, the torus was almost always affected with bilateral USL involvement with 95.7% of bilateral uterosacral DIE showing torus plaques.…”

Section: Discussionsupporting

confidence: 90%

Role of preoperative ultrasound mapping in the surgical management of deep infiltrating endometriosis: a prospective observational study

El-Maadawy

Alaaeldin²,

Nagy³

2021

Egypt J Radiol Nucl Med

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Background Endometriosis is a challenging gynecological condition that has a profound influence on the quality of life of affected women. Transvaginal ultrasound is considered the first-line imaging method in preoperative assessment of the extent and severity of endometriosis. Accurate preoperative mapping can aid the surgeon in patient counselling, selection of the most appropriate surgical method that minimizes the operative and post-operative complications. The aim of our study is to evaluate the accuracy of transvaginal sonography (TVS) in precisely assessing the size, location and extent of deep infiltrating endometriosis (DIE) using a new modified endometriosis mapping proforma with histopathological confirmation. Our prospective observational study included 101 women with clinically suspected DIE who underwent TVS followed by laparoscopy from October 2018 to December 2020 with a maximum of 4 weeks interval. Precise mapping of DIE was done during TVS and laparoscopy. Results were correlated with histopathology findings. Results DIE was confirmed by histopathology in 88 patients. Sensitivity and specificity for individual DIE locations were rectovaginal septum 67.9% and 98.6%; vagina 52.2% and 98.7%; uterosacral ligaments 82.5% and 96.2%; torus 96.4% and 97.3%; parametrium 68.8% and 96.9%; rectum 100% and 98.8%; bladder 100% and 100%, ureters 63.4% and 99.0%; scar endometriosis 100% and 100%; pouch of Douglas obliteration 97.7% and 100%. No statistically significant difference was detected between ultrasound and histopathology size. Ultrasound tended to underestimate the lesion size; the underestimation was more pronounced for lesions > 3 cm. “Butterfly” and “tram-track” signs are two new sonographic signs related to posterior compartment DIE. No post-operative complications were recorded. There were no cases of DIE recurrence. Eleven out of 22 cases of infertility achieved pregnancy during 18 months follow-up. Conclusion TVS provides a thorough and accurate evaluation of the extent of endometriosis. An experienced radiologist can use E-PEP to provide an accurate demonstration of the location and extent of DIE which helps the surgeon select the most appropriate surgical approach ensuring radical treatment of the disease and minimizing short- and long-term complications.

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Correlation between ultrasound findings and laparoscopy in prediction of deep infiltrating endometriosis (DIE)

Cited by 10 publications

References 11 publications

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

Diagnostic Accuracy of Transvaginal Sonography for Deeply Infiltrating Endometriosis and Pouch of Douglas Obliteration in the Presence or Absence of Ovarian Endometrioma

Role of preoperative ultrasound mapping in the surgical management of deep infiltrating endometriosis: a prospective observational study

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