Impact of Uterine Sliding Sign in Routine United States Ultrasound Practice

Abstract

Objectives The study aim was to evaluate the diagnostic performance of the uterine sliding sign in predicting deeply infiltrating endometriosis in the setting of non‐physician sonographers performing but not interpreting the maneuver. The impact of uterine sliding sign has not been previously demonstrated in this practice setting. Methods Physicians' remote interpretations of transvaginal ultrasound examinations in 2016, before uterine sliding sign, were compared to examinations in 2019 after addition of uterine sliding sign to determine the diagnostic rates. Surgical and histopathological results were reviewed to determine sensitivity and specificity of the respective exam techniques. Results Two hundred eighty‐five transvaginal ultrasounds were performed in 2016 and 390 sliding sign ultrasounds in 2019. The number of deeply infiltrating endometriosis cases identified increased significantly from 2% to 6% during the study period (chi‐square, Fisher's exact test p = .012). The sensitivity and specificity of routine pelvic sonography for detecting deeply infiltrating endometriosis improved from 36%/94% to 68%/98%. Conclusions Uterine sliding sign videos should be included in the standard sonographic protocol for patients presenting with chronic pelvic pain, endometriosis history, or sonographic evidence of endometriosis in the setting of physicians interpreting sonographic images obtained by non‐physicians.

Anatomical distribution of endometriosis: A cross‐sectional analysis of transvaginal ultrasound in symptomatic patients

“…This discrepancy brings attention to the potentially significant number of patients with a complex assessment of the pelvic posterior compartment disease that could be misdiagnosed and potentially undertreated if they have undergone surgical treatments without the preoperative knowledge of the bowel disease or obliteration of the POD. It has also been demonstrated in other settings that the detection of DE could increase significantly with the recognition of dynamic ultrasonographic abnormalities 17 . Therefore, we advocate using the advanced TVS technique based on the IDEA consensus for every patient with suspected endometriosis, also in line with the notion that the ultrasound should be the first‐line imaging modality for the diagnosis of endometriosis 12 …”

“…It has also been demonstrated in other settings that the detection of DE could increase significantly with the recognition of dynamic ultrasonographic abnormalities. 17 Therefore, we advocate using the advanced TVS technique based on the IDEA consensus for every patient with suspected endometriosis, also in line with the notion that the ultrasound should be the firstline imaging modality for the diagnosis of endometriosis. 12 Our results also agree with other publications about the low prevalence of RVS and anterior compartment lesions.…”

Sliding Sign: Could It Be a New Marker for Predicting Perinatal Outcomes

“…'Sliding sign' was first used in obstetrics and gynecology to predict adhesions secondary to endometriosis. 4 Then it was suggested as a transabdominal sonographic marker in obstetrics useful for foreseeing intraabdominal adhesions in repeat cesarean sections with acceptable sensitivity and specificity. 5 In this study we present data on the effectiveness of the 'sliding sign' for the prediction of intraabdominal adhesions in repeat cesarean sections and its relationship with skin-to-delivery time and APGAR scores.…”