Interpreting the real-time dynamic ‘sliding sign’ and predicting pouch of Douglas obliteration: an interobserver, intraobserver, diagnostic-accuracy and learning-curve study

Abstract

Objective To determine inter-and intraobserver agreement, diagnostic accuracy and the learning curve required for interpreting the 'sliding sign' and predicting pouch of Douglas (POD) obliteration. Methods This was an inter-/intraobserver 65.4 to 96.2%, 80.0 to 100%, 64.7 to 100%, 50.0 to 100% and 94.7

Performance of ultrasound‐based endometriosis staging system (UBESS) for predicting level of complexity of laparoscopic surgery for endometriosis

“…Although results from recent published data strengthen the clinical utilization of UBESS by demonstrating high reproducibility and acceptable interobserver agreement for phenotypes of higher‐stage endometriosis (e.g. bowel DIE and POD obliteration), it is important to evaluate appropriately the reproducibility and interobserver agreement of other components of UBESS in future studies, especially among observers with different levels of training. Finally, UBESS was developed and applied retrospectively.…”

Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

“…found that non‐specialist operators who had carried out 200 or more prior gynecological US examinations performed better than did those with less prior experience (50 prior scans) in the interpretation of offline videos of the sliding sign. Furthermore, the reproducibility of the sliding sign is good. Our findings suggest that absence of the sliding sign is more important than is presence of KO, as the latter had very high specificity but very low sensitivity, while for the former both sensitivity and specificity were around 75%.…”

“…demonstrated that two less experienced operators (trainees) achieved competence in detecting POD obliteration by absent sliding sign after only 42 and 37 patients, respectively. Menakaya et al . found that non‐specialist operators who had carried out 200 or more prior gynecological US examinations performed better than did those with less prior experience (50 prior scans) in the interpretation of offline videos of the sliding sign.…”

“…observed a strong association between this sign and the presence of RS endometriosis, with similar sensitivity and specificity. Menakaya et al ,. on the other hand, criticized this latter association, suggesting that RS endometriosis can occur with or without POD obliteration and vice versa .…”

“…on the other hand, criticized this latter association, suggesting that RS endometriosis can occur with or without POD obliteration and vice versa . These authors also stated that the sliding sign is simple to demonstrate and does not require advanced sonographic skills, while recognizing that the high diagnostic accuracy of US for RS is dependent on the experience of the operator. Other indirect signs of the presence of DE have been suggested, such as the presence of US signs of uterine adenomyosis, ovarian endometrioma, adhesions of the ovary to the uterus (‘reduced ovarian mobility’) and ‘kissing ovaries’ (KO).…”