Preoperative ultrasound diagnosis of deep endometriosis: importance of the examiner's expertise and lesion size

Abstract

Objectives: To evaluate the accuracy of transvaginal sonography (TVS) in the diagnosis of deep infiltrating endometriosis (DIE) of the posterior compartment (rectovaginal septum, uterosacral ligaments, rectosigmoid colon, vagina) when undertaken by physicians of varying experience and to investigate if size of the nodule is relevant in influencing diagnostic accuracy. Methods: 381 patients who were operated on between January 2007 and December 2010 for suspected pelvic endometriosis were prospectively recruited. Clinical, surgical and histopathologic data were collected and a preoperative TVS was carried out. Comparison was made between the diagnostic accuracy of TVS performed by two groups of physicians of different expertise. Results: One hundred and thirty‐six patients underwent removal of deep endometriotic lesions of the posterior compartment. Sensitivity, specificity, positive and negative predictive value and the overall diagnostic accuracy of the expert operators were 77%, 95%, 90%, 87% and 88% respectively. Corresponding values for first‐level operators were: 45%, 98%, 92%, 79% and 81%. In patients with positive findings at TVS, the mean diameter of the endometriotic nodule was of 4.7 ± 3.4 cm while, in cases with negative findings, the average diameter was 2.6 ± 1.1 cm (P < 0.05). Conclusions: TVS is accurate in detecting the presence of DIE. Accuracy is dependent on the experience of the physician and the size of the nodule.

Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis

“…1 represents the selection of studies. Of the 45 ( Fedele et al , 1998 ; Dessole et al , 2003 ; Delpy et al , 2005 ; Takeuchi et al , 2005 ; Bahr et al , 2006 ; Abrao et al , 2007 ; Biscaldi et al , 2007 ; Guerriero et al , 2007 ; Griffiths et al , 2008 ; Guerriero et al , 2008 ; Ribeiro et al , 2008 ; Valenzano Menada et al , 2008 ; Bazot et al , 2009 ; Hottat et al , 2009 ; Hudelist et al , 2009 ; Piketty et al , 2009 ; Bergamini et al , 2010 ; Chassang et al , 2010 ; Faccioli et al , 2010 ; Goncalves et al , 2010 ; Grasso et al , 2010 ; Pascual et al , 2010 ; Ferrero et al , 2011 ; Hudelist et al , 2011 ; Fiaschetti et al , 2012 ; Savelli et al , 2012 ; Bazot et al , 2013 ; Holland et al , 2013 ; Hudelist et al , 2013 ; Manganaro et al , 2013 ; Stabile Ianora et al , 2013 ; Leon et al , 2014 ; Tammaa et al , 2015 ; Baggio et al , 2016 ; Menakaya et al , 2016 ; Ferrero et al , 2017 ; Guerriero et al , 2017 ; Jiang et al , 2017 ; Ros et al , 2017 ; Alborzi et al , 2018 ; Carfagna ...…”

Magnetic resonance imaging versus transvaginal ultrasound for complete survey of the pelvic compartments among patients with deep infiltrating endometriosis

“…The findings of the present study are in agreement with other investigators who showed that TVU was more effective than MRI in detecting recto‐vaginal endometriosis (TVU accuracy 97% vs MRI accuracy 71%). Savelli showed that TVU was an accurate method for detecting posterior DIE, but that this imaging technique strictly depended on the experience of the physician and the size of the nodule.…”

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

“…9 Pre-operative ultrasounds performed by less experienced physicians (residents in training with 12-24 months of experience in gynaecological ultrasound) as compared to experienced physicians (gynaecologist specialised in gynaecologic ultrasound with more than 10 years experience) had a significantly reduced accuracy (80.9% vs 88.1%) and sensitivity (45.3% vs 77.1%). 9 Interestingly, it has been shown that sonographers are able to attain a skill level matched to that in expert centres within 38 scans if trained appropriately. 10 This adds further to the argument therefore that DIE-TVUS should become a part of standard ultrasound training or that only centres with a special interest and further training in endometriosis ultrasound should offer the service.…”

“…However, TRUS is highly operator‐dependent and good diagnostic results may only be achieved by an adequately trained and experienced medical team 9 . Pre‐operative ultrasounds performed by less experienced physicians (residents in training with 12–24 months of experience in gynaecological ultrasound) as compared to experienced physicians (gynaecologist specialised in gynaecologic ultrasound with more than 10 years experience) had a significantly reduced accuracy (80.9% vs 88.1%) and sensitivity (45.3% vs 77.1%) 9 …”