Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy

Leonardi, Mathew; Espada, Mercedes; Choi, SH; Chou, Danny; Chang, Tim; Smith, Christopher G.; Rowan, Katrina; Condous, G.

doi:10.1016/j.jmig.2020.02.014

Cited by 42 publications

(33 citation statements)

References 22 publications

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“…Pouch of Douglas (POD) obliteration is of particular concern, as it signals advanced endometriosis 1,2 . It is associated with posterior compartment deep endometriosis (DE), 3 specifically bowel DE 4 .…”

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confidence: 99%

One‐Size‐Fits‐All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills

Leonardi

Ong

Espada

et al. 2020

J of Ultrasound Medicine

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Objectives-To evaluate whether gynecologic surgical trainees (fellows) can become competent in the real-time classification of the pouch of Douglas (POD) obliteration state and direct visualization of bowel deep endometriosis (DE) during a program with a prespecified number of transvaginal ultrasound (TVUS) examinations. Methods-We performed a prospective study between December 2017 and December 2018. Three fellows (F1-F3) performed 50 scans each, which were all supervised by an expert sonologist, who performed the reference standard TVUS examination. The fellows performed a focused TVUS examination to assess the bowel and POD state, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's official classifications. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. Results-A total of 150 examinations were performed on 145 patients. Twentysix (17.9%) patients had a diagnosis of bowel DE, and 34 (23.4%) were classified as having a negative sliding sign by the reference standard. The overall accuracy of the presence/absence of bowel DE was 90% (range, 82%-94%). The overall accuracy of POD state classification was 93% (range, 90%-96%). The cumulative summation test for the learning curve for bowel DE showed that F1 did not reach competency by 50 scans, whereas F2 and F3 required 21 and 25 scans, respectively. For POD obliteration, F2 did not reach competency, whereas F1 and F3 required 40 and 22 scans. Conclusions-Not all trainees can reach competency for TVUS evaluations of POD obliteration and bowel DE in a predefined number of scans.

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confidence: 99%

One‐Size‐Fits‐All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills

Leonardi

Ong

Espada

et al. 2020

J of Ultrasound Medicine

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“…A single database was created using an Excel spreadsheet (2007 Microsoft Corp., Redmond, WA) to collect clinical, ultrasound, and laparoscopic surgical data of women with suspected endometriosis. Data on the 200 women included in this study have been published in 1 other study by Leonardi et al [7]. The current study ran until April 1, 2018 (n = 200), whereas the study by Leonardi et al [7] (n = 204) ran until April 30, 2018.…”

Section: Patientsmentioning

confidence: 84%

“…Data on the 200 women included in this study have been published in 1 other study by Leonardi et al [7]. The current study ran until April 1, 2018 (n = 200), whereas the study by Leonardi et al [7] (n = 204) ran until April 30, 2018.…”

Section: Patientsmentioning

confidence: 84%

A Multicenter International Temporal and External Validation Study of the Ultrasound-based Endometriosis Staging System

Espada

Leonardi

Aas-Eng

et al. 2021

Journal of Minimally Invasive Gynecology

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The aim of this study was to validate temporally and externally the ultrasound-based endometriosis staging system (UBESS) to predict the level of complexity of laparoscopic surgery for endometriosis. Design: A multicenter, international, retrospective, diagnostic accuracy study was carried out between January 2016 and April 2018 on women with suspected pelvic endometriosis. Setting: Four different centers with advanced ultrasound and laparoscopic services were recruited (1 for temporal validation and 3 for external validation). Patients: Women with pelvic pain and suspected endometriosis. Interventions: All women underwent a systematic transvaginal ultrasound and were staged according to the UBESS system, followed by classification of laparoscopic level of complexity according to the Royal College of Obstetricians and Gynaecologists (RCOG) levels 1 to 3. Measurements and Main Results: UBESS I, II, and III were then correlated with RCOG levels 1, 2, and 3, respectively. A comparison between temporal and external sites (skipping "A") and between each site was performed in terms of the diagnostic accuracy of UBESS to predict RCOG laparoscopic skill level. A total of 317 consecutive women who underwent laparoscopy with suspected endometriosis were included. Complete transvaginal ultrasound and laparoscopic surgical outcomes were available for 293/317 (92.4%). At the temporal site, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of UBESS I to predict RCOG level 1 were 80.

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“…Finally, the current situation mandates a more discerning approach to surgery now and in the future, so that we "operate sparingly and operate well." This approach can be guided by preoperative triaging tools including advanced clinical algorithms and imaging strategies (29) to avoid multiple repeated surgical procedures.…”

Section: Future Considerationsmentioning

confidence: 99%

Endometriosis and the Coronavirus (COVID-19) Pandemic: Clinical Advice and Future Considerations

Leonardi

Horne

Armour

et al. 2020

Front. Reprod. Health

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Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy

Cited by 42 publications

References 22 publications

One‐Size‐Fits‐All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills

One‐Size‐Fits‐All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills

A Multicenter International Temporal and External Validation Study of the Ultrasound-based Endometriosis Staging System

Endometriosis and the Coronavirus (COVID-19) Pandemic: Clinical Advice and Future Considerations

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