scholarly journals Transvaginal ultrasound in deep endometriosis: pictorial essay

2019 ◽  
Vol 52 (5) ◽  
pp. 337-341 ◽  
Author(s):  
Jorge Gilmar Amaral de Oliveira ◽  
Vanessa Bonfada ◽  
Janice de Fátima Pavan Zanella ◽  
Janaina Coser
Keyword(s):  
Preoperative Planning ◽  
Low Cost ◽  
Transvaginal Ultrasound ◽  
Standard Test ◽  
Pelvic Endometriosis ◽  
First Line ◽  
Deep Endometriosis ◽  
Gold Standard Test ◽  
Pictorial Essay ◽  
Deep Pelvic Endometriosis

Abstract Endometriosis is characterized by the presence of endometrial tissue outside the uterus. When endometrial implants penetrate more than 5 mm into the peritoneum, the condition is referred to as deep pelvic endometriosis. Although laparoscopy is the gold standard test to establish a diagnosis of deep endometriosis, transvaginal ultrasound represents an alternative that can contribute to detection of the disease, because it is an accessible, low-cost, noninvasive examination that allows preoperative planning in cases requiring surgical treatment. However, in clinical practice, transvaginal ultrasound is still not widely used as the first-line examination in suspected cases of endometriosis. This essay describes the findings of deep endometriosis on transvaginal ultrasound, in order to disseminate knowledge of the utility of the technique for the diagnosis of this disease.

scholarly journals Transvaginal Ultrasound as a First-Line Approach in Deep Endometriosis: A Pictorial Essay

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 444
Author(s):  
Bogdan Doroftei ◽  
Radu Maftei ◽  
Ovidiu-Dumitru Ilie ◽  
Gabriela Simionescu ◽  
Emil Anton ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
First Line ◽  
Deep Endometriosis ◽  
Benign Condition ◽  
Hands On ◽  
Pictorial Essay ◽  
Optimal Approach ◽  
Fertile Women

Endometriosis (EMS) is a benign condition characterized by a systemic inflammation that affects fertile women at reproductive age. Ultrasound became, in recent years, the method of choice for both effective diagnostic and preoperative planning. Therefore, accurate characterization and mapping of endometriotic lesions is imperative in such circumstances to enable optimal approach of treatment, whether surgical or non-surgical based on the severity of the findings. This pictorial essay outlines a practical approach to evaluating patients with deep endometriosis by means of transvaginal ultrasound. The technical aspects are in conjunction with both consensus of the International Deep Endometriosis Analysis (IDEA) group and the hands-on experience acquired through daily clinical practice.

scholarly journals Intra- and interobserver reproducibility of pelvic ultrasound for the detection and measurement of endometriotic lesions

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
E Bean ◽  
P Chaggar ◽  
N Thanatsis ◽  
W Dooley ◽  
C Bottomley ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Separate Analysis ◽  
Pelvic Endometriosis ◽  
Pelvic Ultrasound ◽  
First Line ◽  
Deep Endometriosis ◽  
Nodule Size ◽  
Good Level ◽  
Intraobserver Reproducibility ◽  
Level Of Agreement

Abstract STUDY QUESTION What is the interobserver and intraobserver reproducibility of pelvic ultrasound for the detection of endometriotic lesions? SUMMARY ANSWER Pelvic ultrasound is highly reproducible for the detection of pelvic endometriotic lesions. WHAT IS KNOWN ALREADY Transvaginal ultrasound (TVS) has been widely adopted as the first-line assessment for the diagnosis and assessment of pelvic endometriosis. Severity of endometriosis as assessed by ultrasound has been shown to have good concordance with laparoscopy (kappa 0.79). The reproducibility of TVS for assessment of ovarian mobility and pouch of Douglas obliteration using the ‘sliding sign’ has already been described in the literature. However, there is no available data in the literature to demonstrate the intraobserver repeatability of measurements for endometriotic cysts and nodules. STUDY DESIGN, SIZE, DURATION This was a prospective observational cross-sectional study conducted over a period of 12 months. We included 50 consecutive women who were all examined by two operators (A and B) during their clinic attendance. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was carried out in a specialist endometriosis centre. We included all consecutive women who had ultrasound scans performed independently by two experienced operators during the same visit to the clinic. The outcomes of interest were the inter- and intraobserver reproducibility for the detection of endometriotic lesions. We also assessed repeatability of the measurements of lesion size. MAIN RESULTS AND THE ROLE OF CHANCE There was a good level of agreement between operator A and operator B in detecting the presence of pelvic endometriotic lesions (k = 0.72). There was a very good level of agreement between operators in identifying endometriotic cysts (k = 0.88) and a good level of agreement in identifying endometriotic nodules (k = 0.61). The inter- and intraobserver repeatability of measuring endometriotic cysts was excellent (intra-class correlation (ICC) ≥ 0.98). There was good interobserver measurement repeatability for bowel nodules (ICC 0.88), but the results for nodules in the posterior compartment were poor (ICC 0.41). The intraobserver repeatability for nodule size measurements was good for both operators (ICC ≥0.86). LIMITATIONS, REASONS FOR CAUTION Within this cohort, there was insufficient data to perform a separate analysis for nodule size in the anterior compartment. All examinations were performed within a specialised unit with a high prevalence of deep endometriosis. Our findings may not apply to operators without intensive ultrasound training in the diagnosis of pelvic endometriosis. WIDER IMPLICATIONS OF THE FINDINGS These findings are important because ultrasound has been widely accepted as the first-line investigation for the diagnosis of pelvic endometriosis, which often determines the need for future investigations and treatment. The detection and measurement of bowel nodules is essential for anticipation of surgical risk and planning surgical excision. STUDY FUNDING/COMPETING INTEREST(S) The authors have no conflict of interest. No funding was obtained for this work.

scholarly journals Transvaginal ultrasound (USTV) for Deep Pelvic Endometriosis: How “To Do” do it

2019 ◽  
Vol 45 ◽  
pp. S100-S101
Author(s):  
Maria Cristina Chammas ◽  
Ana Paula Klautau Leite ◽  
Sandra Monica Tochetto ◽  
Julia Diva Zavariz
Keyword(s):  
Transvaginal Ultrasound ◽  
Pelvic Endometriosis ◽  
Deep Pelvic Endometriosis

Ultrasound Diagnosis of Pelvic Endometriosis

2011 ◽  
Vol 3 (2) ◽  
pp. 105-119
Author(s):  
Antonio Maiorana ◽  
Domenico Incandela ◽  
Laura Giambanco ◽  
Walter Alio ◽  
Luigi Alio
Keyword(s):  
Imaging Techniques ◽  
Diagnostic Technique ◽  
Ultrasound Diagnosis ◽  
Transvaginal Sonography ◽  
Anatomical Location ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
First Line ◽  
Intestinal Endometriosis ◽  
Deep Endometriosis

Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and patients alike. Routine clinical examination is insufficient to diagnose and evaluate the extent of pelvic endometriosis which can be assessed by means of imaging techniques, including transvaginal sonography (TVS), transrectal sonography (TRS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI). Our purpose was to analyze the different imaging techniques and their efficacy for the ultrasound diagnosis of pelvic endometriosis. Materials and methods This review examined 85 studies on the ultrasound diagnosis of endometriosis published between 2005 and 2010. The structure of the review is based first on the anatomical location of the endometriosis lesion, and then on the study of the techniques used, including transvaginal sonography, transrectal sonography, rectal endoscopic sonography, and MRI. Results TVS is the first-line imaging technique for diagnosing pelvic endometriosis. Many studies have demonstrated that sensitivities and specificities of TVS for diagnosing endometriomas range from 75% to 91% and 88% to 99%, respectively, while for RES the percentages are 88% and 90%, respectively, for the diagnosis of intestinal endometriosis. TVS and RES can correctly diagnose posterior deep infiltrating endometriosis (DIE) with an accuracy of 86.4% and 74.1%, respectively. Conclusions The analysis of these results show that ultrasound is the first-line diagnostic technique for the diagnosis of pelvic endometriosis. RES can help to identify the presence and the degree of wall infiltration of bowel sites. However, in patients with a consistent clinical suspicion of deep endometriosis, MRI is a good “all in one” examination to diagnose and define the exact extent of DIE.

scholarly journals Diagnostic Accuracy of Ultrasound and MRI in the Mapping of Deep Pelvic Endometriosis Using the International Deep Endometriosis Analysis (IDEA) Consensus

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
T. Indrielle-Kelly ◽  
F. Frühauf ◽  
M. Fanta ◽  
A. Burgetova ◽  
D. Lavu ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Lower Sensitivity ◽  
Pelvic Endometriosis ◽  
Reference Standard ◽  
Deep Endometriosis ◽  
Preoperative Mapping ◽  
Index Tests ◽  
Deep Pelvic Endometriosis ◽  
Good Agreement

Objectives. The primary aim was to investigate the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the mapping of deep pelvic endometriosis (DE) in a diseased population. The secondary aim was to offer first insights into the clinical applicability of the new International Deep Endometriosis Analysis group (IDEA) consensus for sonographic evaluation, which was also adapted for MRI and surgical reporting in this study. Methods. The study was a prospective observational cohort study. In this study, consecutive women planned for surgical treatment for DE underwent preoperative mapping of pelvic disease using TVS and MRI (index tests). The results were compared against the intraoperative findings with histopathological confirmation (reference standard). In case of disagreement between intraoperative and pathology findings, the latter was prioritised. Index tests and surgical findings were reported using a standardised protocol based on the IDEA consensus. Results. The study ran from 07/2016 to 02/2018. One-hundred and eleven women were approached, but 60 declined participation. Out of the 51 initially recruited women, two were excluded due to the missing reference standard. Both methods (TVS and MRI) had the same sensitivity and specificity in the detection of DE in the upper rectum (UpR) and rectosigmoid (RS) (UpR TVS and MRI sensitivity and specificity 100%; RS TVS and MRI sensitivity 94%; TVS and MRI specificity 84%). In the assessment of DE in the bladder (Bl), uterosacral ligaments (USL), vagina (V), rectovaginal septum (RVS), and overall pelvis (P), TVS had marginally higher specificity but lower sensitivity than MRI (Bl TVS sensitivity 89%, specificity 100%, MRI sensitivity 100%, specificity 95%; USL TVS sensitivity 74%, specificity 67%, MRI sensitivity 94%, specificity 60%; V TVS sensitivity 55%, specificity 100%, MRI sensitivity 73%, specificity 95%; RVS TVS sensitivity 67%, specificity 100%, MRI sensitivity 83%, specificity 93%; P TVS sensitivity 78%, specificity 97%, MRI sensitivity 91%, specificity 91%). No significant differences in diagnostic accuracy between TVS and MRI were observed except USL assessment (p=0.04) where MRI was significantly better and pouch of Douglas obliteration (p=0.04) where TVS was significantly better. Overall, there was a good agreement between reference standards and both index tests (TVS kappa value (κ) = 0.727 [p≤0.001), MRI κ = 0.755 [p=p≤0.001]). Conclusion. We found that both imaging techniques had overall good agreement with the reference standard in the detection of deep pelvic endometriosis. This is the first study to date involving the IDEA consensus for ultrasound, its modified version for MRI, and intraoperative reporting of deep pelvic endometriosis in clinical practice.

scholarly journals Ultrasound in the Diagnosis of Deep Endometriosis

2009 ◽  
Vol 3 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Silvia Ajossa ◽  
Anna Maria Paoletti ◽  
Nicoletta Garau ◽  
Valerio Mais ◽  
Bruno Piras ◽  
...  
Keyword(s):  
Gold Standard ◽  
Low Cost ◽  
Transvaginal Ultrasonography ◽  
Rectovaginal Septum ◽  
Specific Training ◽  
First Line ◽  
Deep Endometriosis ◽  
Uterosacral Ligaments ◽  
Diagnostic Capability ◽  
Bladder Endometriosis

Abstract Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. Although laparoscopy and biopsy remain the gold standard for diagnosis, transvaginal ultrasonography should be considered as the first-line procedure because of its high diffusion and relatively low cost and discomfort. We analyzed in the present review the diagnostic capability of transvaginal ultrasonography in the detection of presence of deep endometriosis in some specific pelvic localizations such as bowel, uterosacral ligaments, rectovaginal septum and/or vagina. We also analyzed the few studies performed in the evaluation of bladder endometriosis. Although some studies are controversial, transvaginal ultrasonography seems to be an accurate technique in the identifications of deep endometriosis in several pelvic locations but a specific training of the operators is suggested.

Deep Pelvic Endometriosis: From Diagnosis to Wellness

2009 ◽  
Vol 1 (3-4) ◽  
pp. 150-156 ◽  
Author(s):  
Carlo Saccardi ◽  
Andrea Cocco ◽  
Alberto Tregnaghi ◽  
Erich Cosmi ◽  
Nicola Baldan ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Rectal Wall ◽  
Transvaginal Ultrasound ◽  
Vaginal Wall ◽  
Complete Separation ◽  
Pelvic Endometriosis ◽  
Laparoscopic Excision ◽  
Segmental Bowel Resection ◽  
Deep Pelvic Endometriosis

Purpose to determine the efficacy of laparoscopic excision of deep pelvic endometriosis (DPE). Methods One hundred and two highly symptomatic women with DPE underwent clinical examination, transvaginal ultrasound, nuclear magnetic resonance (NMR) and sonovaginography. Among the 102 women, 50 patients, with severe symptoms, underwent laparoscopic excision of DPE. Endoscopic surgery was performed with complete separation of the rectovaginal space and resection of the node. In the case of vaginal involvement vaginal exeresis was performed, in the case of rectal wall involvement of more than 50%, segmental bowel resection was performed. Operative data as well as dysmenorrhea, dyspareunia, chronic pelvic pain and dyschezia before and 6 and 12 months after surgical treatment were recorded. Results Mean operative time was 126.4 ± 34.7 min, mean blood loss was 76.2 ± 22 ml. In 17 (34%) cases we performed excision of the posterior vaginal fornix due to vaginal wall involvement. In six (12%) cases we performed excision of the rectal wall. At 12-month follow-up 39 (78%) women revealed absent or mild dysmenorrhea, 45 (90%) women revealed absent or mild dyspareunia, 46 (92%) women revealed absent or mild chronic pelvic pain, 48 (96%) women revealed absent or mild dyschezia. Conclusions Surgical management of DPE could be a radical approach for this disease but conservative for the patients, ensuring good improvement in symptoms and good patient satisfaction, and only performing vaginal or rectal exeresis when strictly necessary.

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