Faculty Opinions recommendation of Diagnostic accuracy of ultrasound and MRI in the mapping of deep pelvic endometriosis using the international deep endometriosis analysis (IDEA) consensus.

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.

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Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis

Diagnostics ◽

10.3390/diagnostics9040225 ◽

2019 ◽

Vol 9 (4) ◽

pp. 225 ◽

Cited By ~ 9

Author(s):

Marco Noventa ◽

Marco Scioscia ◽

Michele Schincariol ◽

Francesco Cavallin ◽

Giovanni Pontrelli ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Imaging Modalities ◽

Transvaginal Sonography ◽

Test Accuracy ◽

Pelvic Endometriosis ◽

Resonance Imaging ◽

Deep Pelvic Endometriosis

Objectives: A meta-analysis, with a head-to-head approach, was carried out to compare the three most common techniques for a deep pelvic endometriosis (DPE) diagnosis. We focused on: transvaginal-sonography (TVS), magnetic-resonance imaging (MRI), and rectal-endoscopy-sonography (RES). Methods: Electronic databases were searched from their inception until December 2018. All prospective and well-defined retrospective studies carried out in tertiary referral centers were considered. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesizing Evidence from Diagnostic Accuracy Tests (SEDATE) guidelines. We considered only papers in which at least two imaging modalities were compared in the same set of patients (head-to-head approach). Meta-analysis of diagnostic test accuracy (DTA) was performed separately for each location of interest. Bivariate or univariate approach has been applied when appropriate. We analyze the DTA of TVS vs. MRI, TVS vs. RES, and MRI vs. RES. Results: Our meta-analysis (17 studies included) showed high-to-moderate DTA of TVS for all endometriosis locations (apart from recto-vaginal septum (RVS)) that were not statistically different from MRI and RES for those localized in the posterior compartment. RES results were more accurate than MRI for RS lesions but less accurate than TVS for other pelvic locations, except for RVS. Conclusions: All approaches provide good accuracy with specific strong points. Ultrasonography demonstrated a diagnostic accuracy not inferior to MRI and RES; therefore, it must be considered the primary approach for DPE diagnosis. MRI has to be considered as a valuable approach in settings where highly skilled sonographers are not available. Keypoints: (1) We confirmed the non-inferiority of TVS compared to MRI and RES for the diagnosis of specific pelvic anatomic location of endometriosis lesions. (2) Ultrasonography could be considered the primary approach for DPE diagnosis (less invasive than RES and less expensive than MRI). (3) MRI has to be considered as a valuable approach in settings where skilled sonographers are not available.

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Application of International Deep Endometriosis Analysis (IDEA) group consensus in preoperative ultrasound and magnetic resonance imaging of deep pelvic endometriosis

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.21960 ◽

2020 ◽

Vol 56 (1) ◽

pp. 115-116 ◽

Cited By ~ 1

Author(s):

T. Indrielle‐Kelly ◽

F. Frühauf ◽

M. Fanta ◽

A. Burgetova ◽

D. Lavu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Group Consensus ◽

Pelvic Endometriosis ◽

Resonance Imaging ◽

Deep Endometriosis ◽

Preoperative Ultrasound ◽

Deep Pelvic Endometriosis

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Transvaginal ultrasound in deep endometriosis: pictorial essay

Radiologia Brasileira ◽

10.1590/0100-3984.2018.0019 ◽

2019 ◽

Vol 52 (5) ◽

pp. 337-341 ◽

Cited By ~ 1

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.

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Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.1108 ◽

2004 ◽

Vol 24 (2) ◽

pp. 180-185 ◽

Cited By ~ 204

Author(s):

M. Bazot ◽

I. Thomassin ◽

R. Hourani ◽

A. Cortez ◽

E. Darai

Keyword(s):

Diagnostic Accuracy ◽

Transvaginal Sonography ◽

Pelvic Endometriosis ◽

Deep Pelvic Endometriosis

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OC.04.2 DIAGNOSTIC ACCURACY OF RECTAL ENDOSCOPIC ULTRASONOGRAPHY TO DIAGNOSE DEEP PELVIC ENDOMETRIOSIS: EXPERIENCE FROM TWO REFERRAL GASTROENTEROLOGY UNITS

Digestive and Liver Disease ◽

10.1016/s1590-8658(12)60169-8 ◽

2012 ◽

Vol 44 ◽

pp. S64

Author(s):

R. Di Mitri ◽

F. Mocciaro ◽

A. Maiorana ◽

I. Tarantino ◽

L. Barresi ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Endoscopic Ultrasonography ◽

Pelvic Endometriosis ◽

Deep Pelvic Endometriosis

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Ultrasonographic 3D Evaluation in the Diagnosis of Bladder Endometriosis: A Prospective Comparative Diagnostic Accuracy Study

Gynecologic and Obstetric Investigation ◽

10.1159/000516634 ◽

2021 ◽

pp. 1-8

Author(s):

Fabio Barra ◽

Franco Alessandri ◽

Carolina Scala ◽

Simone Ferrero

Keyword(s):

Diagnostic Accuracy ◽

Three Dimensional ◽

3D Ultrasound ◽

Diagnostic Accuracy Study ◽

Extensive Experience ◽

Deep Endometriosis ◽

3D Reconstructions ◽

Analysis Group ◽

Bladder Endometriosis ◽

Accuracy Study

Objective: The use of three-dimensional (3D) transvaginal ultrasonography (TVS) has been investigated for the diagnosis of deep endometriosis (DE). This study aimed to evaluate if 3D reconstructions improve the performance of TVS) in assessing the presence and characteristics of bladder endometriosis (BE). Design: This was a single-center comparative diagnostic accuracy study. Participants/Materials, Setting, Methods: Patients referred to our institution (Piazza della Vittoria 14 Srl, Genova, Italy) with clinical suspicion of DE were included. In case of surgery, women underwent systematic preoperative ultrasonographic imaging; an experienced sonographer performed a conventional TVS; another experienced sonographer, blinded to results of the previous exam, performed TVS, with the addition of 3D modality. The presence and characteristics of BE nodules were described in accord with International DE Analysis group consensus. Ultrasound data were compared with surgical and histological results. Results: Overall, BE was intraoperatively found in 34 out of 194 women who underwent surgery for DE (17.5%; 95% confidence interval: 12.8–23.5%). TVS without and with 3D reconstructions were able to detect endometriotic BE in 82.2% (n = 28/34) and 85.3% (n = 29/34) of the cases (p = 0.125). Both the exams similarly estimated the largest diameter of BE (p = 0.652) and the distance between the endometriotic nodule and the closest ureteral meatus (p = 0.341). However, TVS with 3D reconstructions was more precise in estimating the volume of BE (p = 0.031). In one case (2.9%), TVS without and with 3D reconstructions detected the infiltration of the intramural ureter, which was confirmed at surgery and required laparoscopic ureterovesical reimplantation. Limitations: The extensive experience of the gynecologists performing the ultrasonographic scans, the lack of prestudy power analysis, and the population selected, which may have been influenced by the position of the institution as a referral center specialized in the treatment of severe endometriosis, are limitations of the current study. Conclusion: Our results demonstrated the high accuracy of ultrasound for diagnosing BE. The addition of 3D reconstructions does not improve the performance of TVS in diagnosing the presence and characteristics of BE. However, the volume of BE may be more precisely assessed by 3D ultrasound.

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