Diagnostic Accuracy of Trans-Vaginal Ultrasound for Deep Infiltrative Endometriosis: A systematic review

Introduction: Deep infiltrative endometriosis (DIE) is a severe form of endometriosis, affecting approximately 20% of women with the disease. It often goes undiagnosed due to its complex presentation and overlap with other pelvic conditions. Early and accurate detection is key to guiding treatment and reducing the disease burden. Transvaginal ultrasound (TVUS) is a first-line imaging method used in clinical settings due to its accessibility and low cost. Despite this, reported accuracy in identifying DIE remains inconsistent. Objective: This review aims to assess the pooled sensitivity and specificity of Trans-Vaginal Ultrasound (TVUS) for diagnosing Deep Infiltrative Endometriosis (DIE). Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted to identify relevant studies published between 2012 and 2024. Eligible studies included those that evaluated the diagnostic accuracy of TVUS for DIE, using surgical and histopathological findings as reference standards. Methodological quality was assessed via the QUADAS-2 tool. Results: Sensitivity of TVUS ranged from 26.7% to 98%, while specificity varied from 46% to 100%. The highest sensitivity noted to be 98%, and the lowest to be 26.7%. Several studies, reported specificity of 100%. Among multicenter prospective studies, reported accuracy values were of 94% and 86.5%, respectively. Conclusion: This systematic review reports the diagnostic utility of TVUS in detecting DIE, with many studies reporting high levels of sensitivity, specificity, and overall accuracy. The variation observed across individual studies emphasizes the impact of methodological differences, imaging techniques, and examiner proficiency on diagnostic outcomes. These findings highlight the need for continued efforts to standardize imaging practices and enhance training to ensure consistent and reliable use of ultrasound in clinical settings.