Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion

Masao Ichikawa, Shigeo Akira, Hanako Kaseki, Kenichiro Watanabe, Shuichi Ono, Toshiyuki Takeshita
Journal of Obstetrics and Gynaecology Research · 2020 · vol. 46(3) , pp. 466–478 · doi:10.1111/jog.14191 · PMID:32003109 · W3003913416
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This study developed and validated a transvaginal ultrasonography adhesion scoring system that accurately predicted pelvic adhesion status and correlated with surgical findings and infertility outcomes.

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Abstract

Abstract Aim To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. Methods In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0–10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. Results Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion‐related score in the revised American Society for Reproductive Medicine classification ( R 2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non‐ in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). Conclusion Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Ovary Tissue Adhesions Ultrasonography Uterus Adult Endometriosis Endometriosis Female Humans Middle Aged Ovary Ovary Pelvis Pelvis Pelvis Preoperative Period Prospective Studies Sensitivity and Specificity Tissue Adhesions

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