Ultrasound Characteristics and Scanning Techniques of Uterosacral Ligaments for the Diagnosis of Endometriosis: A Systematic Review

Shae Maple; Jane Chalmers; Eva Bezak; Henry K; Katelyn Henry; Nayana Parange

doi:10.1002/jum.16129

Ultrasound Characteristics and Scanning Techniques of Uterosacral Ligaments for the Diagnosis of Endometriosis: A Systematic Review

Shae Maple, Jane Chalmers, Eva Bezak, Henry K, Katelyn Henry, Nayana Parange

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2022 · vol. 42(6) , pp. 1193–1209 · doi:10.1002/jum.16129 · PMID:36409651 · W4309496959

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This systematic review identified inconsistent reporting of ultrasound techniques and characteristics for uterosacral ligaments in deep endometriosis diagnosis, yet found that detecting pathological findings aids in early diagnosis.

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Abstract

Endometriosis is a common and painful gynaecological condition that takes an average of 6.4years to diagnose. While laparoscopic surgery is the recommend gold standard in diagnosis of endometriosis, transvaginal ultrasound (TVS) is able to assist surgeons in the planning and management of patients, especially when there is limited visualisation in the posterior compartment. Uterosacral ligaments (USL) are located in the posterior compartment and are one of the first and most common places that endometriosis deposits, The International Deep Endometriosis Analysis (IDEA) group consensus, which are the current guidelines for DE imaging, recommends a thorough ultrasound assessment to identify endometriotic disease. This includes an assessment of anatomic structures in the posterior compartment including the USLs. However, IDEA does not explicitly articulate specifics of USL imaging and measurements on ultrasound. The primary aim of this review is to determine is to identify ultrasound techniques and characteristics of USLs in the diagnosis of deep infiltrative endometriosis (DE). The secondary aim is to describe and summarise these findings into normal and pathological findings. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A population, interventions, comparator, and outcome framework was used to define a search strategy. Articles were screened using Covidence review management system, and data was extracted by two authors using a standardised and piolet-tested form. Quality assessment was conducted using the Critical Appraisal Skills Programme (CASP). Medline, Embase and Scopus and Google Scholar were searched yielding 250 articles, with 22 being included in the review. Analysis of the data demonstrated inconsistent reporting of ultrasound techniques and characteristics of USLs. Most (20/22) papers described abnormal criteria of USLs, only 5/22 papers determined what the normal USL appearance is or what techniques (11/22) were applied. Even though reporting was heterogeneous, there was a high level of tertiary centre participation with gynaecological experienced operators, therefore was a high level of agreement. Through review of the current literature, this study has investigated ultrasound techniques and characteristics of USLs for the diagnosis of DE. All papers included in this review reported presence of pathological sonographic findings of the USLs when DE was presented therefore it is recommended that USL examination become a part of TVS exams when DE is clinically suspected. This study also demonstrated that there was lack of data and no agreement when it comes to measuring USLs with DE. Even so, the current evidence demonstrates that scanning the USLs, and locating, identifying, and describing USL thickening and endometriotic nodules in the various locations using the described techniques and characteristics in this review has clinical value in early diagnosis.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (10)

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[1] Accuracy of transvaginal sonography and contrast‐enhanced magnetic resonance‐colonography for the presurgical staging of deep infiltrating endometriosis via openalex

[2] Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis via openalex

[3] Accuracy of transvaginal ultrasound for diagnosis of deep infiltrating endometriosis in the uterosacral ligaments: Systematic review and meta-analysis via openalex

[4] Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification via openalex

[5] A pictorial guide to the ultrasound identification and assessment of uterosacral ligaments in women with potential endometriosis via openalex

[6] A prospective study comparing rectal water contrast‐transvaginal ultrasonography with sonovaginography for the diagnosis of deep posterior endometriosis via openalex

[7] Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis via openalex

[8] Classification of endometriosis via openalex

[9] Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis via openalex

[10] Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery via openalex

[11] Deep Infiltrating Endometriosis: Comparison Between 2‐Dimensional Ultrasonography (US), 3‐Dimensional US, and Magnetic Resonance Imaging via openalex

[12] Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography via openalex

[13] Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis via openalex

[14] Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis via openalex

[15] Diagnostic accuracy of transvaginal sonography (TVS) for non-invasive diagnosis of rectosigmoidal endometriosis – a systematic review and meta-analysis via openalex

[16] Diagnostic accuracy of transvaginal sonography (TVS) for non-invasive diagnosis of rectosigmoidal endometriosis – a systematic review and meta-analysis via openalex

[17] Diagnostic value of transvaginal 'tenderness-guided' ultrasonography for the prediction of location of deep endometriosis via openalex

[18] Endometriosis via openalex

[19] Endometriosis on the uterosacral ligament: a marker of ureteral involvement via openalex

[20] Evaluation of Uterosacral Ligament Involvement in Deep Endometriosis by Transvaginal Ultrasonography via openalex

[21] Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results via openalex

[22] Initial Accuracy of and Learning Curve for Transvaginal Ultrasound with Bowel Preparation for Deep Endometriosis in a US Tertiary Care Center via openalex

[23] Interobserver agreement and accuracy of non‐invasive diagnosis of endometriosis by transvaginal sonography via openalex

[24] Laparoscopic surgery for severe ureteric endometriosis via openalex

[25] Multicentre retrospective study to assess diagnostic accuracy of ultrasound for superficial endometriosis—Are we any closer? via openalex

[26] Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments via openalex

[27] Practice Bulletin No. 114: Management of Endometriosis via openalex

[28] Proposed technique to visualize and classify uterosacral ligament deep endometriosis with and without infiltration into parametrium or torus uterinus via openalex

[29] Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies via openalex

[30] Role of preoperative ultrasound mapping in the surgical management of deep infiltrating endometriosis: a prospective observational study via openalex

[31] Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research via openalex

[32] Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group via openalex

[33] The #Enzian classification: A comprehensive non‐invasive and surgical description system for endometriosis via openalex

[34] The importance of pre‐operative ultrasound diagnosis of pouch of Douglas obliteration via openalex

[35] The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound 'sliding sign' technique: inter- and intra-observer reproducibility via openalex

[36] Transvaginal sonography for preoperative assessment of deep endometriosis via openalex

[37] Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis via openalex

[38] Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study via openalex

[39] Ultrasound of the Uterosacral Ligament, Parametrium, and Paracervix: Disagreement in Terminology between Imaging Anatomy and Modern Gynecologic Surgery via openalex

[40] W2161374186 via openalex

[41] W2560042681 via openalex

[42] W2134618546 via openalex

[43] W2101299378 via openalex

[44] W2992320497 via openalex

[45] W3004386584 via openalex

[46] W3106867679 via openalex

[47] W3214092784 via openalex

[48] W4214754424 via openalex

[49] W6781576200 via openalex

[50] W2160903422 via openalex