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

This systematic review and meta-analysis evaluated the diagnostic accuracy of transvaginal sonography for non-invasive, presurgical detection of rectosigmoidal deep infiltrating endometriosis, using MEDLINE and EMBASE searches for studies where diagnosis was confirmed by laparoscopy and/or histopathology. Ten eligible studies (1106 patients with suspected endometriosis) showed high pooled sensitivity (91%) and specificity (98%), with positive and negative likelihood ratios of 30.36 and 0.09 and PPVs and NPVs of 98% and 95%, respectively, though several estimates had wide confidence intervals. The authors noted that bowel preparation varied across studies (including bowel preparations to visualize the rectal wall) and that one study compared water contrast transvaginal sonography to no enema, finding a lower negative likelihood ratio for water contrast (0.04 vs 0.47). This paper is centrally about endometriosis — it specifically assesses transvaginal sonography accuracy for diagnosing rectosigmoidal bowel endometriosis.

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