The diagnostic accuracy of transvaginal ultrasound for detection of ureteral involvement in deep infiltrating endometriosis

Objective—The aim of this study is to determine the accuracy of transvaginal \nultrasound (TVU) for the diagnosis of ureteral involvement in women with deep \ninfiltrating endometriosis (DIE). \nMethods—The meta-analysis included primary studies comparing the use of \nTVU for diagnosing endometriotic involvement of the ureter, using laparoscopic surgery and histological diagnosis as the reference standard. Search \nwas performed in several databases (Scopus, Web of Science, and PubMed/ \nMEDLINE). The studies’ quality and bias risk were assessed using the \nQuality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2). Diagnostic performance was estimated by assessing pooled sensitivity and \nspecificity. \nResults—A total of 496 citations were found. Six articles were ultimately selected \nfor this systematic review and meta-analysis after the inclusion and exclusion \ncriteria were applied. Pooled sensitivity and specificity were 0.81 (95% CI: 0.42– \n0.96), 1.00 (95% CI: 0.93–1.00). The heterogeneity observed was high for both \nsensitivity and specificity. Overall risk of bias was low. \nConclusion—TVU is a valuable tool for the pre-operative identification of ureteral involvement by DIE.