Preoperative Imaging in Patients with Deep Infiltrating Endometriosis: An Important Aid in Predicting Depth of Infiltration in Rectosigmoid Disease

Sloss S, Samantha Sloss, Samantha Mooney, Ellett L, Lenore Ellett, Emma Readman, Readman E, Ma T, Tony Ma, Brouwer R, Richard Brouwer, Yang N, Natalie Yang, Kerryn Ireland-Jenkin, Kerryn Ireland‐Jenkin, Ireland-Jenkin K, Stone K, Kate Stone, Peter Maher, Maher P
Journal of minimally invasive gynecology · 2022 · vol. 29(5) , pp. 633–640 · doi:10.1016/j.jmig.2021.12.015 · PMID:34990811 · W4205827044
article OA: closed CC0 ⤵ 7 in-corpus citations
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Preoperative imaging was evaluated as a tool to predict the depth of rectosigmoid infiltration in patients with deep infiltrating endometriosis.

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Abstract

Study objectiveTo determine the diagnostic accuracy of specialist-performed transvaginal ultrasound (TVUS) and pelvic magnetic resonance imaging (MRI) modalities in predicting depth of deep infiltrating endometriosis (DIE) of the rectosigmoid by comparison with histologic specimens obtained at surgery.DesignA retrospective analysis, which met the Standards for Reporting of Diagnostic Accuracy Studies (2015) guidelines for a diagnostic accuracy study.SettingTertiary teaching hospital.PatientsA total of 194 cases who underwent preoperative discussion at the gynecologic endosurgery unit multidisciplinary meeting between January 2012 and December 2019 were eligible for inclusion.InterventionsRetrospective assessment of the accuracy of TVUS and MRI in predicting histologic depth of rectosigmoid DIE after operative management.Measurements and main resultsAl total of 135 surgeries were performed for DIE; 20 underwent a rectal shave, 14 had a disc/wedge resection, 38 an anterior/segmental resection, and 63 had no rectosigmoid surgery. Of the 52 patients with full-thickness rectal wall excision, all patients had at least one imaging modality available for review; 42 (81%) had both. At least one imaging modality was in agreement with histologic depth in 48 cases (92%) (sensitivity, 94%; specificity, 50%; positive predictive value [PPV], 97.9%; negative predictive value [NPV], 25.0%; area under the receiver operating curve, 0.720; 95% confidence interval, 0.229-1.000). When TVUS was assessed in isolation, the test remained sensitive for any rectal wall involvement (sensitivity, 93.6%; specificity, 50.0%; PPV, 97.8%; NPV, 25.0%; area under the receiver operating curve, 0.718; 95% confidence interval, 0.227-1.000). When only MRI was assessed, the test demonstrated both high sensitivity and specificity for rectal wall disease (sensitivity, 86.4%; specificity, 100%; PPV, 100%; NPV, 14.2).ConclusionSpecialist-performed TVUS and MRI are accurate in predicting depth of disease in rectosigmoid endometriosis. These modalities were similar in their diagnostic performance at assessing depth of rectal wall involvement, and their use is justified in the preoperative planning of these gynecologic surgeries.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Endometriosis Rectal Diseases Rectal Diseases Rectal Diseases Rectal Diseases Female Humans Magnetic Resonance Imaging Rectum Rectum Rectum Rectum Retrospective Studies Sensitivity and Specificity Ultrasonography Ultrasonography

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