Non-invasive Diagnostic Accuracy of Transvaginal Ultrasound in Patients with Bowel Endometriosis: Systematic Review and Meta-analysis

Background: Concerning endometriosis transvaginal sonography (TVS) is a quite sensitive tool for the detection of ovarian endometriomas and is a long way superior to routine clinical examination alone. Aim: This work aims to determine the accuracy, sensitivity, and specificity of non-invasive transvaginal ultrasound in bowel endometriosis patients. Materials and Methods: A systematic search was performed over different medical databases to identify Obstetrics & Gynecology studies, which studied the accuracy, sensitivity, and specificity of non-invasive transvaginal ultrasound in bowel endometriosis patients. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on diagnostic accuracy (AUC) as a primary outcome, and sensitivity and specificity as secondary outcomes. Results: Eight studies were identified involving 1119 patients. The meta-analysis process revealed a pooled accuracy of 94.8%, a pooled sensitivity of 85.4%, and a pooled specificity of 98.1% (p < 0.01 respectively). Conclusion: To conclude, Transvaginal ultrasonography (TVUS) has become the primary diagnostic tool in the diagnosis of deep infiltrating pelvic endometriosis. In the majority of cases, TVUS will give enough information to the surgeon allowing for adequate preoperative planning without the need for magnetic resonance imaging (MRI). Compared to MRI, TVUS is widely available in gynecologic outpatient clinics, well-tolerated, less time-consuming, and less expensive.