Can rectal endoscopic sonography be used to predict infiltration depth in patients with deep infiltrating endometriosis of the rectum?

Luciano Andrés Rossi, L Rossi, Rossi L, L. Palazzo, Palazzo L, C Yazbeck, Chadi Yazbeck, Walker F, Francine Walker, F Walker, Chis C, C. Chis, Luton D, Dominique Luton, D Luton, M Koskas, Martin Koskas
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2013 · vol. 43(3) , pp. 322–327 · doi:10.1002/uog.12535 · PMID:23754206 · W1506937810
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Rectal endoscopic sonography accurately predicts muscularis layer infiltration by rectal endometriosis but is less accurate for submucosal/mucosal involvement, limiting its use in surgical approach selection.

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Abstract

OBJECTIVES: To evaluate the diagnostic accuracy of rectal endoscopic sonography (RES) in the prediction of the infiltration depth of rectal endometriosis and to ascertain whether RES could be used to choose between segmental bowel resection and a more conservative approach, such as shaving or discoid resection. METHODS: In this retrospective study, 38 consecutive patients with symptomatic deep infiltrating endometriosis of the rectum who underwent laparoscopic colorectal resection were included. RES results for infiltration depth of rectal endometriosis were compared with results of pathological examination. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LRs) and test accuracy were calculated for the presence of infiltration of the muscularis layers and submucosal/mucosal layers, as demonstrated by RES and confirmed by histopathological analysis. RESULTS: For the detection of muscularis layer infiltration by endometriosis, the PPV of RES was 100%, whereas for the detection of submucosal/mucosal layer involvement, the sensitivity was 89%, specificity was 26%, PPV was 55%, NPV was 71%, test accuracy was 58% and positive and negative LRs were 1.21 and 0.40, respectively. CONCLUSIONS: RES is a valuable tool for detecting rectal endometriosis as endometriotic infiltration of the muscularis layer can be predicted accurately. However, RES is less accurate in detecting submucosal/mucosal layer involvement and cannot, therefore, be used to choose between bowel resection and a more conservative approach.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endosonography Laparoscopy Rectal Diseases Adult Endometriosis Endometriosis Endometriosis Female Humans Laparoscopy Middle Aged Predictive Value of Tests Rectal Diseases Rectal Diseases Rectal Diseases Retrospective Studies Sensitivity and Specificity

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