Can Enhanced Techniques Improve the Diagnostic Accuracy of Transvaginal Sonography and Magnetic Resonance Imaging for Rectosigmoid Endometriosis? A Systematic Review and Meta-analysis

Ana Maria Gomes Pereira, Pereira AMG, Valéria Silva Cândido Brizon, Brizon VSC, Carvas Junior N, Nelson Carvas, Nelson Carvas Junior, Mariana de Sousa Ribeiro de Carvalho, de Carvalho MSR, Estevan Matheus Cuvero, Cuvero EM, Anna Maria Buehler, Buehler AM, Pereira TDV, Tiago da Veiga Pereira, Reginaldo Guedes Coelho Lopes, Lopes RGC
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2019 · vol. 42(4) , pp. 488–499.e4 · doi:10.1016/j.jogc.2019.07.016 · PMID:31767378 · W2990492936
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This meta-analysis compared transvaginal sonography and MRI for rectosigmoid endometriosis, finding both highly accurate, with enhanced MRI techniques potentially improving diagnostic performance.

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Abstract

ObjectiveOur aim was to perform a systematic review and meta-analysis of the most commonly used examinations for rectosigmoid lesions of deeply infiltrating endometriosis, transvaginal sonography (TVS) and magnetic resonance imaging (MRI), to compare their diagnostic accuracy and enhanced or non-enhanced techniques.MethodsA systematic search was performed until March 2018 without time or language restrictions. Eligibility criteria included studies that compared the accuracy of TVS and MRI for diagnosis of rectosigmoid endometriosis. The quality of the studies was assessed by means of Quality Assessment of Diagnostic Accuracy Studies-2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Bivariate and hierarchical analysis were performed. The difference in the accuracy of TVS and MRI was tested, and heterogeneity was addressed by means of meta-regression, sensitivity, or subgroup analysis.ResultsA total of 1754 studies were screened; 105 studies were eligible, and 11 studies were included in the meta-analysis. Overall pooled sensitivity, specificity, and area under the receiver operating characteristic curve were 0.80, 0.94, and 0.95, respectively. The measures for MRI were 0.82, 0.94, and 0.95, respectively. There was no statistical difference between the accuracy values of TVS and MRI (P = 0.90). The use of bowel preparation and vaginal contrast could enhance the accuracy of MRI. Along with rectosigmoid prevalence, bowel and vaginal contrast explained a significant proportion of the statistical heterogeneity.ConclusionsBoth TVS and MRI showed high diagnostic accuracy for rectosigmoid deeply infiltrating endometriosis lesions. There is no strong evidence suggesting that the two diagnostic methods might differ in specificity or sensitivity, but enhanced techniques may increase the accuracy measures.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Rectum Ultrasonography Endometriosis Female Humans Magnetic Resonance Imaging Rectum Sensitivity and Specificity Ultrasonography

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