Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis

Gernot Hudelist, G Hudelist, K Ballard, Jane A. English, J English, J Wright, J. Timothy Wright, S Banerjee, H Mastoroudes, Heleni Mastoroudes, A Thomas, CF Singer, C F Singer, J Keckstein
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2011 · vol. 37(4) , pp. 480–487 · doi:10.1002/uog.8935 · PMID:21433168 · W2049680134
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Transvaginal sonography demonstrated superior performance over clinical vaginal examination in detecting ovarian and rectosigmoidal deep infiltrating endometriosis.

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Abstract

OBJECTIVE: The aim of this study was to compare the diagnostic performance of clinical vaginal examination with that of transvaginal sonography (TVS) in the presurgical diagnosis of deep infiltrating endometriosis. METHODS: One-hundred and fifty-five women with symptoms suggestive of endometriosis were included. One-hundred and twenty-nine patients met the inclusion criteria and were prospectively and independently assessed by vaginal examination and TVS prior to a diagnostic laparoscopy and, where appropriate, radical resection and histological confirmation of endometriosis was performed. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and positive and negative likelihood ratios (LR+ and LR-) were calculated for each test method. RESULTS: In total, 83 (64%) women had histological confirmation of endometriosis, 52 (40%) of whom had deep infiltrating endometriosis. The prevalence of endometriosis on the uterosacral ligaments, pouch of Douglas, vagina, bladder, rectovaginal space and rectosigmoid was 23.3%, 16.3%, 8.5%, 3.1%, 6.9% and 24%. PPV, NPV, LR+ and LR- for vaginal examination were 92%, 87%, 41.56 and 0.60 for ovarian endometriosis; 43%, 84%, 2.48 and 0.63 for uterosacral ligament disease; 64%, 95%, 9.14 and 0.26 for involvement of the pouch of Douglas; 80%, 97%, 42.91 and 0.28 for vaginal endometriosis; 78%, 98%, 46.67 and 0.23 for endometriosis of the rectovaginal space; 100%, 98%, 75.60 and 0.75 for bladder involvement; 86%, 84%, 18.97 and 0.63 for rectosigmoidal endometriosis. Values for TVS were similar with regard to vaginal and rectovaginal space endometriosis, but were clearly superior to vaginal examination in cases of ovarian (87%, 99%, 24.56 and 0.04), uterosacral ligament (91%, 90%, 31.35 and 0.37) and rectosigmoidal (97%, 97%, 88.51 and 0.1) endometriosis. CONCLUSIONS: TVS is a more useful test than is vaginal examination in detecting endometriosis in the ovaries and rectosigmoid.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Gynecological Examination Uterus Vagina Adult Endometriosis Endometriosis Endometriosis Female Gynecological Examination Humans Laparoscopy Middle Aged Predictive Value of Tests Preoperative Care Prospective Studies Sensitivity and Specificity Treatment Outcome Ultrasonography Uterus

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