Extended Transvaginal Sonography in Deep Infiltrating Endometriosis

Mauricio León, León M, Humberto Vaccaro, Vaccaro H, H Vaccaro, Juan Luis Alcázar, Alcázar Jl, J.C. Martínez Martínez, Martinez J, Jaime Martinez, Gutierrez J, Jorge Gutierrez, Jorge Gutiérrez, F. Amor, Amor F, Fernando Amor, Iturra A, Alberto Iturra, A. Iturra, Sovino H, Hugo Sovino
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2014 · vol. 33(2) , pp. 315–321 · doi:10.7863/ultra.33.2.315 · PMID:24449735 · W2010664580
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Extended transvaginal sonography demonstrated good diagnostic performance for rectosigmoid, vaginal, retrocervical, and pouch of Douglas deep infiltrating endometriosis but not bladder involvement.

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Abstract

OBJECTIVES: The purpose of this study was to assess the diagnostic performance of extended transvaginal sonography for diagnosing deep infiltrating endometriosis. METHODS: A prospective study was conducted comprising 51 women (mean age, 32.9 years; range, 23-43 years) with suspected deep infiltrating endometriosis based on clinical symptoms. All women underwent extended transvaginal sonography, which included assessment of 2 pelvic compartments (anterior compartment: bladder and distal ureters; and posterior compartment: posterior vaginal fornix, retrocervical area, pouch of Douglas, and rectosigmoid). The sliding sign for detecting pouch of Douglas obliteration was also assessed. All patients received bowel preparation before sonographic examinations. A single examiner performed all examinations. All women underwent laparoscopic surgery, and histologic confirmation of endometriosis was done. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated. RESULTS: Some women had more than 1 lesion, giving a total of 55 histologically confirmed lesions (rectosigmoid, n = 13; vagina, n = 5; retrocervical, n = 32; bladder, n = 5). The sensitivity, specificity, and LR+ for rectosigmoid involvement were 100%, 93%, and 14.0, respectively. The sensitivity, specificity, LR+, and LR- for vaginal involvement were 60%, 98%, 30.0, and 0.41. The sensitivity, specificity, LR+, and LR- for retrocervical involvement were 84%, 96%, 19.4, and 0.16. The sensitivity, specificity, and LR- for bladder involvement were 20%, 100%, and 0.80. The sensitivity, specificity, LR+, and LR- of the sliding sign for diagnosing pouch of Douglas obliteration were 89%, 92%, 10.7, and 0.12. CONCLUSIONS: Except for bladder involvement, extended transvaginal sonography has good diagnostic performance for deep infiltrating endometriosis.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Intestinal Diseases Laxatives Ultrasonography Urinary Bladder Diseases Vaginal Creams, Foams, and Jellies Vaginal Diseases Adult Endometriosis Female Humans Image Enhancement Image Enhancement Intestinal Diseases Reproducibility of Results Sensitivity and Specificity Ultrasonography Urinary Bladder Diseases Vaginal Diseases Young Adult

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