OC16.04: Diagnostic accuracy of transvaginal ultrasound for diagnosis of deep endometriosis: systematic review and meta‐analysis

To evaluate the diagnostic accuracy of transvaginal ultrasound (TVUS) in the preoperative detection of deep endometriosis, using the pathologic and/or surgical data as a reference standard. An extensive search was performed in Medline (Pubmed) and ISI Web of Knowledge from January 1990 to March 2015. In order to obtain more robust data, we decided to exclude studies with less than 50 patients. Quality was assessed using QUADAS-2 tool. Our extended search identified a total of 378 citations but we finally examined the full text of the 18 articles including 2510 patients. With respect to the bladder location, TVUS overall pooled estimated sensitivity was 0.75 (95%CI, 0.43–1.00) with an I2 of 0% and a Cochran Q of 1,88 and specificity was 0.99 (95%CI, 0.90–1.00) with an I2 of 0% and a Cochran Q of 0.07. With respect to the recto-sigmoid location, pooled estimated sensitivity was 0.87 (0.81–0.93) with an I2 of 7.61% and a Cochran Q of 18.4 and specificity was 0.96 (0.92–1.00) with an I2 of 0% and a Cochran Q of 3.02. With respect to the uterosacral ligament location, pooled estimated sensitivity was 0.55 (0.49–0.60) with an I2 of 93.1% and a Cochran Q of 116.09 and specificity was 0.90 (0.83–0.97) with an I2 of 0% and a Cochran Q of 2.54. With respect to the vaginal location, estimated sensitivity was 0.65 (0.61–0.79) with an I2 of 0% and a Cochran Q of 4.76 and specificity was 0.93 (0.84–1.00) with an I2 of 0% and a Cochran Q of 1.69. With respect to the rectovaginal septum, pooled estimated sensitivity was 0.68 (0.54–0.81) with an I2 of 0% and a Cochran Q of 2.68 and specificity was 0.91 (0.77–1.00) with an I2 of 0% and a Cochran Q of 0.49. No significant evidence of heterogeneity was found for sensibility nor specificity in any of the groups analysed. Overall diagnostic performance of TVS for detecting deep endometriosis is acceptable. However, more studies with improved quality in design are needed.