A systematic review and meta-analysis on transvaginal ultrasonography in the diagnosis of deep invasive endometriosis

Yuanhua Xiang, Gang Wang, Lingjuan Zhou, Qin Wang, Qinjie Yang
Annals of palliative medicine · 2022 · vol. 11(1) , pp. 281–290 · doi:10.21037/apm-21-3761 · PMID:35144419 · W4206648810
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This meta-analysis of 12 studies found transvaginal ultrasonography (TVS) demonstrates high sensitivity and specificity for diagnosing deep invasive endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 ⓘ

This systematic review and meta-analysis evaluated the diagnostic sensitivity of transvaginal ultrasonography (TVS) for diagnosing deep invasive endometriosis (DIE), using studies retrieved from PubMed, Medline, Embase, and Cochrane Central up to June 2021. Eligible studies included adults with DIE diagnosed by histopathology, symptoms consistent with endometriosis, and transvaginal ultrasound testing; 12 articles were included after exclusions, and sensitivity was meta-analyzed using effect sizes derived from the ratio of detected to total cases, alongside heterogeneity and quality assessments (Cochrane bias items and QUADAS). The paper reports that the pooled analysis incorporated tests for threshold and non-threshold heterogeneity and used either fixed- or random-effects models accordingly, while also performing leave-one-out checks to assess the stability of the combined results. A major limitation explicitly acknowledged in the methods is that the included evidence reflects study quality heterogeneity and that bias risk could be “unknown” when reporting was insufficient. This paper is centrally about endometriosis — it specifically synthesizes evidence on how well transvaginal ultrasonography detects deep invasive endometriosis.

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Abstract

BACKGROUND: The uterus is prone to many diseases, including endometriosis. Transvaginal ultrasonography (TVS) has become a frequently used detection method for deep invasive endometriosis (DIE). METHODS: The combinations of relevant keywords and medical topic title terms were searched in the databases of PubMed, Medline, and Embase, and the Cochrane Central Register of Controlled Trials (endometriosis) from their inception to June 2021. Based on the descriptive terms of endometriosis, deep infiltrating endometrium, heterotopia, deep endometriosis, ultrasound, and TVS, the full texts of the target articles were obtained and subjected to a manual search. Meta-analysis was performed using RevMan 5.3 software provided by the Cochrane collaboration. RESULTS: A total of 12 articles were included in this study, involving 1,707 patients overall. The sensitivity range was 0.57 to 0.98, and the specificity range was 0.87 to 1.00. The positive likelihood ratio (PLR) was 6.2282 [95% confidence interval (CI): 3.774 to 8.932]; the negative likelihood ratio (NLR) was 0.0664 (95% CI: 0.03 to 0.09); and the duration of remission was 1,174.7 (95% CI: 683.8 to 1,793.4). The sensitivity, specificity, PLR, NLR, and diagnostic odds ratio (DOR) of χ2 were 36.10 (P=0.021), 27.00 (P=0.035), 53.11 (P=0.001), 55.22 (P=0.001), and 63.89 (P=0.001), respectively, and the differences were statistically significant. DISCUSSION: A total of 12 articles were included in this meta-analysis, and the results were basically stable. Diagnosis with TVS showed high sensitivity (98%) and specificity (nearly 100%), indicating that it is a reasonable detection method for DIE, improving the disease status of patients.

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Condition tags

mesh:D004715endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Female Humans Sensitivity and Specificity Ultrasonography

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (30)

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