Evaluation of the Diagnostic Performance of Physical Examination Combined with Transvaginal Ultrasonography in Patients with Endometriosis

Talha Tıryakı, Tolga Karacan, Seyma Yesiralioglu, Eser Özyürek, H. Asuman Kiyak, Engin Oral
In: Gynecology Obstetrics & Reproductive Medicine · 2019 · vol. 26(2) , pp. 116–122 · doi:10.21613/gorm.2019.901 · W2946617736
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Combining physical examination with transvaginal ultrasonography better predicts endometriosis in symptomatic premenopausal patients than in asymptomatic premenopausal or postmenopausal patients.

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This retrospective cohort study evaluated whether a physician’s initial history/physical examination impression combined with transvaginal ultrasonography better predicts histopathologically confirmed endometriosis in patients presenting with symptoms suggestive of endometriosis versus asymptomatic patients, including both premenopausal and postmenopausal groups. Among 138 patients with endometriosis at surgery, the combination’s positive predictive value and positive likelihood ratio were highest in premenopausal symptomatic patients (PPV 97.8%, LR+ 11.5) and lower in other strata, including substantially reduced performance in asymptomatic presentations. The authors explicitly note that diagnostic performance in asymptomatic patients could not match the accuracy observed in symptomatic patients. This paper is centrally about endometriosis — it assesses the diagnostic performance of combining physical examination with transvaginal ultrasonography for endometriosis prediction.

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Abstract

Objective: Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation.Study Design: In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.Results: The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.Conclusion: The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.
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Objective

Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation. Study Design: In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.

Results

The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.

Conclusion

The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms. Downloads Downloads Published How to Cite Issue Section License All the articles published in GORM are licensed with "Creative Commons Attribution 4.0 License (CC BY 4.0)". This license entitles all parties to copy, share and redistribute all the articles, data sets, figures and supplementary files published in this journal in data mining, search engines, web sites, blogs and other digital platforms under the condition of providing references.

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Condition tags

endometriosis

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.

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