Diagnostic accuracy of transvaginal sonography (TVS) for non-invasive diagnosis of rectosigmoidal endometriosis – a systematic review and meta-analysis

The paper is a systematic review and meta-analysis evaluating the diagnostic accuracy of transvaginal sonography (TVS) for the non-invasive, presurgical detection of deep infiltrating endometriosis (DIE) involving the rectosigmoid bowel. MEDLINE and EMBASE were searched for studies using laparoscopy and/or histopathology as the reference standard, and 10 eligible studies (1106 patients with suspected endometriosis) were included; the authors recalculated likelihood ratios and pooled sensitivities/specificities. They found pooled sensitivity of 91% and specificity of 98%, with PPV and NPV of 98% and 95%, and positive/negative likelihood ratios of 30.36 and 0.09, though ranges and confidence intervals were wide, reflecting variability across studies. The paper reports that bowel preparation or contrast techniques may affect performance (e.g., negative LHR 0.04 for water contrast TVS vs 0.47 for TVS). This paper is centrally about endometriosis — specifically the diagnostic accuracy of transvaginal sonography for rectosigmoidal deep infiltrating endometriosis.

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