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Diagnostic accuracy of transvaginal ultrasound for non‐invasive diagnosis of bowel endometriosis: systematic review and meta‐analysis
Author(s) -
Hudelist G.,
English J.,
Thomas A. E.,
Tinelli A.,
Singer C. F.,
Keckstein J.
Publication year - 2011
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.8858
Subject(s) - medicine , endometriosis , meta analysis , laparoscopy , enema , diagnostic accuracy , confidence interval , bowel preparation , radiology , colonoscopy , colorectal cancer , cancer
Objective To critically analyze the diagnostic value of transvaginal sonography (TVS) for non‐invasive, presurgical detection of bowel endometriosis. Methods MEDLINE (1966–2010) and EMBASE (1980–2010) databases were searched for relevant studies investigating the diagnostic accuracy of TVS for diagnosing deep infiltrating endometriosis involving the bowel. Diagnosis was established by laparoscopy and/or histopathological analysis. Likelihood ratios (LRs) were recalculated in addition to traditional measures of effectiveness. Results Out of 188 papers, a total of 10 studies fulfilled predefined inclusion criteria involving 1106 patients with suspected endometriosis. The prevalence of bowel endometriosis varied from 24 to 73.3%. LR+ ranged from 4.8 to 48.56 and LR− ranged from 0.02 to 0.36, with wide confidence intervals. Pooled estimates of sensitivities and specificities were 91 and 98%; LR+ and LR− were 30.36 and 0.09; and positive and negative predictive values were 98 and 95%, respectively. Three of the studies used bowel preparations to enhance the visibility of the rectal wall; one study directly compared the use of water contrast vs. no prior bowel enema, for which the LR− was 0.04 and 0.47, respectively. Conclusions TVS with or without the use of prior bowel preparation is an accurate test for non‐invasive, presurgical detection of deep infiltrating endometriosis of the rectosigmoid. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.