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Extended Transvaginal Sonography in Deep Infiltrating Endometriosis
Author(s) -
León Mauricio,
Vaccaro Humberto,
Alcázar Juan Luis,
Martinez Jaime,
Gutierrez Jorge,
Amor Fernando,
Iturra Alberto,
Sovino Hugo
Publication year - 2014
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.33.2.315
Subject(s) - medicine , pouch , endometriosis , vagina , positive predicative value , radiology , prospective cohort study , urology , gynecology , surgery , predictive value
Objectives The purpose of this study was to assess the diagnostic performance of extended transvaginal sonography for diagnosing deep infiltrating endometriosis. Methods A prospective study was conducted comprising 51 women (mean age, 32.9 years; range, 23–43 years) with suspected deep infiltrating endometriosis based on clinical symptoms. All women underwent extended transvaginal sonography, which included assessment of 2 pelvic compartments (anterior compartment: bladder and distal ureters; and posterior compartment: posterior vaginal fornix, retrocervical area, pouch of Douglas, and rectosigmoid). The sliding sign for detecting pouch of Douglas obliteration was also assessed. All patients received bowel preparation before sonographic examinations. A single examiner performed all examinations. All women underwent laparoscopic surgery, and histologic confirmation of endometriosis was done. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated. Results Some women had more than 1 lesion, giving a total of 55 histologically confirmed lesions (rectosigmoid, n = 13; vagina, n = 5; retrocervical, n = 32; bladder, n = 5). The sensitivity, specificity, and LR+ for rectosigmoid involvement were 100%, 93%, and 14.0, respectively. The sensitivity, specificity, LR+, and LR− for vaginal involvement were 60%, 98%, 30.0, and 0.41. The sensitivity, specificity, LR+, and LR− for retrocervical involvement were 84%, 96%, 19.4, and 0.16. The sensitivity, specificity, and LR− for bladder involvement were 20%, 100%, and 0.80. The sensitivity, specificity, LR+, and LR− of the sliding sign for diagnosing pouch of Douglas obliteration were 89%, 92%, 10.7, and 0.12. Conclusions Except for bladder involvement, extended transvaginal sonography has good diagnostic performance for deep infiltrating endometriosis.