Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis

Utility of Transvaginal Ultrasound to detect Deep Infiltrating Endometriosis

Key Points

Importance:

• The ability to offer patients noninvasive imaging options for the evaluation and diagnosis of DIE is paramount to effective surgical planning and treatment of endometriosis.

Highlights:

• Transvaginal ultrasound has varying sensitivities, specificities, and accuracies in diagnosing various pelvic organs for endometriosis involvement.  

What’s done here:

• This is an updated review of transvaginal ultrasound and its utility in diagnosing deep infiltrating endometriosis.

Key Results:

• In four articles, the sensitivity and the specificity of TVUS for the diagnosis of DIE ranged from 78.5% to 85.3%, and 46.1% to 92.5%, respectively while accuracies from 75.7% to 97% in seven studies.
• TVUS was seen to offer varying accuracies for the diagnosis of DIE involvement in various pelvic organs including the bladder, uterosacral ligaments, ovaries, pouch of Douglas, and rectosigmoid colon.

Limitations:

• For results regarding DIE of the bladder, some articles groups the diagnosis of the bladder with other anterior compartment organs and it was not specified if the bladder was full upon scanning.

Lay Summary

Transvaginal ultrasound (TVUS) is an imaging tool that is irreplaceable for the diagnosis of multiple gynecologic conditions such as ovarian torsion, ectopic pregnancy, and uterine leiomyomas. TVUS is increasingly being used in the diagnosis of endometriosis as it can assess the presence of endometriosis in not only the uterus and ovaries but also in deeper pelvic structures. Due to its increasing use, the question remains as to whether TVUS is as accurate in the diagnosis of DIE as other imaging modalities such as MRI. This article aims to determine the accuracy of TVUS to DIE and to evaluate the extent of operator dependence in the outpatient setting.

Research studies between January 2000 and November 2019 were screened from 4 online databases with the inclusion criteria of (1) TVUS (or a variation such as 3‐dimensional [3D] TVUS, sono-vaginography [SVG], rectal water contrast [RWC] TVUS, or saline contrast TVUS); (2) participants underwent surgery (with or without a histologic examination); (3) the focus was on endometriosis in the ovaries, peritoneum, bowel, bladder, uterosacral ligaments (USLs), vaginal walls, rectovaginal septum, or pouch of Douglas (POD); and (4) original research articles only (not case studies, systematic reviews, or meta‐analyses). The total studies included were 35 after exclusion criteria were met.

In four articles, the sensitivity and specificity of TVUS for the diagnosis of DIE ranged from 78.5% to 85.3%, and 46.1% to 92.5%, respectively while accuracies ranged from 75.7% to 97% in seven studies. The article then assesses the utility of TVUS for specific DIE involvement including the bladder, uterosacral ligaments, ovaries, pouch of Douglas, and rectosigmoid colon. The sensitivity of TVUS for the diagnosis of bladder endometriosis was very varied (some studies varied from 20% to 100%. However, many of these studies had a very small sample size of bladder endometriosis. On average, however, the sensitivity and of TVUS to diagnose bladder endometriosis was low. For uterosacral ligament involvement, eight studies reported sensitivities of less than 70% and a specificity of greater than 80%. The detection of ovarian disease (especially endometriomas) on TVUS was often high, with sensitivities greater than 80% and specificities of greater than 90% for most studies. For the detection of endometriosis involvement in the pouch of Douglas (POD), TVUS had a sensitivity and specificity 72-99% and 90-100%, respectively. The sensitivity of the uterine sliding sign in particular varied from 31%-89%. For the detection of rectosigmoid involvement, TVUS was seen to have high specificity and specificity (>90%) in several studies but most studies were limited in study population numbers. Of note, it was found that there is no significant improvement in the sensitivity, specificity, or accuracy when bowel preparation was used before TVUS was performed. 

Overall, TVUS remains as a great tool for the initial assessment of patients suspected to have DIE. Depending on the location of endometriotic lesions, the ability to rule in or rule out pelvic organ involvement may require additional imaging such as MRI. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/32083336