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Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study.

Holland TK, Cutner A, Saridogan E, Mavrelos D, Pateman K, Jurkovic D - BMC Womens Health (2013)

Bottom Line: The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions.Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal.The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 8RX, UK. tomkholland@yahoo.com.

ABSTRACT

Background: Endometriosis is a common condition which causes pain and reduced fertility. Treatment can be difficult, especially for severe disease, and an accurate preoperative assessment would greatly help in the managment of these patients. The objective of this study is to assess the accuracy of pre-operative transvaginal ultrasound scanning (TVS) in identifying the specific features of pelvic endometriosis and pelvic adhesions in comparison with laparoscopy.

Methods: Consecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. They all underwent a systematic transvaginal ultrasound examination in order to identify discrete endometriotic lesions and pelvic adhesions. The accuracy of ultrasound diagnosis was determined by comparing pre-operative ultrasound to laparoscopy findings.

Results: 198 women who underwent preoperative TVS and laparoscopy were included in the final analysis. At laparoscopy 126/198 (63.6%) women had evidence of pelvic endometriosis. 28/126 (22.8%) of them had endometriosis in a single location whilst the remaining 98/126 (77.2%) had endometriosis in two or more locations. Positive likelihood ratios (LR+) for the ultrasound diagnosis of ovarian endometriomas, moderate or severe ovarian adhesions, pouch of Douglas adhesions, and bladder deeply infiltrating endometriosis (DIE), recto-sigmoid colon DIE, rectovaginal DIE, uterovesical fold DIE and uterosacral ligament DIE were >10, whilst for pelvic side wall DIE and any ovarian adhesions the + LH was 8.421 and 9.81 respectively.The negative likelihood ratio (LR-) was: <0.1 for bladder DIE; 0.1-0.2 for ovarian endometriomas, moderate or severe ovarian adhesions, and pouch of Douglas adhesions; 0.5-1 for rectovaginal, uterovesical fold, pelvic side wall and uterosacral ligament DIE. The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions.

Conclusions: Our study has shown that the TVS diagnosis of endometriotic lesion is very specific and false positive results are rare. Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal. The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.

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Bar chart of total number of endometriotic lesions seen at laparoscopy against mean proportion of lesions diagnosed on scan in each group.
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Figure 3: Bar chart of total number of endometriotic lesions seen at laparoscopy against mean proportion of lesions diagnosed on scan in each group.

Mentions: The LR + and –LR for all adhesions on the ovaries were moderately and somewhat useful respectively. However for the assessment of moderate or severe adhesions on the ovary the LR + and –LR was very and moderately useful respectively as detailed in Table 4. When the diagnosis of ovarian adhesions was stratified according to the ASRM classification into mild, moderate and severe the overall level of agreement between scan and laparoscopy was very good (Table 5). The LR + and –LR for adhesions in the pouch of Douglas were very and moderately useful respectively as detailed in Table 4. When pouch of Douglas obliteration was assessed according to the ASRM classification into partial and complete obliteration the overall level of agreement between scan and laparoscopy was very good (Table 6). Table 7 shows that the accuracy of the diagnosis of DIE increases significantly with the total number of endometriotic lesions present. This data is represented graphically in Figure 1. Table 8 shows that although the number of endometriotic lesions seen on scan significantly increases with the number of lesions present (Figure 2) the proportion of the total lesions correctly diagnosed increases to a maximum at three lesions present at laparoscopy then declines (Figure 3).


Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study.

Holland TK, Cutner A, Saridogan E, Mavrelos D, Pateman K, Jurkovic D - BMC Womens Health (2013)

Bar chart of total number of endometriotic lesions seen at laparoscopy against mean proportion of lesions diagnosed on scan in each group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815071&req=5

Figure 3: Bar chart of total number of endometriotic lesions seen at laparoscopy against mean proportion of lesions diagnosed on scan in each group.
Mentions: The LR + and –LR for all adhesions on the ovaries were moderately and somewhat useful respectively. However for the assessment of moderate or severe adhesions on the ovary the LR + and –LR was very and moderately useful respectively as detailed in Table 4. When the diagnosis of ovarian adhesions was stratified according to the ASRM classification into mild, moderate and severe the overall level of agreement between scan and laparoscopy was very good (Table 5). The LR + and –LR for adhesions in the pouch of Douglas were very and moderately useful respectively as detailed in Table 4. When pouch of Douglas obliteration was assessed according to the ASRM classification into partial and complete obliteration the overall level of agreement between scan and laparoscopy was very good (Table 6). Table 7 shows that the accuracy of the diagnosis of DIE increases significantly with the total number of endometriotic lesions present. This data is represented graphically in Figure 1. Table 8 shows that although the number of endometriotic lesions seen on scan significantly increases with the number of lesions present (Figure 2) the proportion of the total lesions correctly diagnosed increases to a maximum at three lesions present at laparoscopy then declines (Figure 3).

Bottom Line: The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions.Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal.The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 8RX, UK. tomkholland@yahoo.com.

ABSTRACT

Background: Endometriosis is a common condition which causes pain and reduced fertility. Treatment can be difficult, especially for severe disease, and an accurate preoperative assessment would greatly help in the managment of these patients. The objective of this study is to assess the accuracy of pre-operative transvaginal ultrasound scanning (TVS) in identifying the specific features of pelvic endometriosis and pelvic adhesions in comparison with laparoscopy.

Methods: Consecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. They all underwent a systematic transvaginal ultrasound examination in order to identify discrete endometriotic lesions and pelvic adhesions. The accuracy of ultrasound diagnosis was determined by comparing pre-operative ultrasound to laparoscopy findings.

Results: 198 women who underwent preoperative TVS and laparoscopy were included in the final analysis. At laparoscopy 126/198 (63.6%) women had evidence of pelvic endometriosis. 28/126 (22.8%) of them had endometriosis in a single location whilst the remaining 98/126 (77.2%) had endometriosis in two or more locations. Positive likelihood ratios (LR+) for the ultrasound diagnosis of ovarian endometriomas, moderate or severe ovarian adhesions, pouch of Douglas adhesions, and bladder deeply infiltrating endometriosis (DIE), recto-sigmoid colon DIE, rectovaginal DIE, uterovesical fold DIE and uterosacral ligament DIE were >10, whilst for pelvic side wall DIE and any ovarian adhesions the + LH was 8.421 and 9.81 respectively.The negative likelihood ratio (LR-) was: <0.1 for bladder DIE; 0.1-0.2 for ovarian endometriomas, moderate or severe ovarian adhesions, and pouch of Douglas adhesions; 0.5-1 for rectovaginal, uterovesical fold, pelvic side wall and uterosacral ligament DIE. The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions.

Conclusions: Our study has shown that the TVS diagnosis of endometriotic lesion is very specific and false positive results are rare. Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal. The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.

Show MeSH
Related in: MedlinePlus