Sage Journals: Discover world-class research

Abstract

Introduction:

This study aims to evaluate the use of transvaginal ultrasound in predicting superficial endometriosis near the uterosacral ligaments, in women with symptoms of endometriosis.

Methods:

This was a prospective observational pilot study in which women with symptoms of endometriosis underwent detailed pre-operative transvaginal ultrasound to assess the uterosacral ligament area for thickening (‘white line sign’), tenderness and small hypoechoic nodules. Women with deep infiltrating endometriosis were excluded. The test characteristics of transvaginal ultrasound were reported using histologically or visually proven endometriosis near the ipsilateral uterosacral ligament as a reference standard.

Results:

In 81 patients who underwent pre-operative transvaginal ultrasound and laparoscopy, no marker had appropriate test characteristics for a diagnostic or screening test for endometriosis near the ipsilateral uterosacral ligament when used alone. The presence of a small hypoechoic nodule on the white line had the highest specificity of the three markers, at 82% (95% confidence interval 66%–92%). Quantitative measurement of the white line also achieved a high specificity of ≥96% using a cut-off of 5.8 and 6.1 mm, on the left and right sides, respectively.

Conclusion:

Transvaginal ultrasound of the uterosacral ligament area using the three proposed markers is not a clinically useful screening test for superficial endometriosis near the uterosacral ligaments. A grossly thickened white line (≥5.8 mm) and/or the presence of small hypoechoic nodules are highly specific findings for superficial endometriosis near the uterosacral ligaments and may prompt surgical management.

Keywords

Diagnostic accuracy endometriosis laparoscopy transvaginal ultrasound uterosacral ligaments

Get full access to this article

View all access options for this article.

References

Melis

Ajossa

Guerriero

et al . Epidemiology and diagnosis of endometriosis. Ann N Y Acad Sci 1994; 734: 352–357.

Giudice

. Clinical practice: endometriosis. N Engl J Med 2010; 362: 2389–2398.

Nnoaham

Hummelshojc

Webster

et al . Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96: 366–373.

Carneiro

Filogonio

Costa

et al . Clinical prediction of deeply infiltrating endometriosis before surgery: is it feasible? A review of the literature. Biomed Res Int 2013; 2013: 564153.

Hudelist

Fritzer

Thomas

et al . Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27: 3412–3416.

Husby

Haugen

Moen

. Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand 2003; 82: 649–653.

Matsuzaki

Canis

Pouly

et al . Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis. Fertil Steril 2006; 86: 1314–1316.

Exacoustos

Manganaro

Zuppi

. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gyaecol 2014; 28: 655–681.

Chapron

Fauconnier

Vieira

et al . Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 2003; 18: 157–161.

10.

Nisenblat

Bossuyt

PMM

Farquhar

et al . Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2: CD009591.

11.

Bazot

Thomassin

Hourani

et al . Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004; 24: 180–185.

12.

Guerriero

Ajossa

Minguez

et al . Accuracy of transvaginalultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 46: 534–545.

13.

Okaro

Condous

Khalid

et al . The use of ultrasound-based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain – can we reduce the need for laparoscopy? BJOG 2006; 113: 251–256.

14.

Holland

Yazbek

Cutner

et al . Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. Ultrasound Obstet Gynecol 2011; 36: 241–248.

15.

Rogers

PAW

Adamson

Al-Jefout

et al . Research priorities for endometriosis. Reprod Sci 2017; 24(2): 202–226.

16.

Reid

Menakaya

Casikar

et al . Can we use the soft marker, site-specific tenderness at transvaginal ultrasound, in the preoperative mapping of peritoneal endometriosis? Ultrasound Obstet Gynecol 2014; 44(Suppl. S1): S38–S39.

17.

Chamie

Blasbalg

Pereira

et al . Findings of pelvic endometriosis at transvaginal ultrasound, magnetic resonance imaging, and laparoscopy. Radiographics 2011; 31: E77–E100.

18.

Ohba

Mizutani

Maeda

et al . Evaluation of endometriosis in uterosacral ligaments by transrectal ultrasonography. Hum Reprod 1996; 11: 2014–2017.

19.

Bazot

Darai

. Sonography and MR imaging for the assessment of deep pelvic endometriosis. J Minim Invasive Gynecol 2005; 12: 178–185.

20.

Fedele

Bianchi

Portuese

et al . Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol 1998; 91: 444–448.

21.

Reid

Casikar

et al . Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol 2013; 41: 685–691.

22.

Gonçalves

Dias

Podgaec

et al . Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis. Int J Gynaecol Obstet 2009; 104: 156–160.

23.

Guerriero

Condous

van den Bosch

et al . Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) Group. Ultrasound Obstet Gynecol 2016; 48(3): 318–332.

24.

Boyle

McCluggage

. Peritoneal stromal endometriosis: a detailed morphological analysis of a large series of cases of a common and under-recognised form of endometriosis. J Clin Pathol 2009; 62: 530–533.

25.

Reid

Winder

Condous

. Sonovaginography: redefining the concept of a ‘normal pelvis’ on transvaginal ultrasound pre-laparoscopic intervention for suspected endometriosis. Australas J Ultrasound Med 2011; 14: 21–24.

26.

Piketty

Chopin

Dousset

et al . Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod 2009; 24: 602–607.

27.

Tammaa

Fritzer

Lozano

et al . Interobserver agreement and accuracy of non-invasive diagnosis of endometriosis by transvaginal sonography. Ultrasound Obstet Gynecol 2015; 46: 737–740.

28.

Menakaya

Reid

et al . Performance of ultrasound based endometriosis staging system (UBESS) for predicting the level of complexity of laparoscopic surgery for endometriosis. Ultrasound Obstet Gynecol 2016; 48(6): 786–795.

29.

Fernando

Soh

Cooper

et al . Reliability of visual diagnosis of endometriosis. J Minim Invasive Gynecol 2001; 20: 783–789.

30.

Clement

. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol 2007; 14: 241–260.

31.

Piessens

Healey

Maher

et al . Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Aust N Z J Obstet Gynaecol 2014; 54: 462–468.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments

Abstract

Introduction:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material