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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.
BMC Womens Health 2013; 13:43BW

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.

Authors+Show Affiliations

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.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

24165087

Citation

Holland, Tom K., et al. "Ultrasound Mapping of Pelvic Endometriosis: Does the Location and Number of Lesions Affect the Diagnostic Accuracy? a Multicentre Diagnostic Accuracy Study." BMC Women's Health, vol. 13, 2013, p. 43.
Holland TK, Cutner A, Saridogan E, et al. Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study. BMC Womens Health. 2013;13:43.
Holland, T. K., Cutner, A., Saridogan, E., Mavrelos, D., Pateman, K., & Jurkovic, D. (2013). Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study. BMC Women's Health, 13, p. 43. doi:10.1186/1472-6874-13-43.
Holland TK, et al. Ultrasound Mapping of Pelvic Endometriosis: Does the Location and Number of Lesions Affect the Diagnostic Accuracy? a Multicentre Diagnostic Accuracy Study. BMC Womens Health. 2013 Oct 29;13:43. PubMed PMID: 24165087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study. AU - Holland,Tom K, AU - Cutner,Alfred, AU - Saridogan,Ertan, AU - Mavrelos,Dimitrios, AU - Pateman,Kate, AU - Jurkovic,Davor, Y1 - 2013/10/29/ PY - 2013/04/05/received PY - 2013/10/08/accepted PY - 2013/10/30/entrez PY - 2013/10/30/pubmed PY - 2014/3/29/medline SP - 43 EP - 43 JF - BMC women's health JO - BMC Womens Health VL - 13 N2 - 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. SN - 1472-6874 UR - https://www.unboundmedicine.com/medline/citation/24165087/Ultrasound_mapping_of_pelvic_endometriosis:_does_the_location_and_number_of_lesions_affect_the_diagnostic_accuracy_A_multicentre_diagnostic_accuracy_study_ L2 - https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-13-43 DB - PRIME DP - Unbound Medicine ER -