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Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy.
J Minim Invasive Gynecol. 2020 Feb 29 [Online ahead of print]JM

Abstract

STUDY OBJECTIVE

To evaluate the diagnostic accuracy of transvaginal ultrasound in predicting a laparoscopic, surgically assigned, revised American Society of Reproductive Medicine (ASRM) endometriosis stage.

DESIGN

A multicenter, retrospective, diagnostic accuracy study.

SETTING

The patients visited 1 of 2 academic gynecologic ultrasound units and underwent laparoscopy led by 1 of 6 surgeons in metropolitan Sydney, Australia, between 2016 and 2018.

PATIENTS

Patients with suspected endometriosis (n = 204).

INTERVENTIONS

Ultrasound followed by laparoscopy.

MEASUREMENTS AND MAIN RESULTS

Surgical cases were identified. The preoperative ultrasound report and surgical operative notes were each used to retrospectively assign an ASRM score and stage. The breakdown of surgical findings was as follows: ASRM 0 (i.e., no endometriosis), 24/204 (11.8%); ASRM 1, 110/204 (53.9%); ASRM 2, 22/204 (10.8%); ASRM 3, 16/204 (7.8%); ASRM 4, 32 204 (15.7%). The overall accuracy of ultrasound in predicting the surgical ASRM stage was as follows: ASRM 1, 53.4%; ASRM 2, 93.8%; ASRM 3, 89.7%; ASRM 4, 93.1%; grouped ASRM 0, 1, and 2, 94.6%; and grouped ASRM 3 and 4 of 94.6%. Ultrasound had better test performance in higher disease stages. When the ASRM stages were dichotomized, ultrasound had sensitivity and specificity of 94.9% and 93.8%, respectively, for ASRM 0, 1, and 2 and of 93.8% and 94.9%, respectively, for ASRM 3 and 4.

CONCLUSION

Ultrasound has high accuracy in predicting the mild, moderate, and severe ASRM stages of endometriosis and can accurately differentiate between stages when ASRM stages are dichotomized (nil/minimal/mild vs moderate/severe). This can have major positive implications on patient triaging at centers of excellence in minimally invasive gynecology for advanced-stage endometriosis.

Authors+Show Affiliations

Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia. Electronic address: mathew.leonardi@sydney.edu.au.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.Department of Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Kingswood; Sydney Medical School Nepean, The University of Sydney, Sydney, Australia (Drs. Leonardi, Espada, and Condous); The Sydney Women's Endosurgery Centre (Drs. Choi and Chou), Sydney; Laparoscopic Surgery for General Gynaecologists (Drs. Chang and Condous), Sydney; Department of Obstetrics and Gynaecology, Sydney Adventist Hospital, Wahroonga (Drs. Choi and Condous); Department of Obstetrics and Gynaecology, St George Private & Public Hospital, Kogarah (Drs. Choi and Chou); Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Campbelltown (Dr. Chang); Department of Obstetrics and Gynaecology, The Mater Hospital, Crows Nest; Department of Obstetrics and Gynaecology, North Shore Private Hospital; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, (Dr. Smith); OMNI Ultrasound & Gynaecological Care (Dr. Condous), St Leonards; Department of Obstetrics and Gynaecology, Prince of Wales Private Hospital, Randwick; Department of Obstetrics and Gynaecology, St Luke's Private Hospital, Elizabeth Bay; Department of Obstetrics and Gynaecology, Sydney Day Surgery, Darlinghurst (Dr. Rowan), Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32126302

Citation

Leonardi, Mathew, et al. "Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy." Journal of Minimally Invasive Gynecology, 2020.
Leonardi M, Espada M, Choi S, et al. Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy. J Minim Invasive Gynecol. 2020.
Leonardi, M., Espada, M., Choi, S., Chou, D., Chang, T., Smith, C., Rowan, K., & Condous, G. (2020). Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2020.02.014
Leonardi M, et al. Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy. J Minim Invasive Gynecol. 2020 Feb 29; PubMed PMID: 32126302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy. AU - Leonardi,Mathew, AU - Espada,Mercedes, AU - Choi,Sarah, AU - Chou,Danny, AU - Chang,Tim, AU - Smith,Christopher, AU - Rowan,Katrina, AU - Condous,George, Y1 - 2020/02/29/ PY - 2019/11/28/received PY - 2020/02/20/revised PY - 2020/02/22/accepted PY - 2020/3/4/pubmed PY - 2020/3/4/medline PY - 2020/3/4/entrez KW - Diagnostic accuracy KW - Non-invasive diagnosis KW - Pelvic pain KW - Pouch of Douglas obliteration KW - Preoperative planning JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol N2 - STUDY OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal ultrasound in predicting a laparoscopic, surgically assigned, revised American Society of Reproductive Medicine (ASRM) endometriosis stage. DESIGN: A multicenter, retrospective, diagnostic accuracy study. SETTING: The patients visited 1 of 2 academic gynecologic ultrasound units and underwent laparoscopy led by 1 of 6 surgeons in metropolitan Sydney, Australia, between 2016 and 2018. PATIENTS: Patients with suspected endometriosis (n = 204). INTERVENTIONS: Ultrasound followed by laparoscopy. MEASUREMENTS AND MAIN RESULTS: Surgical cases were identified. The preoperative ultrasound report and surgical operative notes were each used to retrospectively assign an ASRM score and stage. The breakdown of surgical findings was as follows: ASRM 0 (i.e., no endometriosis), 24/204 (11.8%); ASRM 1, 110/204 (53.9%); ASRM 2, 22/204 (10.8%); ASRM 3, 16/204 (7.8%); ASRM 4, 32 204 (15.7%). The overall accuracy of ultrasound in predicting the surgical ASRM stage was as follows: ASRM 1, 53.4%; ASRM 2, 93.8%; ASRM 3, 89.7%; ASRM 4, 93.1%; grouped ASRM 0, 1, and 2, 94.6%; and grouped ASRM 3 and 4 of 94.6%. Ultrasound had better test performance in higher disease stages. When the ASRM stages were dichotomized, ultrasound had sensitivity and specificity of 94.9% and 93.8%, respectively, for ASRM 0, 1, and 2 and of 93.8% and 94.9%, respectively, for ASRM 3 and 4. CONCLUSION: Ultrasound has high accuracy in predicting the mild, moderate, and severe ASRM stages of endometriosis and can accurately differentiate between stages when ASRM stages are dichotomized (nil/minimal/mild vs moderate/severe). This can have major positive implications on patient triaging at centers of excellence in minimally invasive gynecology for advanced-stage endometriosis. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/32126302/Transvaginal_Ultrasound_Can_Accurately_Predict_the_American_Society_of_Reproductive_Medicine_Stage_of_Endometriosis_Assigned_at_Laparoscopy L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(20)30117-5 DB - PRIME DP - Unbound Medicine ER -
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