Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis

Abstract

Objective: To compare the value of physical examination, transvaginal sonography (TVS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) for the assessment of different locations of deep infiltrating endometriosis (DIE).

Design: Retrospective longitudinal study.

Setting: Tertiary university gynecology unit.

Patient(s): Ninety-two consecutive patients with clinical evidence of pelvic endometriosis.

Intervention(s): Physical examination, TVS, RES, and MRI, performed preoperatively.

Main outcome measure(s): Descriptive statistics, calculation of likelihood ratios (LR(+) and LR(-)) of physical examination, TVS, RES, and MRI for DIE in specific locations confirmed by surgery/histology.

Result(s): The sensitivity and LR(+) and LR(-) values of physical examination, TVS, RES, and MRI were, respectively, 73.5%, 3.3, and 0.34, 78.3%, 2.34, and 0.32, 48.2%, 0.86, and 1.16, and 84.4%, 7.59, and 0.18 for uterosacral ligament endometriosis; 50%, 3.88, and 0.57, 46.7%, 9.64, and 0.56, 6.7%, -, and 0.93, and 80%, 5.51, and 0.23 for vaginal endometriosis; and 46%, 1.67, and 0.75, 93.6%, -, and 0.06, 88.9%, 12.89, and 0.12, and 87.3%, 12.66, and 0.14 for intestinal endometriosis.

Conclusion(s): The MRI performs similarly to TVS and RES for the diagnosis of intestinal endometriosis but has higher sensitivity and likelihood ratios for uterosacral ligament and vaginal endometriosis.