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. 2020 Oct;20(4):3208-3220.
doi: 10.3892/etm.2020.9043. Epub 2020 Jul 24.

Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta-analysis of diagnostic accuracy studies

Xiao Zhang  1 , Tao He  1 , Wen Shen  1
Affiliations

Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta-analysis of diagnostic accuracy studies

Xiao Zhang et al. Exp Ther Med. 2020 Oct.

Abstract

Visual inspection via laparoscopy is considered the gold standard for the diagnosis of deep infiltrating endometriosis. Laparoscopy is an invasive procedure; therefore, it would be beneficial to patients if accurate non-invasive modalities were available for the diagnosis of deep infiltrating endometriosis. The purpose of the current review and meta-analysis was to assess the diagnostic accuracy of clinical examination, transvaginal ultrasound (TVUS), transrectal ultrasound (TRUS) and MRI as alternative methods for diagnosis of deep infiltrating endometriosis. A systematic search of the Medline, Scopus, Embase and Cochrane library databases, between their inception and September 2019, was performed. The quality of trials was assessed using the quality assessment of diagnostic accuracy studies-2 tool. Meta-analyses were conducted to obtain the pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio for each of the three imaging modalities and clinical examination. A total of 30 studies with 4,565 participants were included in the review. Physical examination had a pooled sensitivity of 71% and a specificity of 69%, with an average diagnostic accuracy [area under the curve (AUC) =0.76]. TVUS had a pooled sensitivity of 76% and a specificity of 94%, with higher diagnostic accuracy than physical examination (AUC =0.92). TRUS had a pooled sensitivity of 91% and a specificity of 80% with an AUC of 0.93. MRI had a pooled sensitivity of 82% and a specificity of 87% with higher diagnostic accuracy than physical examination (AUC =0.91). All the imaging modalities had good clinical utility, as indicated by the Fagan plot. The present analysis demonstrates that the imaging modalities TVUS, TRUS and MRI may be highly useful alternatives to laparoscopy for diagnosis of deep infiltrating endometriosis and that these techniques have a high sensitivity and specificity.

Keywords: MRI; deep infiltrating endometriosis; ultrasonography; validation.

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Figures

Figure 1
Figure 1
Flow chart of search strategy.
Figure 2
Figure 2
Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound. Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
Figure 2
Figure 2
Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound. Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
Figure 2
Figure 2
Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound. Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
Figure 2
Figure 2
Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound. Forest plot exhibiting pooled sensitivity and specificity for non-invasive modalities in diagnosing deep infiltrating endometriosis. (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
Figure 3
Figure 3
sROC curves for non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound. (C) Transrectal ultrasound. (D) Magnetic resonance imaging. sROC, summary receiver operator characteristic.
Figure 4
Figure 4
Fagan nomogram evaluating the overall value of non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
Figure 4
Figure 4
Fagan nomogram evaluating the overall value of non-invasive modalities in diagnosing deep infiltrating endometriosis. (A) Physical examination. (B) Transvaginal ultrasound (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
Figure 5
Figure 5
Bivariate box plot of the sensitivity and specificity in the included studies. (A) Physical examination. (B) Transvaginal ultrasound. (C) Transrectal ultrasound. (D) Magnetic resonance imaging.
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References

    1. Irving JA, Clement PB. Diseases of the Peritoneum. In: Blaustein's Pathology of the Female Genital Tract. Kurman RJ, Ellenson LH and Ronnett BM (eds) Springer US, Boston, MA, pp625-678, 2011.
    1. Wheeler JM. Epidemiology of endometriosis-associated infertility. J Reprod Med. 1989;34:41–46. - PubMed
    1. Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, Spadola S, Caltabiano R, Iraci M, Basile A, et al. Endometriosis: Clinical features, MR imaging findings and pathologic correlation. Insights Imaging. 2018;9:149–172. doi: 10.1007/s13244-017-0591-0. - DOI - PMC - PubMed
    1. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;68:585–596. doi: 10.1016/s0015-0282(97)00191-x. - DOI - PubMed
    1. Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: Histology and clinical significance. Fertil Steril. 1990;53:978–983. doi: 10.1016/s0015-0282(16)53570-5. - DOI - PubMed

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