Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis
Received 15 April 2008; received in revised form 11 July 2008; accepted 2 September 2008. published online 18 November 2008.
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.
aServices de Radiologie, Hôpital Tenon, Paris, France
bServices de Gynécologie-Obstétrique, Hôpital Tenon, Paris, France
cCentre Chirurgical Trocadéro, Département d'Endoscopie Digestive, Paris, France
Reprint requests: Marc Bazot, M.D., Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Assistance Publique–Hôpitaux de Paris, 75020 Paris, France (FAX: 33-1-56-01-64-02).
M.B. has nothing to disclose. C.L. has nothing to disclose. R.R. has nothing to disclose. G.R. has nothing to disclose. I.T.-N. has nothing to disclose. E.D. has nothing to disclose.
ABSTRACT