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Title: Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis
Citation: HUMAN REPRODUCTION, v.28, suppl.1, p.217-217, 2013
Abstract: Study question The aim of this study is to implement and to determine the ability of the transvaginal ultrasound technique to detect the presence of deeply infiltrating endometriosis in different pelvic locations. Summary answer Transvaginal ultrasound with bowel preparation showed a high accuracy for predicting deeply infiltrating endometriosis at laparoscopy. What is known already Deeply infiltrating endometriosis is a prevalent gynecologic disease characterized by lesions that penetrate below the surface of the pelvic peritoneum. It constitutes a major concern in view of the greater severity of the symptoms associated with this form of the disease, and its therapeutic complexity. Currently, magnetic resonance imaging, transrectal ultrasonography and transvaginal ultrasonography, are considered appropriate diagnostics methods. Nevertheless, the last offers advantages in terms of accessibility, cost-effectiveness and tolerability. Study design, size, duration Observational analysis, trasversal multicenter study of diagnostic test, conducted between September 2011 and September 2012 at the Instituto de Investigaciones Materno Infantil, of the Universidad de Chile and at the Centro de Reproducción Humana of the Universidad de Valparaiso. This study has the approval of the Ethics Committee. Participants/materials, setting, methods This prospective study included 57 consecutive patients, with suspected rectovaginal endometriosis, who underwent surgical laparoscopy. Before surgery, transvaginal ultrasound was performed by a single operator with prior bowel preparation. The presence, location, size and degree of infiltration of endometriosic lesions were evaluated. Ultrasonographic results were compared to surgical and histological findings. Main results and the role of chance Of the 57 patients submitted to surgery, 24 had moderate cyclic pain (42%), 15 severe cyclic pain (26%), 16 moderate dyspareunia (28%) and 11 severe dyspareunia (19%). Endometriosis was confirmed histologically in 35/57 patients. Endometrioma and deeply infiltrating endometriosis (DIE) were present in 35 and 31 of the women, respectively. For the diagnosis of DIE, sensitivity was 93%, specificity 100%, positive predictive value 100%, negative predictive value of 90%, positive likelihood ratio was undetermined and negative likelihood ratio 0.062. Specifically, for the diagnosis of uterosacral endometriosis, the S, E, PPV and NPV were: 75%, 100%, 100% and 88,2% respectively. For the diagnosis of intestinal endometriosis, the S, E, PPV and NPV were 100%. Limitations, reason for caution The ultrasound explorations where performed by a sinlge operator, so an universal extrapolation of this results can be cuestioned. Also, the operator was unmasked for the symptoms of the patient wich can be a bias of the results obtained. Wider implications of the findings These findings suggest that TVUS is an adequate exam for determining the presence of deeply infiltrating endometriosis. This information is usefull when the surgical decision and planification are performed. It is also important when deciding the type of resection. We belive that the implementation of this technique in gynecological centers will increase the ability to reproduce these results and the quality of the primary evaluation of patients with suspected endometriosis. Study funding/competing interest(s) This study was funded by the Instituto de Investigaciones Materno Infantil, of the Universidad de Chile.
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Comunicações em Eventos - FM/MOG
Departamento de Obstetrícia e Ginecologia - FM/MOG

Comunicações em Eventos - HC/ICHC
Instituto Central - HC/ICHC

Comunicações em Eventos - LIM/58
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular

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