Abstract

CRUZ, Joana et al. Diagnostic accuracy of sonovaginography for deep infiltrating endometriosis. Acta Obstet Ginecol Port [online]. 2018, vol.12, n.3, pp.190-194. ISSN 1646-5830.

Objective: The aim of this study was to assess the performance and accuracy of sonovaginography (SVG) for preoperative diagnosis and characterization of deep infiltrating endometriosis (DIE) lesions. Study Design: A prospective study was conducted between January 2014 and January 2016, including all premenopausal women with clinical and/or imaging suspicion of DIE that underwent laparoscopic surgery. We performed consecutive evaluation with transvaginal ultrasound complemented by SVG of all women with clinical suspicion of DIE and assessed for suspected lesions in the anterior compartment (bladder and vesicouterine pouch), rectovaginal septum (RVS), pouch of Douglas (POD), uterosacral ligaments, vagina and rectosigmoid colon. Accuracy of SVG to identify lesions of DIE was assessed for the different sites of DIE, relative to laparoscopic and histological findings. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were determined. Results: Fifty nine women were evaluated by SVG and 19 (32%) underwent laparoscopic surgery. Median age was 35 years (range 26-42 years), nine women (47.4%) were nulliparous and five (26.3%) had infertility. Most common symptoms were dysmenorrhea (14/19) and deep dyspareunia (14/19). DIE was confirmed in all patients, 18/19 (94.7%) had involvement of the posterior and 3/19 (8.9%) of the anterior compartments. We found high sensitivity for the diagnosis of lesions involving the POD (92%) and RVS (90%). Our diagnostic sensitivity was lower for DIE lesions involving the anterior compartment (67%), rectosigmoid colon (50%), vagina (50%) and uterosacral ligaments (23%). Conclusions: SVG is a simple, non-invasive method with good diagnostic sensitivity for DIE lesions involving particularly RVS and POD. This technique has a relatively short learning curve for experienced operators and provides an effective alternative to other more invasive and expensive imaging techniques.

Keywords : Ultrasound; Sonography; Deep infiltrating endometriosis; Endometriosis.

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