TY - JOUR
T1 - To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis
T2 - Ultrasound “sliding sign,” transvaginal ultrasound direct visualization or both?
AU - Reid, Shannon
AU - Espada, Mercedes
AU - Lu, Chuan
AU - Condous, George
N1 - Funding Information:
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. We would like to acknowledge Drs Ishwari Casikar, Fernando Infante, Uche Menakaya, Bassem Gerges, and Batool Nadim for their contribution to the data collection. We would also like to thank the following laparoscopic surgeons for their contribution to this study: Jason Abbott, Dheya Al Mashat, Greg Cario, Michael Cooper, Qemer Khoshnow, David Kowalski, Geoffrey Reid, Danny Chou, Tim Chang, John Pardey, Nasreen Shammas, and Sonal Karia.
Publisher Copyright:
© 2018 Nordic Federation of Societies of Obstetrics and Gynecology
PY - 2018/11/1
Y1 - 2018/11/1
N2 - INTRODUCTION: The study aim was to evaluate the transvaginal sonography (TVS) "sliding sign" alone, direct visualization of the bowel with TVS, and the combination of both methods (ie "sliding sign" and direct visualization of the bowel), to determine the optimal TVS method for the prediction of rectal/rectosigmoid deep endometriosis (DE).MATERIAL AND METHODS: Multicenter prospective observational study (January 2009-February 2017). All women underwent TVS to determine whether the "sliding sign" was positive/negative and whether rectal/rectosigmoid DE was present, followed by laparoscopic surgery. The association between a negative TVS "sliding sign" alone and the direct visualization of a rectal/rectosigmoid DE nodule alone during the TVS were correlated with the presence of rectal/rectosigmoid DE at laparoscopy. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were evaluated. Data were analyzed using Fisher's exact test.RESULTS: During the recruitment period, 410 consecutive women with suspected endometriosis were included. Complete TVS and laparoscopic surgical outcomes were available for 376 of the women (91.7%). Complete TVS and laparoscopic data were available for 376 women. Of the 376 women 76 (20.2%) had rectal/rectosigmoid DE at laparoscopy. The accuracy, sensitivity, specificity, PPV, NPV, positive and negative LRs for each method to predict bowel DE were: negative "sliding sign": 87%, 73.7%, 90.3%, 65.9%, 93.1%, 7.62, and 0.29, respectively; direct visualization: 91.0%, 86.8%, 92.3%, 74.2%, 96.5%, 11.3, and 0.14, respectively; combined approach: 90.2%, 69.7%, 95.3%, 79.1%, 92.6%, 14.94, and 0.32, respectively. A negative TVS "sliding sign" was significantly associated with the need for bowel surgery (P < 0.05).CONCLUSIONS: The combination of the TVS "sliding sign" and direct visualization of the bowel during TVS appears to provide the most accurate assessment for the identification of rectal/rectosigmoid DE preoperatively.
AB - INTRODUCTION: The study aim was to evaluate the transvaginal sonography (TVS) "sliding sign" alone, direct visualization of the bowel with TVS, and the combination of both methods (ie "sliding sign" and direct visualization of the bowel), to determine the optimal TVS method for the prediction of rectal/rectosigmoid deep endometriosis (DE).MATERIAL AND METHODS: Multicenter prospective observational study (January 2009-February 2017). All women underwent TVS to determine whether the "sliding sign" was positive/negative and whether rectal/rectosigmoid DE was present, followed by laparoscopic surgery. The association between a negative TVS "sliding sign" alone and the direct visualization of a rectal/rectosigmoid DE nodule alone during the TVS were correlated with the presence of rectal/rectosigmoid DE at laparoscopy. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were evaluated. Data were analyzed using Fisher's exact test.RESULTS: During the recruitment period, 410 consecutive women with suspected endometriosis were included. Complete TVS and laparoscopic surgical outcomes were available for 376 of the women (91.7%). Complete TVS and laparoscopic data were available for 376 women. Of the 376 women 76 (20.2%) had rectal/rectosigmoid DE at laparoscopy. The accuracy, sensitivity, specificity, PPV, NPV, positive and negative LRs for each method to predict bowel DE were: negative "sliding sign": 87%, 73.7%, 90.3%, 65.9%, 93.1%, 7.62, and 0.29, respectively; direct visualization: 91.0%, 86.8%, 92.3%, 74.2%, 96.5%, 11.3, and 0.14, respectively; combined approach: 90.2%, 69.7%, 95.3%, 79.1%, 92.6%, 14.94, and 0.32, respectively. A negative TVS "sliding sign" was significantly associated with the need for bowel surgery (P < 0.05).CONCLUSIONS: The combination of the TVS "sliding sign" and direct visualization of the bowel during TVS appears to provide the most accurate assessment for the identification of rectal/rectosigmoid DE preoperatively.
KW - transvaginal sonography
KW - "sliding sign"
KW - deep endometriosis
KW - rectal deep endometriosis
KW - laparoscopy
KW - “sliding sign”
KW - Prospective Studies
KW - Humans
KW - Ultrasonography/methods
KW - Rectal Diseases/diagnostic imaging
KW - Endometriosis/diagnostic imaging
KW - Sensitivity and Specificity
KW - Female
KW - Sigmoid Diseases/diagnostic imaging
UR - http://www.scopus.com/inward/record.url?scp=85052467413&partnerID=8YFLogxK
U2 - 10.1111/aogs.13425
DO - 10.1111/aogs.13425
M3 - Article
C2 - 30007066
SN - 0001-6349
VL - 97
SP - 1287
EP - 1292
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
IS - 11
ER -