Bazot Marc, Detchev Romain, Cortez Annie, Amouyal Paul, Uzan Serge, Daraï Emile
Services de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
Hum Reprod. 2003 Aug;18(8):1686-92. doi: 10.1093/humrep/deg314.
Endometriosis and possible rectal involvement are difficult to assess by physical examination. Previous studies have shown the diagnostic value of magnetic resonance imaging and rectal endoscopic sonography (RES) in this setting, but not that of transvaginal sonography (TVS). The aims of this study were to compare the accuracy of TVS and RES for the diagnosis of pelvic endometriosis, and to compare the results with histological findings.
In a prospective study, 30 consecutive patients referred with clinical signs of endometriosis underwent TVS and RES; the images were interpreted blindly with regard to physical findings.
Endometriosis was confirmed histologically in 28 (93%) of the 30 patients. Endometriomas were also present in 67% of cases. For the diagnosis of uterosacral endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 75 and 75%, 83 and 67, 95 and 90%, and 45 and 40% respectively. For the diagnosis of rectosigmoid endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 95 and 82%, 100 and 88%, 100 and 95%, and 89 and 64% respectively.
Despite the large proportion of our patients who had intestinal endometriosis, representing a possible source of bias, our results suggest that TVS is as efficient as RES for detecting posterior pelvic endometriosis and should therefore be used as the first-line examination.
子宫内膜异位症及可能存在的直肠受累情况通过体格检查很难评估。既往研究已表明磁共振成像及直肠腔内超声检查（RES）在这种情况下的诊断价值，但未表明经阴道超声检查（TVS）的诊断价值。本研究的目的是比较TVS和RES诊断盆腔子宫内膜异位症的准确性，并将结果与组织学检查结果进行比较。
在一项前瞻性研究中，30例因子宫内膜异位症临床症状前来就诊的连续患者接受了TVS和RES检查；图像解读时对体格检查结果不知情。
30例患者中有28例（93%）经组织学确诊为子宫内膜异位症。67%的病例还存在卵巢巧克力囊肿。对于子宫骶骨韧带子宫内膜异位症的诊断，TVS和RES的敏感性、特异性、阳性预测值和阴性预测值分别为75%和75%、83%和67%、95%和90%、45%和40%。对于直肠乙状结肠子宫内膜异位症的诊断，TVS和RES的敏感性、特异性、阳性预测值和阴性预测值分别为95%和82%、100%和88%、100%和95%、89%和64%。
尽管我们的患者中有很大比例患有肠道子宫内膜异位症，这可能是一个偏倚来源，但我们的结果表明，TVS在检测盆腔后部子宫内膜异位症方面与RES一样有效，因此应作为一线检查方法。
