Piketty Mathilde, Chopin Nicolas, Dousset Bertrand, Millischer-Bellaische Anne-Elodie, Roseau Gilles, Leconte Mahaut, Borghese Bruno, Chapron Charles
Department of Gynecology, Obstetrics II and Reproductive Medicine, Université Paris Descartes, Paris, France.
Hum Reprod. 2009 Mar;24(3):602-7. doi: 10.1093/humrep/den405. Epub 2008 Dec 17.
Transvaginal ultrasonography (TVUS) has important advantages compared with transrectal ultrasonography (TRUS): it is less invasive, is cost-effective, is a familiar and well-accepted approach, and anesthesia is not required. We compared the accuracy of TVUS and TRUS for diagnosing rectal wall involvement in patients presenting with histologically proved deeply infiltrating endometriosis (DIE).
Prospective study of 134 patients with histologically proved DIE underwent preoperative investigations using both TVUS and TRUS. The radiologist (TVUS) and sonographer (TRUS) were unaware of the clinical findings but knew that DIE was suspected.
DIE was confirmed histologically for all the patients. A rectal wall involvement was histologically proved for 75 patients (56%). For the diagnosis of infiltration of the intestinal wall, TVUS and TRUS, respectively, had a sensitivity of 90.7% and 96.0%, a specificity of 96.5% and 100.0%, a positive predictive value of 97.1% and 100.0% and a negative predictive value of 88.9% and 95.2%.
TVUS and TRUS have similar degrees of accuracy for predicting intestinal involvement. TVUS must be the first-line imaging process to perform for patients presenting with clinically suspected DIE. The question for the coming years is to define if it is necessary for TRUS to be carried out systematically in cases of clinically suspected DIE.
经阴道超声检查（TVUS）与经直肠超声检查（TRUS）相比具有重要优势：侵入性较小、具有成本效益、是一种熟悉且被广泛接受的方法，并且无需麻醉。我们比较了TVUS和TRUS在诊断组织学证实为深部浸润性子宫内膜异位症（DIE）患者直肠壁受累情况时的准确性。
对134例组织学证实为DIE的患者进行前瞻性研究，术前同时使用TVUS和TRUS进行检查。放射科医生（TVUS）和超声检查医师（TRUS）不知道临床检查结果，但知道怀疑为DIE。
所有患者均经组织学证实为DIE。75例患者（56%）经组织学证实存在直肠壁受累。对于肠壁浸润的诊断，TVUS和TRUS的敏感性分别为90.7%和96.0%，特异性分别为96.5%和100.0%，阳性预测值分别为97.1%和100.0%，阴性预测值分别为88.9%和95.2%。
TVUS和TRUS在预测肠道受累方面具有相似的准确性。对于临床怀疑为DIE的患者，TVUS必须作为首选的影像学检查方法。未来几年的问题是，对于临床怀疑为DIE的病例，是否有必要系统性地进行TRUS检查。
