Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, 30130-100 Belo Horizonte, MG, Brazil.
Biomed Res Int. 2013;2013:564153. doi: 10.1155/2013/564153. Epub 2013 Sep 5.
Endometriosis is a chronic benign gynecologic disease that can cause pelvic pain and infertility affecting almost 10% of reproductive-age women. Deeply infiltrating endometriosis (DIE) is a specific entity responsible for painful symptoms which are related to the anatomic location of the lesions. Definitive diagnosis requires surgery, and histological confirmation is advisable. The aim of this paper is to review the current literature regarding the possibility of diagnosing DIE accurately before surgery. Despite its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should not be completely omitted as a basic diagnostic tool in detecting endometriosis and planning further therapeutic interventions. Recently, transvaginal ultrasound (TVUS) has been reported as an excellent tool to diagnose DIE lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid, and vesical wall) with good accuracy.
There are neither sufficiently sensitive and specific signs and symptoms nor diagnostic tests for the clinical diagnosis of DIE, resulting in a great delay between onset of symptoms and diagnosis. Digital examination, in addition to TVS, may help to gain better understanding of the anatomical extent and dimension of DIE which is of crucial importance in defining the best surgical approach.
子宫内膜异位症是一种慢性良性妇科疾病，可导致盆腔疼痛和不孕，影响近 10%的育龄妇女。深部浸润性子宫内膜异位症（DIE）是一种特殊的实体，可引起与病变解剖位置相关的疼痛症状。明确诊断需要手术，且建议进行组织学确认。本文旨在回顾目前关于在手术前准确诊断 DIE 的可能性的文献。尽管其灵敏度和特异性较低，但阴道检查和评估特定症状不应完全忽略，因为它是发现子宫内膜异位症和计划进一步治疗干预的基本诊断工具。最近，经阴道超声（TVUS）已被报道为诊断不同部位（直肠阴道隔、宫颈后和子宫旁区域、直肠和乙状结肠以及膀胱壁）DIE 病变的一种极好工具，具有良好的准确性。
DIE 的临床诊断既没有足够敏感和特异的体征和症状，也没有诊断性检查，导致症状出现与诊断之间存在很大的延迟。除 TVS 外，数字检查还可以帮助更好地了解 DIE 的解剖范围和维度，这对于确定最佳手术方法至关重要。
