Department of Obstetrics and Gynecology, Medical School, Clinica Universidad de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.
J Ultrasound Med. 2014 Feb;33(2):315-21. doi: 10.7863/ultra.33.2.315.
The purpose of this study was to assess the diagnostic performance of extended transvaginal sonography for diagnosing deep infiltrating endometriosis.
A prospective study was conducted comprising 51 women (mean age, 32.9 years; range, 23-43 years) with suspected deep infiltrating endometriosis based on clinical symptoms. All women underwent extended transvaginal sonography, which included assessment of 2 pelvic compartments (anterior compartment: bladder and distal ureters; and posterior compartment: posterior vaginal fornix, retrocervical area, pouch of Douglas, and rectosigmoid). The sliding sign for detecting pouch of Douglas obliteration was also assessed. All patients received bowel preparation before sonographic examinations. A single examiner performed all examinations. All women underwent laparoscopic surgery, and histologic confirmation of endometriosis was done. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated.
Some women had more than 1 lesion, giving a total of 55 histologically confirmed lesions (rectosigmoid, n = 13; vagina, n = 5; retrocervical, n = 32; bladder, n = 5). The sensitivity, specificity, and LR+ for rectosigmoid involvement were 100%, 93%, and 14.0, respectively. The sensitivity, specificity, LR+, and LR- for vaginal involvement were 60%, 98%, 30.0, and 0.41. The sensitivity, specificity, LR+, and LR- for retrocervical involvement were 84%, 96%, 19.4, and 0.16. The sensitivity, specificity, and LR- for bladder involvement were 20%, 100%, and 0.80. The sensitivity, specificity, LR+, and LR- of the sliding sign for diagnosing pouch of Douglas obliteration were 89%, 92%, 10.7, and 0.12.
Except for bladder involvement, extended transvaginal sonography has good diagnostic performance for deep infiltrating endometriosis.
本研究旨在评估经阴道超声延伸检查诊断深部浸润性子宫内膜异位症的诊断性能。
本前瞻性研究纳入了 51 名（平均年龄 32.9 岁；范围 23-43 岁）疑似深部浸润性子宫内膜异位症的患者。所有患者均行经阴道超声检查，包括评估 2 个盆腔间隙（前间隙：膀胱和远端输尿管；后间隙：阴道后穹窿、宫颈后区、Douglas 窝和直肠乙状结肠）。还评估了检测 Douglas 窝闭合的滑动征。所有患者在超声检查前均行肠道准备。由 1 名检查者完成所有检查。所有患者均行腹腔镜手术，并进行子宫内膜异位症的组织学确认。计算了灵敏度、特异性、阳性似然比（LR+）和阴性似然比（LR-）。
一些患者有多个病灶，总共 55 个病灶经组织学证实（直肠乙状结肠，n=13；阴道，n=5；宫颈后区，n=32；膀胱，n=5）。直肠乙状结肠受累的灵敏度、特异性和 LR+分别为 100%、93%和 14.0。阴道受累的灵敏度、特异性、LR+和 LR-分别为 60%、98%、30.0 和 0.41。宫颈后区受累的灵敏度、特异性、LR+和 LR-分别为 84%、96%、19.4 和 0.16。膀胱受累的灵敏度、特异性和 LR-分别为 20%、100%和 0.80。滑动征诊断 Douglas 窝闭合的灵敏度、特异性、LR+和 LR-分别为 89%、92%、10.7 和 0.12。
除膀胱受累外，经阴道超声延伸检查对深部浸润性子宫内膜异位症具有良好的诊断性能。
