Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, Chou D, Almashat D, Condous G
Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia.
Ultrasound Obstet Gynecol. 2014 Dec;44(6):710-8. doi: 10.1002/uog.13422.
To use office gel sonovaginography (SVG) to predict posterior deep infiltrating endometriosis (DIE) in women undergoing laparoscopy.
This was a multicenter prospective observational study carried out between January 2009 and February 2013. All women were of reproductive age, had a history of chronic pelvic pain and underwent office gel SVG assessment for the prediction of posterior compartment DIE prior to laparoscopic endometriosis surgery. Gel SVG findings were compared with laparoscopic findings to determine the diagnostic accuracy of office gel SVG for the prediction of posterior compartment DIE.
In total, 189 women underwent preoperative gel SVG and laparoscopy for endometriosis. At laparoscopy, 57 (30%) women had posterior DIE and 43 (23%) had rectosigmoid/anterior rectal DIE. For the prediction of rectosigmoid/anterior rectal (i.e. bowel) DIE, gel SVG had an accuracy of 92%, sensitivity of 88%, specificity of 93%, positive predictive value (PPV) of 79%, negative predictive value (NPV) of 97%, positive likelihood ratio (LR+) of 12.9 and negative likelihood ratio (LR-) of 0.12 (P = 3.98E-25); for posterior vaginal wall and rectovaginal septum (RVS) DIE, respectively, the accuracy was 95% and 95%, sensitivity was 18% and 18%, specificity was 99% and 100%, PPV was 67% and 100%, NPV was 95% and 95%, LR+ was 32.4 and infinity and LR- was 0.82 and 0.82 (P = 0.009 and P = 0.003).
Office gel SVG appears to be an effective outpatient imaging technique for the prediction of bowel DIE, with a higher accuracy for the prediction of rectosigmoid compared with anterior rectal DIE. Although the sensitivity for vaginal and RVS DIE was limited, gel SVG had a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy.
运用经阴道超声凝胶造影（SVG）预测接受腹腔镜检查的女性的深部浸润型子宫内膜异位症（DIE）。
这是一项于2009年1月至2013年2月开展的多中心前瞻性观察性研究。所有女性均处于生育年龄，有慢性盆腔疼痛病史，在腹腔镜子宫内膜异位症手术前接受经阴道超声凝胶造影评估以预测后盆腔DIE。将超声凝胶造影结果与腹腔镜检查结果进行比较，以确定经阴道超声凝胶造影对后盆腔DIE预测的诊断准确性。
共有189名女性因子宫内膜异位症接受了术前超声凝胶造影和腹腔镜检查。在腹腔镜检查中，57名（30%）女性患有后盆腔DIE，43名（23%）患有直肠乙状结肠/直肠前壁DIE。对于直肠乙状结肠/直肠前壁（即肠道）DIE的预测，超声凝胶造影的准确率为92%，敏感性为88%，特异性为93%，阳性预测值（PPV）为79%，阴性预测值（NPV）为97%，阳性似然比（LR+）为12.9，阴性似然比（LR-）为0.12（P = 3.98E - 25）；对于阴道后壁和直肠阴道隔（RVS）DIE，准确率分别为95%和95%，敏感性分别为18%和18%，特异性分别为99%和100%，PPV分别为67%和100%，NPV分别为95%和95%，LR+分别为32.4和无穷大，LR-分别为0.82和0.82（P = 0.009和P = 0.003）。
经阴道超声凝胶造影似乎是一种有效的门诊成像技术，可用于预测肠道DIE，对直肠乙状结肠DIE的预测准确性高于直肠前壁DIE。尽管对阴道和直肠阴道隔DIE的敏感性有限，但超声凝胶造影对所有类型的后盆腔DIE具有较高的特异性和阴性预测值，这表明超声凝胶造影检查结果为阴性高度提示腹腔镜检查时不存在DIE。
