Gerges B, Lu C, Reid S, Chou D, Chang T, Condous G
Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
Department of Computer Sciences, University of Wales, Aberystwyth, UK.
Ultrasound Obstet Gynecol. 2017 Jun;49(6):793-798. doi: 10.1002/uog.15990.
To examine the association between ovarian immobility and presence of endometriomas and assess the diagnostic accuracy of transvaginal sonographic (TVS) ovarian immobility in the detection of deep infiltrating endometriosis (DIE).
This was a multicenter prospective observational study of women presenting with chronic pelvic pain from January 2009 to March 2015. Women with or without history of endometriosis who were scheduled to undergo laparoscopic surgery for endometriosis gave a detailed history and underwent specialized TVS in a tertiary referral unit prior to laparoscopy. During TVS, ovarian mobility and the presence of endometriomas were assessed. The relationship between TVS ovarian mobility, with or without endometriomas, and DIE was correlated with the gold standard, diagnosis of endometriosis at laparoscopy.
Included in the analysis were 265 women with preoperative TVS and laparoscopic outcomes. Ovarian immobility on TVS was significantly associated with presence of endometriomas at surgery, with a prevalence of 12.2%, 10.8% and 52.7% for fixation of the left ovary only, the right ovary only and bilateral ovaries, respectively, compared with 4.2%, 3.7% and 7.3% for normal ovaries. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and positive and negative likelihood ratios of TVS ovarian immobility for diagnosis at surgery of immobility of ovaries with endometriomas in the left ovary only were 44.4%, 92.3%, 44.4%, 92.3%, 5.8, 0.6, in the right ovary only were 50.0%, 98.5%, 80.0%, 94.2%, 33.0, 0.5 and bilaterally were 74.4%, 68.6%, 72.5%, 70.6%, 2.4, 0.4, while those for diagnosis of immobility of normal ovaries were 25.0%, 87.9%, 8.3%, 96.4%, 2.1, 0.9 for left ovary only, 14.3%, 92.9%, 7.1%, 96.6%, 2.0, 0.9 for right ovary only and 35.7%, 97.2%, 50.0%, 95.0%, 12.6, 0.7 bilaterally, respectively (P < 0.05 except for normal left and right ovaries with P = 0.2 and 0.4, respectively). The sensitivity, specificity, PPV and NPV for performance of ovarian immobility in the prediction of DIE for all women were 58.3%, 74.1%, 60.6%, 72.2% and in the prediction of need for bowel surgery were 78.2%, 71.1%, 41.3%, 92.6%, respectively.
There is a significant association between ovarian immobility and the presence of endometriomas. Ovarian immobility as a sonographic 'soft marker' of DIE performs better in the presence of endometriomas compared with in normal ovaries. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
探讨卵巢固定不动与子宫内膜异位囊肿的相关性，并评估经阴道超声（TVS）检查卵巢固定不动对深部浸润性子宫内膜异位症（DIE）的诊断准确性。
这是一项多中心前瞻性观察性研究，研究对象为2009年1月至2015年3月因慢性盆腔疼痛就诊的女性。有或无子宫内膜异位症病史、计划接受子宫内膜异位症腹腔镜手术的女性，在腹腔镜手术前，在三级转诊单位详细记录病史并接受专门的TVS检查。TVS检查期间，评估卵巢活动度及子宫内膜异位囊肿的情况。将TVS检查的卵巢活动度（无论有无子宫内膜异位囊肿）与DIE的关系，与腹腔镜检查诊断子宫内膜异位症的金标准进行相关性分析。
纳入分析的有265例有术前TVS检查及腹腔镜手术结果的女性。TVS检查发现卵巢固定不动与手术时存在子宫内膜异位囊肿显著相关，仅左侧卵巢固定、仅右侧卵巢固定及双侧卵巢固定的发生率分别为12.2%、10.8%和52.7%，而正常卵巢的发生率分别为4.2%、3.7%和7.3%。仅左侧卵巢存在子宫内膜异位囊肿时，TVS检查卵巢固定不动对手术时卵巢固定的诊断的敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）以及阳性似然比和阴性似然比分别为44.4%、92.3%、44.4%、92.3%、5.8、0.6；仅右侧卵巢存在时分别为50.0%、98.5%、80.0%、94.2%、33.0、0.5；双侧卵巢存在时分别为74.4%、68.6%、72.5%、70.6%、2.4、0.4；而对于正常卵巢固定的诊断，仅左侧卵巢时分别为25.0%、87.9%、8.3%、96.4%、2.1、0.9，仅右侧卵巢时分别为14.3%、92.9%、7.1%、96.6%、2.0、0.9，双侧卵巢时分别为35.7%、97.2%、50.0%、95.0%、12.6、0.7（除正常左侧和右侧卵巢P分别为0.2和0.4外，其他P均<0.05）。对所有女性而言，TVS检查卵巢固定不动预测DIE的敏感度、特异度、PPV和NPV分别为58.3%、74.1%、60.6%、72.2%，预测肠道手术需求的分别为78.2%、71.1%、41.3%、92.6%。
卵巢固定不动与子宫内膜异位囊肿之间存在显著相关性。与正常卵巢相比，卵巢固定不动作为DIE的超声“软指标”，在存在子宫内膜异位囊肿时诊断性能更佳。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
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