Philip C-A, Dubernard G
Service de Gynécologie-Obstétrique, CHU Lyon Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France; Université Claude-Bernard - Lyon 1, 69000 Lyon, France.
Service de Gynécologie-Obstétrique, CHU Lyon Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France; Université Claude-Bernard - Lyon 1, 69000 Lyon, France.
Gynecol Obstet Fertil Senol. 2018 Mar;46(3):185-199. doi: 10.1016/j.gofs.2018.02.026. Epub 2018 Mar 12.
Endometriosis is difficult to diagnose clinically. Transvaginal sonography (TVS) is a procedure that is known to be operator-dependent, which mean that published evidences has to be balanced with the level of the sonographer that produced the data. The objective of this publication was to assess the performances of the sonography in the diagnosis of endometriosis in order to establish the French national recommendations. We searched the MEDLINE database for publication from January 2000 to September 2017 using keywords associated with endometriosis and sonography. Eighty-four trial and reviews published in English or French were included. Ovarian endometrioma can usually be diagnosed by a non-expert sonographer, especially when its aspect is typical. In case of an ovarian cyst with atypical presentation, it is recommended to control the sonography by a referent or to perform an MRI. In menopaused women, any ovarian cyst should be considered as a cancer until proven otherwise. In the diagnosis of posterior deep invasive endometriosis (DIE), TVS with sensitivity and specificity of 96 and 99% respectively, seems at least equivalent if not superior to MRI. However, these performances are related to expert sonographers. To reach sufficient efficiency in posterior DIE, the estimated learning curve for a sonographer is 44 cases. When posterior DIE is suspected, we recommend proposing a TVS "performed by an expert" or a MRI "at least interpreted by an expert". In anterior DIE, TVS has a good specificity (100%), but its sensitivity is poor in the literature (64%). TVS is therefore not able to eliminate the diagnosis. However a renal ultrasound should be proposed each time a urinary endometriosis is confirmed, and should be considered whenever posterior DIE is diagnosed especially the lesion is superior to 3cm.
子宫内膜异位症在临床上难以诊断。经阴道超声检查（TVS）是一种已知依赖操作者的检查方法，这意味着已发表的证据必须与产生数据的超声检查人员的水平相平衡。本出版物的目的是评估超声检查在子宫内膜异位症诊断中的性能，以便制定法国国家指南。我们使用与子宫内膜异位症和超声检查相关的关键词在MEDLINE数据库中搜索了2000年1月至2017年9月发表的文献。纳入了84篇以英文或法文发表的试验和综述。卵巢子宫内膜异位囊肿通常可由非专业超声检查人员诊断，尤其是当其表现典型时。对于表现不典型的卵巢囊肿，建议由专家复查超声检查或进行磁共振成像（MRI）检查。在绝经后女性中，任何卵巢囊肿在未证实为其他情况之前均应视为癌症。在诊断深部浸润性子宫内膜异位症（DIE）时，TVS的敏感性和特异性分别为96%和99%，即使不优于MRI，至少与之相当。然而，这些性能与专家超声检查人员有关。为了在诊断后位DIE时达到足够的效率，超声检查人员的估计学习曲线为44例病例。当怀疑有后位DIE时，我们建议进行“由专家操作”的TVS检查或“至少由专家解读”的MRI检查。在前位DIE中，TVS具有良好的特异性（100%），但其敏感性在文献中较差（64%）。因此，TVS不能排除诊断。然而，每次确诊泌尿系统子宫内膜异位症时均应进行肾脏超声检查，并且在诊断后位DIE时，尤其是病变大于3cm时，均应考虑进行该项检查。
