Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
Ultrasound Obstet Gynecol. 2019 Oct;54(4):538-544. doi: 10.1002/uog.20274. Epub 2019 Sep 6.
To assess the overall accuracy of transvaginal ultrasound (TVS) for diagnosis of all types of extrauterine ectopic pregnancy (EUEP) in a large group of women who were managed surgically. We also aimed to assess the positive predictive value (PPV) of TVS for each of the different ultrasound morphological types of EUEP.
This was a retrospective observational study of all pregnant women who underwent emergency surgery following ultrasound diagnosis of EUEP at a single early pregnancy unit between January 2009 and December 2017. The preoperative TVS findings were recorded, including the exact location and morphological type (Type I-V; defined using ultrasound criteria) of EUEP. TVS findings were compared with operative and histological findings. The performance of ultrasound in diagnosing EUEP overall and according to morphological type was assessed, using visual confirmation of ectopic pregnancy at surgery as the reference standard.
A total of 26 401 women presented with early-pregnancy complications during the study period, including 1241 (4.7%; 95% CI, 4.5-5.0%) women with a conclusive diagnosis of EUEP on TVS or a presumed diagnosis based on severe pain and significant hemoperitoneum. Surgery was performed in 721/1241 (58.1%; 95% CI, 55.3-60.8%) cases, of which 710 (98.5%; 95% CI, 97.6-99.4%) had a conclusive diagnosis of EUEP on preoperative TVS. The remaining 11 women had severe pain and significant hemoperitoneum and were managed surgically on clinical grounds as an emergency, without an ectopic pregnancy having been identified on ultrasound examination. At laparoscopy, the diagnosis of EUEP was confirmed in 706/710 (99.4%; 95% CI, 98.6-99.8%) women with a positive ultrasound diagnosis and in all 11 women with a presumed ultrasound diagnosis of EUEP. The PPV of preoperative ultrasound for the diagnosis of EUEP was 99.4% (95% CI, 98.6-99.8%) with sensitivity of 98.5% (95% CI, 97.3-99.1%). There was no statistically significant difference in the accuracy of preoperative ultrasound diagnosis between the five morphological types (P = 0.76).
The accuracy of preoperative ultrasound for diagnosis of EUEP is high. The morphological type of EUEP on TVS had no significant effect on the accuracy of preoperative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
评估经阴道超声（TVS）对大量接受手术治疗的异位妊娠（EUEP）患者的所有类型异位妊娠的总体诊断准确性。我们还旨在评估 TVS 对 EUEP 的不同超声形态类型的阳性预测值（PPV）。
这是一项回顾性观察性研究，纳入了 2009 年 1 月至 2017 年 12 月期间在一家早期妊娠单位因 EUEP 的超声诊断而行急诊手术的所有孕妇。记录术前 TVS 检查结果，包括 EUEP 的准确位置和形态类型（I-V 型；使用超声标准定义）。将 TVS 检查结果与手术和组织学结果进行比较。使用手术中异位妊娠的视觉确认作为参考标准，评估超声对 EUEP 整体和根据形态类型的诊断性能。
在研究期间，共有 26401 名妇女因早期妊娠并发症就诊，其中 1241 名（4.7%；95%置信区间，4.5-5.0%）妇女经 TVS 确诊或基于严重腹痛和大量血腹症的假定诊断为 EUEP。在 721/1241 例（58.1%；95%置信区间，55.3-60.8%）病例中进行了手术，其中 710 例（98.5%；95%置信区间，97.6-99.4%）在术前 TVS 中确诊为 EUEP。其余 11 名妇女因严重腹痛和大量血腹症而行临床紧急手术，超声检查未发现异位妊娠。在腹腔镜检查中，706/710 例（99.4%；95%置信区间，98.6-99.8%）经超声诊断为 EUEP 的妇女和所有 11 例假定超声诊断为 EUEP 的妇女均确诊为 EUEP。术前超声对 EUEP 的诊断的阳性预测值为 99.4%（95%置信区间，98.6-99.8%），敏感度为 98.5%（95%置信区间，97.3-99.1%）。五种形态类型的术前超声诊断准确性之间无统计学差异（P=0.76）。
术前超声诊断 EUEP 的准确性较高。TVS 上 EUEP 的形态类型对术前诊断的准确性没有显著影响。
