Department of Obstetrics and Gynecology (Drs. Maheux-Lacroix, Belanger, Pinard, Lemyre, and Laberge), CHU de Quebec, Université Laval, Quebec; Department of Obstetrics and Gynaecology (Dr. Boutin), University of British Columbia, Vancouver, Canada.
Department of Obstetrics and Gynecology (Drs. Maheux-Lacroix, Belanger, Pinard, Lemyre, and Laberge), CHU de Quebec, Université Laval, Quebec; Department of Obstetrics and Gynaecology (Dr. Boutin), University of British Columbia, Vancouver, Canada.
J Minim Invasive Gynecol. 2020 Feb;27(2):433-440.e1. doi: 10.1016/j.jmig.2019.11.010. Epub 2019 Nov 22.
To evaluate the diagnostic accuracy of intraoperative laparoscopic imaging tools in reference to that of histopathology for detecting endometriotic lesions and to compare them with conventional white-light inspection by performing a systematic review with meta-analysis.
We searched the MEDLINE, EMBASE, and CENTRAL databases in addition to citations and reference lists until the end of February 2019.
Two authors screened 1038 citations for eligibility. We included randomized controlled trials or prospective cohort studies published in English, assessing the accuracy of intraoperative imaging tools for diagnosing endometriosis during laparoscopy. We considered studies using histopathologic evaluation as a standard criterion.
TABULATION, INTEGRATION, AND RESULTS: Seven studies were eligible, including 472 women and 1717 histopathologic specimens, and they involved study of the use of narrow-band imaging (2 studies), 5-aminolevulinic acid-induced fluorescence (2 studies), autofluorescence imaging (1 study), indocyanine green (1 study), and a 3-dimensional robotic laparoscopy (1 study). Two authors extracted data and assessed the validity of the included studies. Bivariate random-effects models and McNemar's test were used to compare the tests and evaluate sources of heterogeneity. Four studies were attributed a high risk of bias, and biopsies of normal-looking peritoneum were not performed to verify the results in 3 studies; both factors were identified as significant sources of heterogeneity, leading to the overestimation of the sensitivity and underestimation of the specificity of imaging tools. In all studies, additional endometriotic lesions were diagnosed with the enhanced imaging tool compared with white-light inspection alone. In the 4 studies that appropriately performed control biopsies (171 women, 448 specimens), enhanced imaging techniques were associated with a higher sensitivity and specificity compared with white-light inspection (0.84 and 0.89 compared with 0.75 and 0.76, respectively, p ≤.001). Adverse events were uncommon (n = 5) and reported only with the use of exogeneous photosensitizers. There were no reports of long-term changes in patient-reported outcomes arising from better detection of endometriosis lesions.
Studies report that enhanced imaging allows for the detection of additional endometriotic lesions missed by conventional white-light laparoscopy. The benefits of finding these additional lesions using enhanced imaging compared with white-light inspection alone on long-term postoperative outcomes have not been determined, and these tools should be considered only in a research context at this time.
通过系统评价和荟萃分析，评估术中腹腔镜成像工具在诊断子宫内膜异位症方面的诊断准确性，并与传统白光检查进行比较。
我们检索了 MEDLINE、EMBASE 和 CENTRAL 数据库，以及截止到 2019 年 2 月底的参考文献和引文列表。
两名作者筛选了 1038 条引文以确定其是否符合入选标准。我们纳入了评估术中成像工具在腹腔镜检查中诊断子宫内膜异位症准确性的随机对照试验或前瞻性队列研究，这些研究均采用组织病理学评估作为标准标准。
列表、综合和结果：有 7 项研究符合条件，包括 472 名女性和 1717 份组织病理学标本，涉及窄带成像（2 项研究）、5-氨基酮戊酸诱导荧光（2 项研究）、自发荧光成像（1 项研究）、吲哚菁绿（1 项研究）和 3 维机器人腹腔镜检查（1 项研究）的研究。两名作者提取数据并评估了纳入研究的有效性。采用双变量随机效应模型和 McNemar 检验比较了这些检查，并评估了异质性的来源。四项研究被认为存在高偏倚风险，且有三项研究未对外观正常的腹膜进行活检以验证结果，这两个因素均为异质性的重要来源，导致成像工具的敏感性被高估，特异性被低估。在所有研究中，与单独使用白光检查相比，增强成像工具可诊断出更多的子宫内膜异位症病变。在适当进行对照活检的四项研究中（171 名女性，448 份标本），与白光检查相比，增强成像技术的敏感性和特异性更高（分别为 0.84 和 0.89 与 0.75 和 0.76，p ≤.001）。不良事件罕见（n=5），仅在用外源性光敏剂时报告。没有报道由于更好地检测子宫内膜异位症病变而导致患者报告的结局出现长期变化。
研究报告称，增强成像可检测到传统白光腹腔镜检查遗漏的额外子宫内膜异位症病变。与单独使用白光检查相比，使用增强成像发现这些额外病变对长期术后结局的益处尚未确定，因此目前仅应在研究背景下考虑这些工具。
