Department of Gynecology, Gynecology and Obstetrics Service, State Public's Servant Medical Assistant Institute, São Paulo, Brazil.
School of Dentistry, State University of Campinas, Campinas, Brazil.
J Obstet Gynaecol Can. 2020 Apr;42(4):488-499.e4. doi: 10.1016/j.jogc.2019.07.016. Epub 2019 Nov 23.
Our aim was to perform a systematic review and meta-analysis of the most commonly used examinations for rectosigmoid lesions of deeply infiltrating endometriosis, transvaginal sonography (TVS) and magnetic resonance imaging (MRI), to compare their diagnostic accuracy and enhanced or non-enhanced techniques.
A systematic search was performed until March 2018 without time or language restrictions. Eligibility criteria included studies that compared the accuracy of TVS and MRI for diagnosis of rectosigmoid endometriosis. The quality of the studies was assessed by means of Quality Assessment of Diagnostic Accuracy Studies-2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Bivariate and hierarchical analysis were performed. The difference in the accuracy of TVS and MRI was tested, and heterogeneity was addressed by means of meta-regression, sensitivity, or subgroup analysis.
A total of 1754 studies were screened; 105 studies were eligible, and 11 studies were included in the meta-analysis. Overall pooled sensitivity, specificity, and area under the receiver operating characteristic curve were 0.80, 0.94, and 0.95, respectively. The measures for MRI were 0.82, 0.94, and 0.95, respectively. There was no statistical difference between the accuracy values of TVS and MRI (P = 0.90). The use of bowel preparation and vaginal contrast could enhance the accuracy of MRI. Along with rectosigmoid prevalence, bowel and vaginal contrast explained a significant proportion of the statistical heterogeneity.
Both TVS and MRI showed high diagnostic accuracy for rectosigmoid deeply infiltrating endometriosis lesions. There is no strong evidence suggesting that the two diagnostic methods might differ in specificity or sensitivity, but enhanced techniques may increase the accuracy measures.
本研究旨在对经阴道超声（TVS）和磁共振成像（MRI）这两种常用于诊断直肠乙状结肠深部浸润型子宫内膜异位症的检查方法进行系统评价和荟萃分析，比较这两种方法的诊断准确性以及增强技术与非增强技术的应用。
本研究无时间和语言限制，系统检索截至 2018 年 3 月的相关文献。纳入标准为比较 TVS 和 MRI 对直肠乙状结肠子宫内膜异位症诊断准确性的研究。采用诊断准确性研究质量评估-2 工具和系统评价和荟萃分析首选报告项目对纳入研究的质量进行评估。采用双变量和分层分析方法。采用荟萃回归、敏感性分析或亚组分析处理异质性问题，检验 TVS 和 MRI 准确性的差异。
共筛选出 1754 篇文献，105 篇文献符合纳入标准，11 篇文献纳入荟萃分析。TVS 和 MRI 的总体汇总敏感性、特异性和受试者工作特征曲线下面积分别为 0.80、0.94 和 0.95。MRI 的相应指标分别为 0.82、0.94 和 0.95。TVS 和 MRI 的准确性值之间无统计学差异（P=0.90）。肠道准备和阴道对比剂的应用可提高 MRI 的准确性。除直肠乙状结肠病变的患病率外，肠道和阴道对比剂还可解释大部分统计学异质性。
TVS 和 MRI 对直肠乙状结肠深部浸润型子宫内膜异位症的诊断准确性均较高。目前尚无强有力的证据表明这两种诊断方法在特异性或敏感性方面可能存在差异，但增强技术可能会提高准确性。
