Leonardi M, Robledo K P, Espada M, Vanza K, Condous G
Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, 2747, Australia; The University of Sydney Nepean Clinical School, Sydney, 2747, Australia; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
Eur J Obstet Gynecol Reprod Biol. 2020 Nov;254:124-131. doi: 10.1016/j.ejogrb.2020.08.051. Epub 2020 Sep 16.
To perform a pilot diagnostic accuracy study of a novel transvaginal ultrasonography procedure called saline-infusion sonoPODography to predict superficial endometriosis in patients with suspected endometriosis.
A prospective single-center diagnostic accuracy study was performed from September 2019-November 2019. The index test sonoPODography was performed and the results were documented in a standardized fashion. SonoPODography was performed by installing saline into the pouch of Douglas (POD) via an intrauterine balloon catheter to create an acoustic window between the ultrasound probe and surrounding structures. The pelvis was then assessed for the presence or absence of superficial endometriosis using pre-defined features. Direct visualization at laparoscopy and histological assessment of excised endometriosis confirmed the outcome. The diagnostic performance of sonoPODography was evaluated.
42 consecutive participants underwent sonoPODography. Superficial endometriosis was identified by sonoPODography in 24/42 (57.1 %) and in 37/42 (88.1 %) participants by direct visualization at laparoscopy. The overall diagnostic performance of sonoPODography was: accuracy 69.1 %, sensitivity 64.9 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 27.8 %. Amongst those without deep endometriosis/endometriomas/pouch of Douglas obliteration, the diagnostic performance was: accuracy 80.0 %, sensitivity 77.7 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 33.3 %. The pouch of Douglas peritoneum was the most common site of superficial endometriosis.
SonoPODography is a novel ultrasound-based procedure that permits the direct visualization of superficial with respectable diagnostic accuracy. The findings of this pilot study are promising and justify the initiation of a larger outpatient study. SonoPODography may establish new avenues for the non-invasive diagnosis and investigation of endometriosis.
对一种名为生理盐水灌注超声盆腔造影的新型经阴道超声检查方法进行初步诊断准确性研究，以预测疑似子宫内膜异位症患者的浅表性子宫内膜异位症。
于2019年9月至2019年11月进行了一项前瞻性单中心诊断准确性研究。进行了索引测试超声盆腔造影，并以标准化方式记录结果。超声盆腔造影是通过宫内球囊导管向Douglas腔（POD）注入生理盐水，以在超声探头与周围结构之间创建一个声学窗口来进行的。然后使用预先定义的特征评估盆腔是否存在浅表性子宫内膜异位症。腹腔镜直视检查和切除的子宫内膜异位症的组织学评估证实了结果。评估了超声盆腔造影的诊断性能。
42名连续参与者接受了超声盆腔造影。超声盆腔造影在24/42（57.1%）的参与者中识别出浅表性子宫内膜异位症，而腹腔镜直视检查在37/42（88.1%）的参与者中识别出该病症。超声盆腔造影的总体诊断性能为：准确性69.1%，敏感性64.9%，特异性100.0%，阳性预测值100.0%，阴性预测值27.8%。在没有深部子宫内膜异位症/子宫内膜瘤/Douglas腔闭塞的患者中，诊断性能为：准确性80.0%，敏感性77.7%，特异性100.0%，阳性预测值100.0%，阴性预测值33.3%。Douglas腔腹膜是浅表性子宫内膜异位症最常见的部位。
超声盆腔造影是一种基于超声的新型检查方法，能够直接观察浅表情况，诊断准确性可观。这项初步研究的结果很有前景，为开展更大规模的门诊研究提供了依据。超声盆腔造影可能为子宫内膜异位症的无创诊断和研究开辟新途径。
