Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.
Acta Obstet Gynecol Scand. 2021 Sep;100(9):1700-1711. doi: 10.1111/aogs.14209. Epub 2021 Jul 8.
Preoperative assessment of deep endometriotic (DE) nodules is necessary to inform patients about the possible treatments and provide informed consent in case of surgery. This study aims to investigate the diagnostic performance of rectal water-contrast transvaginal ultrasonography (RWC-TVS) and sonovaginography (SVG) in women with suspicion of posterior DE.
This prospective comparative study (NCT04296760) enrolled women with clinical suspicion of DE at our institution (Piazza della Vittoria 14 SRL, Genoa, Italy). Exclusion criteria were previous diagnosis of DE by imaging techniques or laparoscopy. All patients underwent RWC-TVS and SVG, independently performed by two gynecological sonologists blinded to the other technique's results. Patients underwent laparoscopic surgery within the following three months; imaging findings were compared with surgical and histological results.
In 208 of 281 (74.0%) patients included, posterior DE was surgically confirmed in rectosigmoid (n = 88), vagina (n = 21), rectovaginal septum (n = 34) and uterosacral ligaments (n = 156). RWC-TVS and SVG demonstrated similar sensitivity (SE; 93.8% vs 89.4%; p = 0.210) and specificity (SP; 86.3% vs 79.4%; p = 0.481) in diagnosing posterior DE. Specifically, both examinations had similar accuracy in detecting nodules of uterosacral ligaments (p = 0.779), vagina (p = 0.688) and rectovaginal septum (p = 0.824). RWC-TVS had higher SE (95.2% vs 82.0%; p = 0.003) and similar SP (99.5% vs 98.5%; p = 0.500) in diagnosing rectosigmoid endometriosis and estimated better infiltration of intestinal submucosa (p = 0.039), and distance between these nodules and anal verge (p < 0.001); only RWC-TVS allowed the estimation of bowel lumen stenosis. A similar proportion of discomfort was experienced during both examinations (p = 0.191), although a statistically higher mean visual analog score was reported during RWC-TVS (p < 0.001).
Although RWC-TVS and SVG have similar accuracy in the diagnosis of DE, RWC-TVS performed better in assessment of the characteristics of rectosigmoid endometriosis.
术前评估深部子宫内膜异位症（DE）结节对于告知患者可能的治疗方法和提供手术知情同意至关重要。本研究旨在探讨直肠水对比经阴道超声（RWC-TVS）和经阴道超声（SVG）在疑似后部 DE 患者中的诊断性能。
这项前瞻性对比研究（NCT04296760）纳入了在我院（意大利热那亚 Piazza della Vittoria 14 SRL）疑似 DE 的女性患者。排除标准为影像学技术或腹腔镜检查先前诊断为 DE。所有患者均由两名妇科超声医生进行 RWC-TVS 和 SVG 检查，两位医生均对其他技术的结果不知情。患者在接下来的三个月内接受腹腔镜手术；将影像学结果与手术和组织学结果进行比较。
在 281 名患者中，有 208 名（74.0%）患者经手术证实为直肠乙状结肠（n=88）、阴道（n=21）、直肠阴道隔（n=34）和子宫骶韧带（n=156）深部子宫内膜异位症。RWC-TVS 和 SVG 在诊断后部 DE 时的敏感性（SE；93.8%对 89.4%；p=0.210）和特异性（SP；86.3%对 79.4%；p=0.481）相似。具体来说，两种检查在检测子宫骶韧带（p=0.779）、阴道（p=0.688）和直肠阴道隔（p=0.824）的结节方面具有相似的准确性。RWC-TVS 在诊断直肠乙状结肠子宫内膜异位症时具有更高的 SE（95.2%对 82.0%；p=0.003）和相似的 SP（99.5%对 98.5%；p=0.500），并且估计肠黏膜下的浸润更好（p=0.039），以及这些结节与肛门缘之间的距离（p<0.001）；只有 RWC-TVS 可以估计肠腔狭窄。两种检查的不适程度相似（p=0.191），但 RWC-TVS 报告的平均视觉模拟评分较高（p<0.001）。
尽管 RWC-TVS 和 SVG 在诊断 DE 方面具有相似的准确性，但 RWC-TVS 在评估直肠乙状结肠子宫内膜异位症的特征方面表现更好。
