Aas-Eng M K, Lieng M, Dauser B, Diep L M, Leonardi M, Condous G, Hudelist G
Department of Gynecology, Oslo University Hospital, Oslo, Norway.
Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria.
Ultrasound Obstet Gynecol. 2021 Dec;58(6):933-939. doi: 10.1002/uog.23728.
To investigate the agreement of measurements of the three diameters of rectosigmoid deep endometriosis (DE) lesions between presurgical evaluation using transvaginal sonography (TVS) and postsurgical specimen measurement (PSM).
This was a prospective observational multicenter study including symptomatic women undergoing surgical treatment for DE involving the rectosigmoid, by either discoid or segmental resection, from April 2017 to December 2019. TVS was performed presurgically to evaluate lesion size (craniocaudal-midsagittal length, anteroposterior thickness and transverse diameter), in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement, and was compared with PSM. The agreement of lesion dimensions between the two methods was assessed by Bland-Altman plots and limits of agreement and additionally by the intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. Systematic and proportional bias was assessed using the paired t-test.
A total of 207 consecutive women were eligible for inclusion. Forty-one women were excluded, leaving 166 women for final analysis. A total of 123 segmental resections and 46 discoid resections were performed (both procedures were performed in three women). The mean difference between TVS and PSM was 0.90 (95% CI, 0.85-0.95) mm for lesion length measurements, 1.03 (95% CI, 0.98-1.09) mm for lesion thickness measurements and 0.84 (95% CI, 0.79-0.89) mm for transverse diameter measurements. Bland-Altman analysis demonstrated good agreement between the two methods for measurements of lesion length. Furthermore, there was good reliability and correlation between TVS and PSM for lesion length measurements, as demonstrated by an ICC of 0.82 (95% CI, 0.75-0.87) and Pearson's correlation coefficient of 0.72 (95% CI, 0.62-0.80), moderate-to-good reliability and correlation for lesion thickness measurements, with an ICC of 0.76 (95% CI, 0.67-0.82) and Pearson's correlation coefficient of 0.61 (95% CI, 0.51-0.70), and poor-to-moderate reliability and correlation for transverse diameter measurements, with an ICC of 0.58 (95% CI, 0.39-0.71) and Pearson's correlation coefficient of 0.46 (95% CI, 0.33-0.58).
Preoperative TVS determines accurately rectosigmoid DE lesion length. TVS can thereby contribute to optimal planning of surgical treatment options in women with rectosigmoid DE. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
探讨经阴道超声（TVS）术前评估与术后标本测量（PSM）对直肠乙状结肠深部子宫内膜异位症（DE）病变三个直径测量值的一致性。
这是一项前瞻性观察性多中心研究，纳入了2017年4月至2019年12月期间因直肠乙状结肠DE接受手术治疗的有症状女性，手术方式为盘状或节段性切除。术前根据国际深部子宫内膜异位症分析（IDEA）小组共识声明，采用TVS评估病变大小（头端尾端 - 正中矢状长度、前后厚度和横径），并与PSM进行比较。通过Bland - Altman图和一致性界限评估两种方法之间病变尺寸的一致性，此外还通过组内相关系数（ICC）和Pearson相关系数进行评估。使用配对t检验评估系统偏差和比例偏差。
共有207名连续女性符合纳入标准。41名女性被排除，最终纳入166名女性进行分析。共进行了123例节段性切除和46例盘状切除（3名女性同时接受了这两种手术）。TVS与PSM之间的平均差值为：病变长度测量值为0.90（95%CI，0.85 - 0.95）mm，病变厚度测量值为1.03（95%CI，0.98 - 1.09）mm，横径测量值为0.84（95%CI，0.79 - 0.89）mm。Bland - Altman分析表明，两种方法在病变长度测量方面具有良好的一致性。此外，TVS与PSM在病变长度测量方面具有良好的可靠性和相关性，ICC为0.82（95%CI，0.75 - 0.87），Pearson相关系数为0.72（95%CI，0.62 - 0.80）；在病变厚度测量方面具有中度至良好的可靠性和相关性，ICC为0.76（95%CI，0.67 - 0.82），Pearson相关系数为0.61（95%CI，0.51 - 0.70）；在横径测量方面具有较差至中度的可靠性和相关性，ICC为0.58（95%CI，0.39 - 0.71），Pearson相关系数为0.46（95%CI，0.33 - 0.58）。
术前TVS能准确测定直肠乙状结肠DE病变长度。因此，TVS有助于为直肠乙状结肠DE女性患者优化手术治疗方案的规划。© 2021作者。《超声医学与妇产科》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
