Alcázar J L, Eguez P M, Forcada P, Ternero E, Martínez C, Pascual M Á, Guerriero S
Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain.
Department of Obstetrics and Gynecology, University Hospital, Badajoz, Spain.
Ultrasound Obstet Gynecol. 2022 Oct;60(4):477-486. doi: 10.1002/uog.24900. Epub 2022 Sep 12.
The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis, using laparoscopy as the reference standard.
A search for studies evaluating the role of the sliding sign in the assessment of pouch of Douglas obliteration and/or bowel involvement using laparoscopy as the reference standard published from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, The Cochrane Library, ClinicalTrials.gov and SCOPUS databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the studies. Analyses were performed using MIDAS and METANDI commands in STATA.
A total of 334 citations were identified. Eight studies were included in the analysis, resulting in 938 and 963 patients available for analysis of the diagnostic accuracy of the sliding sign for pouch of Douglas obliteration and bowel involvement, respectively. The mean prevalence of pouch of Douglas obliteration was 37% and the mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting pouch of Douglas obliteration were 88% (95% CI, 81-93%), 94% (95% CI, 91-96%), 15.3 (95% CI, 10.2-22.9), 0.12 (95% CI, 0.07-0.21) and 123 (95% CI, 62-244), respectively. The heterogeneity was moderate for sensitivity and low for specificity for detecting pouch of Douglas obliteration. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting bowel involvement were 81% (95% CI, 64-91%), 95% (95% CI, 91-97%), 16.0 (95% CI, 9.0-28.6), 0.20 (95% CI, 0.10-0.40) and 81 (95% CI, 34-191), respectively. The heterogeneity for the meta-analysis of diagnostic accuracy for bowel involvement was high.
The sliding sign on TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
本系统评价和荟萃分析旨在以腹腔镜检查为参考标准，评估经阴道超声（TVS）滑动征在检测疑似子宫内膜异位症患者Douglas窝闭塞和肠道受累方面的诊断准确性。
在PubMed/MEDLINE、Web of Science、CINAHL、Cochrane图书馆、ClinicalTrials.gov和SCOPUS数据库中检索2000年1月至2021年10月发表的以腹腔镜检查为参考标准评估滑动征在Douglas窝闭塞和/或肠道受累评估中作用的研究。使用诊断准确性研究质量评估-2（QUADAS-2）来评估研究质量。在STATA中使用MIDAS和METANDI命令进行分析。
共识别出334篇引文。8项研究纳入分析，分别有938例和963例患者可用于分析滑动征对Douglas窝闭塞和肠道受累的诊断准确性。Douglas窝闭塞的平均患病率为37%，肠道受累的平均患病率为23%。TVS滑动征检测Douglas窝闭塞的合并估计敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为88%（95%CI，81-93%）、94%（95%CI，91-96%）、15.3（95%CI，10.2-22.9）、0.12（95%CI，0.07-0.21）和123（95%CI，62-244）。检测Douglas窝闭塞时，敏感性的异质性为中度，特异性的异质性为低度。TVS滑动征检测肠道受累的合并估计敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为81%（95%CI，64-91%）、95%（95%CI，91-97%）、16.0（95%CI，9.0-28.6）、0.20（95%CI，0.10-0.40）和81（95%CI，34-191）。肠道受累诊断准确性的荟萃分析异质性较高。
TVS滑动征在预测疑似子宫内膜异位症女性的Douglas窝闭塞和肠道受累方面具有良好的诊断性能。©2022作者。《超声妇产科》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
