Garcia-Jimenez Rocio, Valero Irene, Borrero Carlota, Garcia-Mejido Jose A, Gonzalez-Herraez Jose V, Muñoz-Chimbo Andrea V, Pelayo-Delgado Irene, Fernandez-Palacin Ana, Sainz Bueno Jose A
Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain.
Quant Imaging Med Surg. 2023 Jun 1;13(6):3735-3746. doi: 10.21037/qims-22-898. Epub 2023 May 15.
The diagnosis of pelvic congestion syndrome (PCS) remains a challenge given the lack of universally accepted criteria. Although venography (VG) is the current gold standard for the diagnosis of PCS, non-invasive techniques like transvaginal ultrasonography (TVU) appear to be a valid alternative. The aim of this study was to design a predictive model for the venographic diagnostic of PCS using the parameters identified by TVU in patients with clinical suspicion of PCS, in order to individually assess the need to perform an invasive diagnostic and therapeutic technique such as VG.
An observational and cross-sectional prospective study was conducted including 61 consecutively recruited patients with clinical suspicion of PCS, who were referred by the Pelvic Floor, Gynecology and Vascular Surgery Units, who were distributed in two groups: 18 belonging to the normal group and 43 to the PCS's group. We implemented and compared 19 binary logistic regression models, including the parameters that showed statistical significance in the prior univariate analysis. We evaluated individual predictive values with a receiver operating characteristic (ROC) curve and the area under the curve (AUC).
The selected model, based on the presence of pelvic veins or venous plexus of 8 mm or larger, observed by transvaginal ultrasound, had an AUC of 0.79 (95% CI: 0.63-0.96; P<0.001), with a sensitivity of 0.90 and specificity of 0.69, while the VG had a sensitivity of 86.05%, a specificity of 66.67%, and a positive predictive value of 86.05%.
This assessment presents a feasible alternative that could potentially be added to our usual gynecological practice.
鉴于缺乏普遍认可的标准，盆腔淤血综合征（PCS）的诊断仍然是一项挑战。尽管静脉造影（VG）是目前诊断PCS的金标准，但经阴道超声检查（TVU）等非侵入性技术似乎是一种有效的替代方法。本研究的目的是利用TVU在临床怀疑患有PCS的患者中识别出的参数，设计一种用于PCS静脉造影诊断的预测模型，以便单独评估进行诸如VG等侵入性诊断和治疗技术的必要性。
进行了一项观察性横断面前瞻性研究，纳入了61例连续招募的临床怀疑患有PCS的患者，这些患者由盆底、妇科和血管外科转诊而来，分为两组：18例属于正常组，43例属于PCS组。我们实施并比较了19个二元逻辑回归模型，包括在先前单变量分析中显示出统计学意义的参数。我们使用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估个体预测值。
基于经阴道超声观察到的盆腔静脉或静脉丛直径≥8 mm选择的模型，其AUC为0.79（95% CI：0.63 - 0.96；P<0.001），敏感性为0.90，特异性为0.69，而VG的敏感性为86.05%，特异性为66.67%，阳性预测值为86.05%。
该评估提供了一种可行的替代方法，有可能添加到我们常规的妇科实践中。
