Centre de recherche du CHU de Québec - Université Laval, Quebec City, Canada.
Université Laval, Quebec City, Canada.
J Obstet Gynaecol. 2024 Dec;44(1):2311664. doi: 10.1080/01443615.2024.2311664. Epub 2024 Feb 13.
The diagnosis of endometriomas in patients with endometriosis is of primary importance because it influences the management and prognosis of infertility and pain. Imaging techniques are evolving constantly. This study aimed to systematically assess the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) in detecting endometrioma using the surgical visualisation of lesions with or without histopathological confirmation as reference standards in patients of reproductive age with suspected endometriosis.
PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov databases were searched from their inception to 12 October 2022, using a manual search for additional articles. Two authors independently performed title, abstract and full-text screening of the identified records, extracted study details and quantitative data and assessed the quality of the studies using the 'Quality Assessment of Diagnostic Accuracy Study 2' tool. Bivariate random-effects models were used to determine the pooled sensitivity and specificity, compare the two imaging modalities and evaluate the sources of heterogeneity.
Sixteen prospective studies (10 assessing TVUS, 4 assessing MRI and 2 assessing both TVUS and MRI) were included, representing 1976 participants. Pooled TVUS and MRI sensitivities for endometrioma were 0.89 (95% confidence interval 'CI', 0.86-0.92) and 0.94 (95% CI, 0.74-0.99), respectively (indirect comparison -value of 0.47). Pooled TVUS and MRI specificities for endometrioma were 0.95 (95% CI, 0.92-0.97) and 0.94 (95% CI, 0.89-0.97), respectively (indirect comparison p-value of 0.51). These studies had a high or unclear risk of bias. A direct comparison (all participants undergoing TVUS and MRI) of the modalities was available in only two studies.
TVUS and MRI have high accuracy for diagnosing endometriomas; however, high-quality studies comparing the two modalities are lacking.
在子宫内膜异位症患者中，对子宫内膜瘤的诊断至关重要，因为它会影响不孕和疼痛的治疗和预后。影像学技术不断发展。本研究旨在系统评估经阴道超声（TVUS）和磁共振成像（MRI）在诊断育龄期疑似子宫内膜异位症患者子宫内膜瘤中的诊断准确性，以手术可视化病变（有或无组织病理学证实）作为参考标准。
从建库至 2022 年 10 月 12 日，检索了 PubMed、Embase、Web of Science、Cumulative Index to Nursing and Allied Health Literature 和 ClinicalTrials.gov 数据库，并用手工搜索额外的文章。两位作者独立筛选了确定记录的标题、摘要和全文，提取了研究细节和定量数据，并使用“诊断准确性研究 2 号质量评估工具”评估了研究的质量。使用双变量随机效应模型确定汇总敏感性和特异性，比较两种影像学方法，并评估异质性来源。
纳入了 16 项前瞻性研究（10 项评估 TVUS，4 项评估 MRI，2 项评估 TVUS 和 MRI），共 1976 名参与者。汇总的 TVUS 和 MRI 对子宫内膜瘤的敏感性分别为 0.89（95%置信区间 'CI'，0.86-0.92）和 0.94（95% CI，0.74-0.99）（间接比较 -值为 0.47）。汇总的 TVUS 和 MRI 对子宫内膜瘤的特异性分别为 0.95（95% CI，0.92-0.97）和 0.94（95% CI，0.89-0.97）（间接比较 p 值为 0.51）。这些研究存在高或不确定的偏倚风险。仅在两项研究中可获得对两种方法的直接比较（所有参与者均进行 TVUS 和 MRI）。
TVUS 和 MRI 对诊断子宫内膜瘤具有较高的准确性；然而，缺乏比较两种方法的高质量研究。
