Abstract：
To calculate the predictive value and thus the clinical usefulness of transvaginal ultrasound (US) imaging for the management of deep endometriosis, knowing that the positive predictive value (PPV) varies with the prevalence and probably with the volume and location of the disease.
After registration on PROSPERO (CRD42022366323), PubMed was searched for all reports describing the diagnostic accuracy of US imaging for deep endometriosis published between January 1, 2000, and October 20, 2022.
The 536 articles on \"endometriosis AND US And diagnosis\" were hand searched, and 30 reports describing sensitivity and specificity of deep endometriosis were found. Besides sensitivity and specificity, the prevalence, localization, and size of deep endometriosis lesions were collected.
Prevalences of deep endometriosis were reported only twice as 12% and 32% by ultrasonographers. In women undergoing surgery, prevalences vary between 40% and 100% because of the variable inclusion criteria. Specificity is higher than sensitivity for all locations: rectovaginal (97% [86-100] vs 74% [31-95], p = .0002), rectosigmoid (97% [63-100] vs 88% [37-97], p = .0082), vesicouterine (100% [97-100] vs 63% [22-100], p = .0021), and uterosacrals (91% [77-99] vs 68% [18-83], p = .0005). Notwithstanding improved equipment, accuracy did not vary over the last 20 years. Sensitivities or specificities have not been stratified by the size of the lesion, and thus, the lower detection limits are not known. In the absence of blinding, the usefulness for surgery could not be established.
The reported sensitivities and specificities of transvaginal US are not only those of imaging but include symptoms and clinical examinations. In referral centers, the reported PPVs are high (94%-100%) given that prevalences are >10% and specificities are >95%. However, the extrapolation of the clinical use before surgical interventions should be considered with care, given that PPVs for smaller lesions and the lower detection limit are unknown and surgeons were not blinded to US results.
After registration on PROSPERO (CRD42022366323), PubMed was searched for all reports describing the diagnostic accuracy of US imaging for deep endometriosis published between January 1, 2000, and October 20, 2022.
The 536 articles on \"endometriosis AND US And diagnosis\" were hand searched, and 30 reports describing sensitivity and specificity of deep endometriosis were found. Besides sensitivity and specificity, the prevalence, localization, and size of deep endometriosis lesions were collected.
Prevalences of deep endometriosis were reported only twice as 12% and 32% by ultrasonographers. In women undergoing surgery, prevalences vary between 40% and 100% because of the variable inclusion criteria. Specificity is higher than sensitivity for all locations: rectovaginal (97% [86-100] vs 74% [31-95], p = .0002), rectosigmoid (97% [63-100] vs 88% [37-97], p = .0082), vesicouterine (100% [97-100] vs 63% [22-100], p = .0021), and uterosacrals (91% [77-99] vs 68% [18-83], p = .0005). Notwithstanding improved equipment, accuracy did not vary over the last 20 years. Sensitivities or specificities have not been stratified by the size of the lesion, and thus, the lower detection limits are not known. In the absence of blinding, the usefulness for surgery could not be established.
The reported sensitivities and specificities of transvaginal US are not only those of imaging but include symptoms and clinical examinations. In referral centers, the reported PPVs are high (94%-100%) given that prevalences are >10% and specificities are >95%. However, the extrapolation of the clinical use before surgical interventions should be considered with care, given that PPVs for smaller lesions and the lower detection limit are unknown and surgeons were not blinded to US results.
摘要：
目的：计算预测值，因此，经阴道超声成像（TV-US）对深部子宫内膜异位症的治疗的临床有用性，知道阳性预测值（PPV）值随患病率以及疾病的体积和位置而变化。
方法：在Prospero（CRD42022366323）上注册后，搜索Pubmed在2000年1月1日至2022年10月20日之间发表的所有描述超声成像对深部子宫内膜异位症诊断准确性的报告。
方法：手工搜索了536篇关于子宫内膜异位症和超声诊断的文章，发现了30篇描述深部子宫内膜异位症敏感性和特异性的报告。除了敏感性和特异性，患病率,收集子宫内膜异位症深部病灶的定位和大小.
结果：超声检查者报告的深部子宫内膜异位症的患病率仅为12％和32％的两倍。在接受手术的女性中，由于不同的纳入标准，患病率在40%到100%之间变化。特异性高于所有位置的敏感性：直肠阴道(97%，86-100对74%，31-95；P=0.0002），直肠乙状结肠(97%，63-100对88%，37-97，P=0.0082），vesicouterine(100%,97-100对63%，22-100，P=0.0021）和子宫骶骨（91％77-99对68％，18-83,P=0.0005)。尽管改进了设备，在过去的20年里，准确性没有变化。.敏感性或特异性尚未根据病变的大小进行分层，因此检测下限未知。在没有盲法的情况下，无法确定手术的有用性。
结论：报道的TV-US的敏感性和特异性不仅是影像学检查，还包括症状和临床检查。在转诊中心，报告的PPV很高（94％至100％），因为患病率高于10％，特异性超过95％。然而,在手术干预之前的临床使用外推应谨慎考虑，由于较小病变的PPV和检测下限是未知的，而且由于外科医生并没有对美国的结果视而不见。
方法：在Prospero（CRD42022366323）上注册后，搜索Pubmed在2000年1月1日至2022年10月20日之间发表的所有描述超声成像对深部子宫内膜异位症诊断准确性的报告。
方法：手工搜索了536篇关于子宫内膜异位症和超声诊断的文章，发现了30篇描述深部子宫内膜异位症敏感性和特异性的报告。除了敏感性和特异性，患病率,收集子宫内膜异位症深部病灶的定位和大小.
结果：超声检查者报告的深部子宫内膜异位症的患病率仅为12％和32％的两倍。在接受手术的女性中，由于不同的纳入标准，患病率在40%到100%之间变化。特异性高于所有位置的敏感性：直肠阴道(97%，86-100对74%，31-95；P=0.0002），直肠乙状结肠(97%，63-100对88%，37-97，P=0.0082），vesicouterine(100%,97-100对63%，22-100，P=0.0021）和子宫骶骨（91％77-99对68％，18-83,P=0.0005)。尽管改进了设备，在过去的20年里，准确性没有变化。.敏感性或特异性尚未根据病变的大小进行分层，因此检测下限未知。在没有盲法的情况下，无法确定手术的有用性。
结论：报道的TV-US的敏感性和特异性不仅是影像学检查，还包括症状和临床检查。在转诊中心，报告的PPV很高（94％至100％），因为患病率高于10％，特异性超过95％。然而,在手术干预之前的临床使用外推应谨慎考虑，由于较小病变的PPV和检测下限是未知的，而且由于外科医生并没有对美国的结果视而不见。
