Abstract：
Around 80% of women with endometriosis have superficial endometriosis (SE) rather than ovarian or deep endometriosis (DE). However, to date, advances in non-invasive, imaging-based diagnosis have been limited to DE or ovarian disease. The objective of this study was to determine whether we can detect SE on transvaginal ultrasound scan (TVS) by assessing the peritoneum of the pouch of Douglas (POD).
This was a retrospective diagnostic test study following a change in practice to include POD peritoneum assessment for SE during TVS at a tertiary London hospital. Eligible patients underwent TVS by a single clinician trained in endometriosis scanning and a subsequent surgical procedure (laparoscopy) between April 2018 and September 2021. Participants formed a consecutive series. The TVS findings were compared with those of laparoscopy as the gold standard. Comparison of TVS findings with intraoperative findings was performed by calculating the diagnostic test performance measures (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive and negative likelihood ratios).
The study included a total of 100 patients. We found that 43/100 (43.0%) patients had no endometriosis, 33/100 (33.0%) had SE and 24/100 (24.0%) had DE on laparoscopy. SE was correctly detected on TVS in 17/33 patients, with a sensitivity of 51.5% (95% CI, 33.5-69.2%), specificity of 94.0% (95% CI, 85.4-98.4%), PPV of 81.0% (95% CI, 60.8-92.1%) and NPV of 79.7% (95% CI, 73.4-84.9%). DE was correctly diagnosed in 20/24 cases, including all ovarian cases, with a sensitivity of 83.3% (95% CI, 62.3-95.3%), specificity of 97.4% (95% CI, 90.8-99.7%), PPV of 90.9% (95% CI, 71.6-97.5%) and NPV of 94.9% (95% CI, 88.3-97.8%). The detection of SE on TVS was most accurate in the POD (sensitivity, 50.0%; specificity, 96.4%; PPV, 76.9%; NPV, 88.9%).
This study shows that the detection of SE in the POD is possible using routine TVS. While negative TVS does not reliably confirm the absence of disease or replace diagnostic laparoscopy, positive TVS facilitates non-invasive diagnosis for a much larger group of women than was previously possible. This should help to reduce the time from the onset of symptoms to diagnosis and enable initiation of medical treatment without the risk, cost and delay associated with a surgical diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
This was a retrospective diagnostic test study following a change in practice to include POD peritoneum assessment for SE during TVS at a tertiary London hospital. Eligible patients underwent TVS by a single clinician trained in endometriosis scanning and a subsequent surgical procedure (laparoscopy) between April 2018 and September 2021. Participants formed a consecutive series. The TVS findings were compared with those of laparoscopy as the gold standard. Comparison of TVS findings with intraoperative findings was performed by calculating the diagnostic test performance measures (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive and negative likelihood ratios).
The study included a total of 100 patients. We found that 43/100 (43.0%) patients had no endometriosis, 33/100 (33.0%) had SE and 24/100 (24.0%) had DE on laparoscopy. SE was correctly detected on TVS in 17/33 patients, with a sensitivity of 51.5% (95% CI, 33.5-69.2%), specificity of 94.0% (95% CI, 85.4-98.4%), PPV of 81.0% (95% CI, 60.8-92.1%) and NPV of 79.7% (95% CI, 73.4-84.9%). DE was correctly diagnosed in 20/24 cases, including all ovarian cases, with a sensitivity of 83.3% (95% CI, 62.3-95.3%), specificity of 97.4% (95% CI, 90.8-99.7%), PPV of 90.9% (95% CI, 71.6-97.5%) and NPV of 94.9% (95% CI, 88.3-97.8%). The detection of SE on TVS was most accurate in the POD (sensitivity, 50.0%; specificity, 96.4%; PPV, 76.9%; NPV, 88.9%).
This study shows that the detection of SE in the POD is possible using routine TVS. While negative TVS does not reliably confirm the absence of disease or replace diagnostic laparoscopy, positive TVS facilitates non-invasive diagnosis for a much larger group of women than was previously possible. This should help to reduce the time from the onset of symptoms to diagnosis and enable initiation of medical treatment without the risk, cost and delay associated with a surgical diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：大约80％的子宫内膜异位症女性患有浅表子宫内膜异位症（SE），而不是卵巢或深部子宫内膜异位症（DE）。然而,到目前为止,非侵入性的进步，基于影像学的诊断仅限于DE或卵巢疾病。这项研究的目的是通过评估道格拉斯袋（POD）的腹膜来确定我们是否可以在经阴道超声扫描（TVS）上检测SE。
方法：这是一项回顾性诊断测试研究，在伦敦一家三级医院的TVS期间，实践改变，包括POD腹膜对SE的评估。符合条件的患者在2018年4月至2021年9月期间接受了子宫内膜异位症扫描和后续外科手术（腹腔镜检查）的单一临床医生的TVS。参与者组成了连续的系列。将TVS结果与腹腔镜检查结果进行比较，以此作为金标准。通过计算诊断测试性能测量（灵敏度，特异性，阳性预测值(PPV)，阴性预测值(NPV)和阳性和阴性似然比)。
结果：本研究共纳入100名患者。我们发现43/100（43.0％）患者没有子宫内膜异位症，33/100（33.0％）在腹腔镜检查中有SE，24/100（24.0％）有DE。在17/33例患者的TVS上正确检测到SE，灵敏度为51.5%（95%CI，33.5-69.2%），特异性为94.0%（95%CI，85.4-98.4%），PPV为81.0%（95%CI，60.8-92.1%），NPV为79.7%（95%CI，73.4-84.9%）。在20/24例中正确诊断为DE，包括所有的卵巢病例,灵敏度为83.3%(95%CI，62.3-95.3%)，特异性为97.4%（95%CI，90.8-99.7%），PPV为90.9%（95%CI，71.6-97.5%），NPV为94.9%（95%CI，88.3-97.8%）。在TVS上检测SE在POD中最准确(灵敏度，50.0%；特异性，96.4%;PPV,76.9%；净现值，88.9%）。
结论：这项研究表明，使用常规TVS可以检测POD中的SE。虽然阴性TVS不能可靠地确认没有疾病或取代诊断性腹腔镜检查，阳性TVS有助于非侵入性诊断比以前可能的更大的女性群体.这应该有助于减少从症状发作到诊断的时间，并能够在没有风险的情况下开始医疗，与手术诊断相关的费用和延误。©2023作者。由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
方法：这是一项回顾性诊断测试研究，在伦敦一家三级医院的TVS期间，实践改变，包括POD腹膜对SE的评估。符合条件的患者在2018年4月至2021年9月期间接受了子宫内膜异位症扫描和后续外科手术（腹腔镜检查）的单一临床医生的TVS。参与者组成了连续的系列。将TVS结果与腹腔镜检查结果进行比较，以此作为金标准。通过计算诊断测试性能测量（灵敏度，特异性，阳性预测值(PPV)，阴性预测值(NPV)和阳性和阴性似然比)。
结果：本研究共纳入100名患者。我们发现43/100（43.0％）患者没有子宫内膜异位症，33/100（33.0％）在腹腔镜检查中有SE，24/100（24.0％）有DE。在17/33例患者的TVS上正确检测到SE，灵敏度为51.5%（95%CI，33.5-69.2%），特异性为94.0%（95%CI，85.4-98.4%），PPV为81.0%（95%CI，60.8-92.1%），NPV为79.7%（95%CI，73.4-84.9%）。在20/24例中正确诊断为DE，包括所有的卵巢病例,灵敏度为83.3%(95%CI，62.3-95.3%)，特异性为97.4%（95%CI，90.8-99.7%），PPV为90.9%（95%CI，71.6-97.5%），NPV为94.9%（95%CI，88.3-97.8%）。在TVS上检测SE在POD中最准确(灵敏度，50.0%；特异性，96.4%;PPV,76.9%；净现值，88.9%）。
结论：这项研究表明，使用常规TVS可以检测POD中的SE。虽然阴性TVS不能可靠地确认没有疾病或取代诊断性腹腔镜检查，阳性TVS有助于非侵入性诊断比以前可能的更大的女性群体.这应该有助于减少从症状发作到诊断的时间，并能够在没有风险的情况下开始医疗，与手术诊断相关的费用和延误。©2023作者。由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
