Meta-analysis and systematic review to determine the optimal imaging modality for the detection of rectosigmoid deep endometriosis

Bassem Gerges* (Corresponding Author), Wentao Li, M Leonardi, B W Mol, G Condous

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

OBJECTIVE: To review the diagnostic accuracy and determine the optimum imaging modality for the detection of rectosigmoid deep endometriosis (DE) in women with a clinical history of endometriosis.

METHODS: A systematic review was conducted using PubMed, Medline, Scopus, Embase and Google Scholar to identify studies published between January 1990 and May 2020. Studies were considered eligible if they were prospective and used any imaging modality pre-operatively to assess for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical data as the reference diagnosis. The eligibility of studies was restricted to those having at least 10 affected and 10 unaffected women. The QUADAS-2 tool was used to assess quality. This study was prospectively registered with PROSPERO (CRD42017059872).

RESULTS: Of the 1,977 references identified, 30 studies (n = 3,374) were included in the analysis. The overall pooled sensitivity and specificity, from which the likelihood ratio of a positive test (LR+), likelihood ratio of a negative test (LR-) and diagnostic odds ratio (DOR) were calculated, were as follows for transvaginal ultrasound (TVS) 89% (95% CI 83 - 93%), 97% (95% CI 95 - 98%), 28.8 (95% CI 16.2 - 51.0), 0.12 (95% CI 0.08 - 0.18) and 248 (95% CI 104 - 594), for magnetic resonance imaging (MRI) 86% (95% CI 79 - 81%), 97% (96% CI 94 - 97%), 21.0 (95% CI 13.4 - 33.1), 0.15 (95% CI 0.09 - 0.23), and 144 (95% CI 70 - 297), for computed tomography (CT) 93% (95% CI 84 - 97%), 95% (95% CI 81 - 99%), 20.3 (95% CI 4.3 - 94.9), 0.07 (95% CI 0.03 - 0.19), and 280 (95% CI 28 - 2826), and for transrectal endoscopic sonography (RES) 92% (95% CI 87 - 95%), 98% (95% CI 96 - 99%), 37.1 (95% CI 21.1 - 65.4), 0.08 (95% CI 0.05 - 0.14), and 455 (95% CI 196 - 1054), respectively. There was significant heterogeneity and the studies were considered poor methodologically according to the QUADAS-2 tool.

CONCLUSIONS: The sensitivity of transvaginal sonography (TVS) for the detection of DE seems to be slightly better than magnetic resonance imaging (MRI), although RES was superior to both. Specificity of both TVS and MRI were excellent. As TVS is the simpler, faster, and more readily available, we believe it should be the first line diagnostic tool for the women with suspected DE. This article is protected by copyright. All rights reserved.

Original languageEnglish
Number of pages67
JournalUltrasound in Obstetrics and Gynecology
Early online date10 Oct 2020
DOIs
Publication statusE-pub ahead of print - 10 Oct 2020

Keywords

  • endometriosis
  • imaging
  • pre-operative
  • laparoscopy
  • rectal
  • rectosigmoid
  • bowel
  • diagnosis

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