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Padmehr, R., Shadjoo, K., Mohazzab, A., Gorgin, A., Karegar, R., Jaberipour, P., Sehat, Z., & Maleki, N. (2023). Transvaginal sonography and surgical findings in the diagnosis of endometriosis individuals: A cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 21(6), 471–480. https://doi.org/10.18502/ijrm.v21i6.13634
https://doi.org/10.18502/ijrm.v21i6.13634
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authors
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Roya Padmehr
Roya Padmehr
Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.
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Khadijeh Shadjoo
Khadijeh Shadjoo
Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.
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Arash Mohazzab
Arash Mohazzab
Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran.
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Atefeh Gorgin
Atefeh Gorgin
Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran.
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Roxana Karegar
Roxana Karegar
Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran.
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Parvin Jaberipour
Parvin Jaberipour
Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran.
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Zahra Sehat
Zahra Sehat
Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran.
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Narges Maleki
Narges Maleki
Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran.
Published Date
- Jul 19, 2023
Transvaginal sonography and surgical findings in the diagnosis of endometriosis individuals: A cross-sectional study
Abstract
Background: Endometriosis is a challenging gynecological disease and a debilitating condition that profoundly affects the individual’s quality of life. Besides pathological confirmation, diagnostic laparoscopy has been internationally accepted as the standard method to identify the accurate mapping of endometriosis. Transvaginal sonography (TVS) is the first non-invasive imaging modality to estimate the severity of endometriosis.
Objective: This study aimed to evaluate the accuracy of TVS in affected women compared with surgical findings.
Materials and Methods: This retrospective cross-sectional study surveyed 170 women with deep infiltrating endometriosis (DIE) referred to the endometriosis part of the Avicenna Infertility Center, Tehran, Iran and they underwent TVS followed by laparoscopy. Recorded data of individuals under study in the medical database system were reviewed. Finally, the agreement rate was calculated for ultrasound reports and intraoperative (IO) findings regarding ovarian endometrium, ovarian adhesion, involvement of cul-de-sac, rectovaginal septum, and bowel and ureter.
Results: 170 women with DIE entered the study. The agreement of TVS and IO findings were 86.76% for left ovarian endometriosis and 70.86% for right ovarian endometriosis, 93.90% for left ovarian adhesion, and 88.90% for right ovarian adhesion, 88.90% for a cul-de-sac, and 84.82% for bowel nodules. The findings, based on a laparoscopic assessment of the pelvic floor, were completely compatible with ultrasound reports (100%).
Conclusion: TVS allows a preoperative evaluation in planning the surgical policy associated. TVS is beneficial for dedicated mapping of DIE; thus, an expert radiologist can aid the surgeon in preoperative evaluation and IO management.
Key words: Endometriosis, Laparoscopy, Pathology.
References
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[2] Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, et al. Endometriosis: Clinical features, MR imaging findings and pathologic correlation. Insights Imaging 2018; 9: 149–172.
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[4] Nouri B, Sarani S, Arab M, Bakhtiari M, Sarbazi F, Karimi A. Comparative study of laparoscopic versus laparotomic surgery for adnexal masses. J Obstet Gynecol Cancer Res 2022; 7: 230–234.
[5] Turocy JM, Benacerraf BR. Transvaginal sonography in the diagnosis of deep infiltrating endometriosis: A review. J Clin Ultrasound 2017; 45: 313–318.
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[14] Deslandes A, Parange N, Childs JT, Osborne B, Bezak E. Current status of transvaginal ultrasound accuracy in the diagnosis of deep infiltrating endometriosis before surgery: A systematic review of the literature. J Ultrasound Med 2020; 39: 1477–1490.
[15] Mattar OM, Namous LO, Ros M, Fathi M, Elgendy FA, Elghazaly SM, et al. Efficacy and safety of Elagolix in the treatment of endometriosis associated pain: A systematic review and network meta-analysis. Proc Obstet Gynecol 2021; 10: 13–26.
[16] Bean E, Naftalin J, Jurkovic D. How to assess the ureters during pelvic ultrasound. Ultrasound Obstet Gynecol 2019; 53: 729–733.
[17] Lima R, Abdalla-Ribeiro H, Nicola AL, Eras A, Lobao A, Ribeiro PA. Endometriosis on the uterosacral ligament: A marker of ureteral involvement. Fertil Steril 2017; 107: 1348–1354.
[18] Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, et al. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril 2014; 102: 143–150.e2.
[19] Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, et al. Ureteral endometriosis: A systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2018; 24: 710–730.
[20] Jeon I, Kong E. Application of simultaneous 18F-FDG PET/MRI for evaluating residual lesion in pyogenic spine infection: A case report. Infect Chemother 2020; 52: 626–633.
[21] Salaffi F, Ceccarelli L, Carotti M, Di Carlo M, Polonara G, Facchini G, et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician? Radiol Med 2021; 126: 843–859.
[22] Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of endometriosis: Looking beyond the endometrioma with a dedicated protocol. Radiographics 2019; 39: 1549–1568.
[23] Keckstein J, Hoopmann M, Merz E, Grab D, Weichert J, Helmy-Bader S, et al. Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Arch Gynecol Obstet 2023; 307: 5–19.
[24] Daniilidis A, Grigoriadis G, Dalakoura D, D’Alterio MN, Angioni S, Roman H. Transvaginal ultrasound in the diagnosis and assessment of endometriosis-an overview: How, why, and when. Diagnostics 2022; 12: 2912.
[25] Gerges B, Li W, Leonardi M, Mol BW, Condous G. Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis. Hum Reprod Open 2021: hoab041.
[26] Hudelist G, Aas-Eng MK, Birsan T, Berger F, Sevelda U, Kirchner L, et al. Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis-A prospective cohort study. Acta Obstet Gynecol Scand 2018; 97: 1438–1446.
[27] Working group of ESGE, ESHRE, and WES, Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, et al. Recommendations for the surgical treatment of endometriosis Part 2: Deep endometriosis. Facts Views Vis Obgyn 2019; 11: 269–297.
[2] Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, et al. Endometriosis: Clinical features, MR imaging findings and pathologic correlation. Insights Imaging 2018; 9: 149–172.
[3] Aas-Eng MK, Montanari E, Lieng M, Keckstein J, Hudelist G. Transvaginal sonographic imaging and associated techniques for diagnosis of ovarian, deep endometriosis, and adenomyosis: A comprehensive review. Semin Reprod Med 2020; 38: 216–226.
[4] Nouri B, Sarani S, Arab M, Bakhtiari M, Sarbazi F, Karimi A. Comparative study of laparoscopic versus laparotomic surgery for adnexal masses. J Obstet Gynecol Cancer Res 2022; 7: 230–234.
[5] Turocy JM, Benacerraf BR. Transvaginal sonography in the diagnosis of deep infiltrating endometriosis: A review. J Clin Ultrasound 2017; 45: 313–318.
[6] Guerriero S, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, et al. Deep infiltrating endometriosis: Comparison between 2-dimensional ultrasonography (US), 3-dimensional US, and magnetic resonance imaging. J Ultrasound Med 2018; 37: 1511–1521.
[7] Alborzi S, Rasekhi A, Shomali Z, Madadi G, Alborzi M, Kazemi M, et al. Diagnostic accuracy of magnetic resonance imaging, transvaginal, and transrectal ultrasonography in deep infiltrating endometriosis. Medicine 2018; 97: e9536.
[8] Akbari E, Sarbazi F, Karimi A, Nouri B, Noori Ardebili S. Comparison of laparoscopic myomectomy outcomes based on myoma weight: A cross-sectional study. Int J Women’s Health Reprod Sci 2022; 10: 16–18.
[9] Sarbazi F, Akbari E, Karimi A, Nouri B, Noori Ardebili SH. The clinical outcome of laparoscopic surgery for endometriosis on pain, ovarian reserve, and cancer antigen 125 (CA-125): A cohort study. Int J Fertil Steril 2021; 15: 275–279.
[10] Guerriero S, Martinez L, Gomez I, Pascual MA, Ajossa S, Pagliuca M, et al. Diagnostic accuracy of transvaginal sonography for detecting parametrical involvement in women with deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021; 58: 669–676.
[11] Carfagna P, De Cicco Nardone C, De Cicco Nardone A, Testa AC, Scambia G, Marana R, et al. Role of transvaginal ultrasound in evaluation of ureteral involvement in deep infiltrating endometriosis. Ultrasound Obstet Gynecol 2018; 51: 550–555.
[12] Moura APC, Ribeiro HSAA, Bernardo WM, Simoes R, Torres US, D’Ippolito G, et al. Correction: Accuracy of transvaginal sonography versus magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: Systematic review and meta-analysis. PLoS One 2019; 14: e0221499.
[13] Hernandez Gutierrez A, Spagnolo E, Hidalgo P, Lopez A, Zapardiel I, Rodriguez R. Magnetic resonance imaging versus transvaginal ultrasound for complete survey of the pelvic compartments among patients with deep infiltrating endometriosis. Int J Gynecol Obstet 2019; 146: 380–385.
[14] Deslandes A, Parange N, Childs JT, Osborne B, Bezak E. Current status of transvaginal ultrasound accuracy in the diagnosis of deep infiltrating endometriosis before surgery: A systematic review of the literature. J Ultrasound Med 2020; 39: 1477–1490.
[15] Mattar OM, Namous LO, Ros M, Fathi M, Elgendy FA, Elghazaly SM, et al. Efficacy and safety of Elagolix in the treatment of endometriosis associated pain: A systematic review and network meta-analysis. Proc Obstet Gynecol 2021; 10: 13–26.
[16] Bean E, Naftalin J, Jurkovic D. How to assess the ureters during pelvic ultrasound. Ultrasound Obstet Gynecol 2019; 53: 729–733.
[17] Lima R, Abdalla-Ribeiro H, Nicola AL, Eras A, Lobao A, Ribeiro PA. Endometriosis on the uterosacral ligament: A marker of ureteral involvement. Fertil Steril 2017; 107: 1348–1354.
[18] Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, et al. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril 2014; 102: 143–150.e2.
[19] Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, et al. Ureteral endometriosis: A systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2018; 24: 710–730.
[20] Jeon I, Kong E. Application of simultaneous 18F-FDG PET/MRI for evaluating residual lesion in pyogenic spine infection: A case report. Infect Chemother 2020; 52: 626–633.
[21] Salaffi F, Ceccarelli L, Carotti M, Di Carlo M, Polonara G, Facchini G, et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician? Radiol Med 2021; 126: 843–859.
[22] Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of endometriosis: Looking beyond the endometrioma with a dedicated protocol. Radiographics 2019; 39: 1549–1568.
[23] Keckstein J, Hoopmann M, Merz E, Grab D, Weichert J, Helmy-Bader S, et al. Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Arch Gynecol Obstet 2023; 307: 5–19.
[24] Daniilidis A, Grigoriadis G, Dalakoura D, D’Alterio MN, Angioni S, Roman H. Transvaginal ultrasound in the diagnosis and assessment of endometriosis-an overview: How, why, and when. Diagnostics 2022; 12: 2912.
[25] Gerges B, Li W, Leonardi M, Mol BW, Condous G. Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis. Hum Reprod Open 2021: hoab041.
[26] Hudelist G, Aas-Eng MK, Birsan T, Berger F, Sevelda U, Kirchner L, et al. Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis-A prospective cohort study. Acta Obstet Gynecol Scand 2018; 97: 1438–1446.
[27] Working group of ESGE, ESHRE, and WES, Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, et al. Recommendations for the surgical treatment of endometriosis Part 2: Deep endometriosis. Facts Views Vis Obgyn 2019; 11: 269–297.