Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis.

Autor: Guerriero S; Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy.; Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, Monserrato, Italy., Ajossa S; Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy., Pascual MA; Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain., Rodriguez I; Unidad Epidemiología y Estadística, Departamento de Obstetricia, Ginecología y Reproducción, Hospital Universitario Dexeus, Barcelona, Spain., Piras A; Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy., Perniciano M; Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy., Saba L; Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Monserrato, Italy., Paoletti AM; Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy., Mais V; Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy., Alcazar JL; Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Jazyk: angličtina
Zdroj: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2020 Feb; Vol. 55 (2), pp. 269-273.
DOI: 10.1002/uog.20289
Abstrakt: Objectives: The aim of this study was to evaluate the use of ultrasound (US) soft markers as a first-line imaging tool to raise suspicion of rectosigmoid (RS) involvement in women suspected of having deep endometriosis.
Methods: We included in this prospective observational study all patients with clinical suspicion of deep endometriosis who underwent diagnostic transvaginal US evaluation at our unit from January 2016 to February 2017. Several US soft markers were evaluated for prediction of RS involvement (presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesion of the ovary to the uterus (reduced ovarian mobility), presence of 'kissing ovaries' (KO) and absence of the 'sliding sign'), using as the gold standard expert US examination for the presence of RS endometriosis.
Results: Included were 333 patients with clinical suspicion of deep endometriosis. Of these, 106 had an US diagnosis of RS endometriosis by an expert. The only significant variables found in the prediction model were absence of the sliding sign (odds ratio (OR), 13.95; 95% CI, 7.7-25.3), presence of KO (OR, 22.5; 95% CI, 4.1-124.0) and the interaction between these two variables (OR, 0.03; 95% CI, 0.004-0.28). Regarding their interaction, RS endometriosis was present when KO was absent and the sliding sign was present in 10% (19/190) of cases, when both KO and the sliding sign were present in 71.4% (5/7) of cases, when both KO and the sliding sign were absent in 60.8% (76/125) of cases and when KO was present and the sliding sign was absent in 54.5% (6/11) of cases. Thus, when the sliding sign was absent and/or KO was present, transvaginal US showed a specificity of 75% (95% CI, 69-80%) and a sensitivity of 82% (95% CI, 73-88%).
Conclusions: US findings of absence of the sliding sign and/or presence of KO in patients with clinical suspicion of endometriosis should raise suspicion of RS involvement and indicate referral for expert US examination, with a low rate of false-negative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
(Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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