Accuracy of combined physical examination, transvaginal ultrasonography, and magnetic resonance imaging to diagnose deep endometriosis

Abstract

To assess the ability of Physical Examination (PE), Transvaginal Ultrasonography (TVUS), and Magnetic Resonance Imaging (MRI) alone and combined to diagnose Deep Infiltrating Endometriosis (DIE). We retrospectively queried our pelvic MRI database to identify women who underwent PE, TVUS, and pelvic MRI for DIE up to 12 months prior to surgery between January 1, 2016 and August 31, 2020. The presence of uterosacral ligaments (USL), vaginal, rectosigmoid (RS), parametrial or sacrorectogenital septum (lateral) DIE shown by PE, TVUS and MRI were correlated with surgical and histological findings. We included 178 patients. The sensitivity, specificity, positive and negative predictive values, and accuracy of each technique separately and combined were assessed for each location. When the three techniques were combined, two models were tested: A) all three techniques positive and concordant, and B) at least two techniques positive and concordant. The prevalence of USL, vaginal, RS, and lateral DIE were 94.4%, 20.2%, 34.3% and 32.6%, respectively. MRI was more sensitive than PE, TVUS or any combination to detect DIE. MRI and model B were the most accurate for detecting USL and RS locations with an accuracy of 90.4% and 82.6%, a sensitivity of 91.1% and 50%, and a specificity of 77.8% and 90.9%, respectively. Model B was the most accurate for the vaginal location with an accuracy of 82.6%, a sensitivity of 50%, and a specificity of 90.9%. Finally, MRI was more accurate than any combination for identifying a lateral location with an accuracy of 75.1%, a sensitivity of 36%, and a specificity of 93.8%. A combination of PE, TVUS and MRI more accurate than each technique separately to diagnose DIE due to the equally high sensitivity of each, and the high specificity of PE and TVUS.