Applications of Ultrasound Elastography in Benign Gynecology: A Scoping Review

Abstract

<h3>Study Objective</h3> To synthesize the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for future research and clinical implementation. <h3>Design</h3> A structured search of EMBASE and Medline databases, last conducted on April 15^th, 2022. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Eligible studies included adult participants with female pelvises. <h3>Interventions</h3> English language papers focusing on the utility of ultrasound elastography applied to benign gynecology were included. Narrative reviews, conference abstracts, and letters to the editor were excluded. Two independent reviewers screened titles and abstracts for inclusion, a third reviewer was consulted in the case of disagreement. Study quality was assessed by a customized checklist for study implementation and elastography technique. Extracted data points included type of elastography, gynecologic application, opportunities for clinical implementation, and technology strengths and limitations. <h3>Measurements and Main Results</h3> The search returned 2026 studies, of which 542 were duplicates. A total of 48 studies were included for data extraction. Studies were published between 2013 and 2022. Studies most frequently used shear wave elastography as the method of UE (n=26), followed by strain elastography (n=19) and acoustic radiation force impulse (n=3). Ultrasound elastography was most frequently applied to the diagnosis of adenomyosis (n=12) and as a method to assess pelvic floor muscle function (n=12). Other areas studied included the identification of endometrial polyps and submucosal fibroids (n=4), of deeply infiltrating endometriosis (n=2), and the elastic properties of polycystic ovaries (n=6) and the uterine cervix (n=5). Identified limitations of the technology were the lack of published reference values for gynecologic organs and difficulties in assessing tissues deep to the transducer. Few studies were deemed of high quality. <h3>Conclusion</h3> Ultrasound elastography has been applied to a broad range of gynecologic pathologies. Future research is needed to establish elastography reference values for the female pelvis and expand on clinical applications of this technology in gynecology.