Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis.

Marco Noventa,Donato D’Antona,Antonio Simone Laganà,Michele Schincariol,Marco Scioscia,Erich Cosmi,Francesco Dessole,Guido Ambrosini,Bruna Virgilio,Giovanni Pontrelli,Amerigo Vitagliano,Salvatore Giovanni Vitale,Alessandra Andrisani,Carlo Saccardi,Francesco Cavallin

doi:10.3390/diagnostics9040225

Abstract

Objectives: A meta-analysis, with a head-to-head approach, was carried out to compare the three most common techniques for a deep pelvic endometriosis (DPE) diagnosis. We focused on: transvaginal-sonography (TVS), magnetic-resonance imaging (MRI), and rectal-endoscopy-sonography (RES). Methods: Electronic databases were searched from their inception until December 2018. All prospective and well-defined retrospective studies carried out in tertiary referral centers were considered. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesizing Evidence from Diagnostic Accuracy Tests (SEDATE) guidelines. We considered only papers in which at least two imaging modalities were compared in the same set of patients (head-to-head approach). Meta-analysis of diagnostic test accuracy (DTA) was performed separately for each location of interest. Bivariate or univariate approach has been applied when appropriate. We analyze the DTA of TVS vs. MRI, TVS vs. RES, and MRI vs. RES. Results: Our meta-analysis (17 studies included) showed high-to-moderate DTA of TVS for all endometriosis locations (apart from recto-vaginal septum (RVS)) that were not statistically different from MRI and RES for those localized in the posterior compartment. RES results were more accurate than MRI for RS lesions but less accurate than TVS for other pelvic locations, except for RVS. Conclusions: All approaches provide good accuracy with specific strong points. Ultrasonography demonstrated a diagnostic accuracy not inferior to MRI and RES; therefore, it must be considered the primary approach for DPE diagnosis. MRI has to be considered as a valuable approach in settings where highly skilled sonographers are not available. Keypoints: (1) We confirmed the non-inferiority of TVS compared to MRI and RES for the diagnosis of specific pelvic anatomic location of endometriosis lesions. (2) Ultrasonography could be considered the primary approach for DPE diagnosis (less invasive than RES and less expensive than MRI). (3) MRI has to be considered as a valuable approach in settings where skilled sonographers are not available.

Highlights

(2) Ultrasonography could be considered the primary approach for deep pelvic endometriosis (DPE) diagnosis. (3) magnetic-resonance imaging (MRI) has to be considered as a valuable approach in settings where skilled sonographers are not available
The prevalence of deep pelvic endometriosis (DPE) is estimated in 15–30% of all women affected by the disease; it is a source of chronic pelvic pain, infertility, and reduced quality of life [1,2,3,4]
Ten manuscripts were included in the first section of TVS versus MRI [17,21,23,24,25,26,27,28,30,31]; eight manuscripts were included in the second section of TVS versus RES [15,18,20,21,22,24,28,30] and seven manuscripts were included in the third section of MRI versus RES [16,19,21,24,28,29,30]

Summary

Introduction

The prevalence of deep pelvic endometriosis (DPE) is estimated in 15–30% of all women affected by the disease; it is a source of chronic pelvic pain, infertility, and reduced quality of life [1,2,3,4]. Different imaging modalities have been proposed for its early diagnosis with contrasting results [1,2,3,4]. The most studied techniques are trans-vaginal sonography (TVS), magnetic resonance imaging (MRI), and rectal-endoscopy sonography (RES) [1,2,5]. TVS is proposed as a first line technique, its diagnostic accuracy varies considerably both for the same and for different DPE locations [1,2,6,7,8,9]. RES demonstrated a good diagnostic accuracy especially for recto-sigmoid (RS), recto-vaginal septum (RVS), and vaginal-wall and vaginal-fornix (VW & VF), but it may be considered as a second-line approach due to its invasiveness [1]. Two recent meta-analyses suggested a good diagnostic accuracy of MRI for all DPE locations, but it seems only slightly superior compared to TVS [6,7,9,10]

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Discussion

Conclusion