Literature Review of the Use of Transvaginal Ultrasound for Rectovaginal Endometriosis

Abstract

<h3>Study Objective</h3> To review recent literature in the Journal of Minimally Invasive Gynecology (JMIG), the only peer-reviewed journal dedicated to minimally invasive gynecologic surgery, on the use of transvaginal ultrasound (TVU) in patients with rectovaginal endometriosis (RVE). <h3>Design</h3> An all-content search of "rectovaginal endometriosis transvaginal ultrasound" on JMIG.org. <h3>Setting</h3> JMIG.org. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The search retrieved 135 results of which 56 were from the last five years. Of these, 22 addressed TVU for RVE patients: 16 research articles, 3 abstracts, 2 editorials, and 1 case report. The research articles were assigned Canadian Task Force classifications to evaluate quality. Only 3 reached level II-1 and none reached level I. There was an even mix of prospective, retrospective studies and case reports. <h3>Conclusion</h3> The majority of articles currently cite TVU as first-line imaging in RVE, but more work is needed to harness sonography's potential. The three studies that met the II-1 classification reviewed conditions that improved TVU's accuracy for RVE, e.g., when used with bowel prep. Presently, use of TVU for RVE is wide-ranging and unstructured. The most common uses include preoperative diagnosis, comparison with different imaging and comparison to histopathology, long-term maintenance and fertility assessment. Clinician experience and limited collaboration can create variability in ultrasound data. As TVU is more globally accessible than other imaging modalities, training gynecologists in endometriosis ultrasound can improve diagnosis and preoperative planning for RVE patients. Given its lower cost, accessibility, and high sensitivity and specificity for endometriosis, TVU is poised to improve patient outcomes for RVE patients. This review of recent literature in <i>JMIG</i> on TVU for RVE indicates a need for standardized structured imaging reports, guidelines, and support. In keeping with <i>JMIG'</i>s mission to improve the quality and safety of healthcare for women through access to minimally invasive surgical options, we must work towards the full potential of ultrasound imaging.