Prediction of MBS Item Codes for Endometriosis Surgery Using Transvaginal Ultrasound.

This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors and the authors declare no competing interests.

How is endometriosis extent described by the #Enzian classification compared to the revised American Society for Reproductive Medicine (rASRM) stages in women undergoing radical surgery for deep endometriosis (DE)? The prevalence and severity grade of endometriotic lesions and adhesions as well as the total number of #Enzian compartments affected by DE increase on average with increasing rASRM stage; however, DE lesions are also present in rASRM stages 1 and 2, leading to an underestimation of disease severity when using the rASRM classification. Endometriotic lesions can be accurately described regarding their localization and severity by sonography as well as during surgery using the recently updated #Enzian classification for endometriosis. This was a prospective multicenter study including a total of 735 women between January 2020 and May 2021. Disease extent in women undergoing radical surgery for DE at tertiary referral centers for endometriosis was intraoperatively described using the #Enzian and the rASRM classification. A total of 735 women were included in the study. Out of 31 women with rASRM stage 1, which is defined as only minimal disease, 65% (i.e. 20 women) exhibited DE in #Enzian compartment B (uterosacral ligaments/parametria), 45% (14 women) exhibited DE in #Enzian compartment A (vagina/rectovaginal septum) and 26% (8 women) exhibited DE in #Enzian compartment C (rectum). On average, there was a progressive increase from rASRM stages 1-4 in the prevalence and severity grade of DE lesions (i.e. lesions in #Enzian compartments A, B, C, FB (urinary bladder), FU (ureters), FI (other intestinal locations), FO (other extragenital locations)), as well as of endometriotic lesions and adhesions in #Enzian compartments P (peritoneum), O (ovaries) and T (tubo-ovarian unit). In addition, the total number of #Enzian compartments affected by DE lesions on average progressively increased from rASRM stages 1-4, with a maximum of six affected compartments in rASRM stage 4 patients. Interobserver variability may represent a possible limitation of this study. The #Enzian classification includes the evaluation of DE in addition to the assessment of endometriotic lesions and adhesions of the ovaries and tubes and may therefore provide a comprehensive description of disease localization and extent in women with DE. No funding was received for this study. All authors declare that they have no conflict of interest. N/A.

Ovarian cancer, the second most common gynecological malignancy, accounts for 3% of all cancers among women in the United States, and has a high mortality rate, largely because existing therapies for widespread disease are rarely curative. Ovarian endometrioid adenocarcinoma (OEA) accounts for about 20% of the overall incidence of all ovarian cancer. We have used proteomics profiling to characterize low stage (FIGO stage 1 or 2) versus high stage (FIGO stage 3 or 4) human OEAs. In general, the low stage tumors lacked p53 mutations and had frequent CTNNB1, PTEN, and/or PIK3CA mutations. The high stage tumors had mutant p53, were usually high grade, and lacked mutations predicted to deregulate Wnt/β-catenin and PI3K/Pten/Akt signaling. We utilized 2-D liquid-based separation/mass mapping techniques to elucidate molecular weight and pI measurements of the differentially expressed intact proteins. We generated 2-D protein mass maps to facilitate the analysis of protein expression between both the low stage and high stage tumors. These mass maps (over a pI range of 5.6-4.6) revealed that the low stage OEAs demonstrated protein over-expression at the lower pI ranges (pI 4.8-4.6) in comparison to the high stage tumors, which demonstrated protein over-expression in the higher pI ranges (pI 5.4-5.2). These data suggest that both low and high stage OEAs have characteristic pI signatures of abundant protein expression probably reflecting, at least in part, the different signaling pathway defects that characterize each group. In this study, the low stage OEAs were distinguishable from high stage tumors based upon the proteomic profiles. Interestingly, when only high-grade (grade 2 or 3) OEAs were included in the analysis, the tumors still tended to cluster according to stage, suggesting that the altered protein expression was not solely dependent upon tumor cell differentiation. Further, these protein profiles clearly distinguish OEA from other types of ovarian cancer at the protein level.

Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001). We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

7062 Background: Pathogenesis of symptomatic CLL involves genetic changes associated with the CLL clone and changes within the microenvironment which contribute to chemo-resistance. To further understand these processes we compared early stage CLL to symptomatic late stage CLL using gene expression profiling as well as serum cytokine profiling for a better insight of the genetic and microenvironment changes associated with the most severe forms of the disease. Methods: We obtained pretreatment blood samples from CLL patients (10 low stage and 14 high stage) at the time of diagnosis. Patients were classified as low stage (Rai stage 0/I/II) and high stage (Rai stage III/IV). Gene expression profiles were obtained on a subset of patients using the HG-U133A 2.0 Affymetrix platform and analyzed for differential gene expression profiles. Serum from a subset of patients was used to perform cytokine profiling using the Raybiotech Cytokine Array platform (AAH-CYT-G1000) that allows for simultaneous measurement of &gt;100 different cytokines. Results: Comparison of low versus high stage CLL revealed a set of 21 differentially expressed genes. 15 genes were up regulated in the high stage versus low stage, while 6 genes were down regulated. GO Molecular function analysis revealed that 9 of the 21 genes are involved in transcription factor activity. Other genes up regulated in the high stage group include CSNK1- shown to be involved in Myc derived oncogenesis and SETD8- a histone lysine methyltransferase previously implicated in several cancers. Serum cytokine profiles showed 6 cytokines to be significantly different in high stage patients. Two chemokines SDF-1/CXCL12 and uPAR known to be involved in stem cell mobilization and homing are increased in the serum of high stage patients. IGFBP-2, BMP-4 and MCP-4 were lower among high stage patients. Conclusions: Our study revealed a novel group of transcription factors are associated with higher stage CLL. Cytokine profiling showed increased levels of SDF-1/CXCL12, a chemokine that plays a key role in mobilization and homing of hematopoietic stem and CLL cells in high stage patients. Our study identifies putative therapeutic targets including CSNK1, SDF-1 and SETD8 for patients with high stage CLL.

Observational and randomized studies designed to compare surgical and medical therapies in patients with left main coronary artery disease (LMCD) have shown that coronary artery bypass graft (CABG) surgery prolongs life in most patients with LMCD. The present report of 1484 patients with LMCD in the Coronary Artery Surgery Study (CASS) Registry extends the originally published 5-year surgical and medical group survival analysis to more than 16 years of follow-up and permits analysis of LMCD patient subgroups. The CASS Registry contains 1484 patients with > or = 50% left main coronary artery stenosis initially treated with either surgical or nonsurgical therapy. The 15-year cumulative survival estimates were 37% for the 1153 patients in the surgical group compared with 27% for the 331 patients in the medical group. Median survival in the surgical group was 13.3 years (12.8 to 13.8 years, 95% confidence limits) compared with only 6.6 years (5.4 to 7.9 years) in the medical group (difference, 6.7 years; P < .0001). Median survival was also significantly longer in the surgical group stratified by age, sex, anginal class, left ventricular (LV) function, coronary anatomy, and the extent of LMCD. However, CABG surgery did not significantly prolong median survival in patient subgroups with (1) left main coronary stenosis of 50% to 59%; (2) normal LV systolic function; (3) normal or mildly abnormal LV systolic function and a right coronary artery stenosis > or = 70%; and (4) a nonstenotic (< or = 70%) right coronary artery. The 15-year cumulative survival for patients with normal LV systolic function in the surgical and medical groups was 42% and 51%, respectively. Median survival was 14.7 years in the surgical group and > 15 years in the medical group (P = NS). In patients with normal LV systolic function and a right coronary artery stenosis > or = 70%, the 15-year cumulative survival rates were also similar in the surgical and medical groups (40% and 48%, respectively). Median survival was 14.3 years in the surgical group and 14.2 years in the medical group (P = NS). The 15-year cumulative survival estimates for all subgroups were affected by convergence of the surgical and medical survival group curves owing to a disproportionate increase in the late surgical group mortality. Overall, 25% of patients in the medical group ultimately underwent CABG surgery. If all medical group patients had survived long enough, about 47% would be estimated to have had surgery by 15 years. This report, which extends follow-up of more than 16 years in CASS Registry patients with LMCD, shows that CABG surgery prolongs life in most clinical and angiographic subgroups. However, median survival was not prolonged by CABG surgery in patients with normal LV systolic function, even if a significant right coronary artery stenosis (> or = 70%) also was present. These results extend our understanding of the natural history of LMCD and permit a more accurate estimate of long-term surgical and medical group survival.

Does a "delay in diagnosis" lead to a child being diagnosed with advanced stage as opposed to early stage medulloblastoma? Correlation between the duration of a patient's presenting symptoms and stage at diagnosis was examined. The population consisted of 72 consecutive patients with histologically proven medulloblastoma diagnosed between July 1, 1983 and July 31, 1995. A standard history and physical examination format was used to record the nature and duration of presenting symptoms. Patients were staged by use of the operative findings, pre- and postoperative cranial computed tomography (CT) scans and, later in the series, cranial magnetic resonance imaging (MRI) studies and, for determination of the M stage, myelography, spinal MRI, and postoperative cerebrospinal fluid cytology. There were 40 males (56%) and 32 females (44%) with a mean age of 11.8 years. The most common presenting symptoms were vomiting (67%), headache (60%), ataxia (40%), and nausea (39%). By the Chang-Harisiadis (CH) system, 39 patients (54%) were found to have high stage medulloblastoma (T3b-4M0 or any TM1-4), 27 (38%) had low stage disease (T1-3aM0), and in 6 (8%) the stage could not be fully determined. By the Langston modification of the Change-Harisiadis system (LCH) 38 patients (54%) had high stage, 24 (32%) had low stage, and in 10 (14%) the stage could not be fully determined. Fifty of the 66 patients for whom the duration of symptoms was known (76%) had < or = 3 months of symptoms prior to stage. High CH stage patients had a mean duration of symptoms of 7.4 +/- 6.9 weeks versus 19.5 +/- 22.5 weeks for low stage patients. (P < 0.001). High LCH stage patients had a mean duration of symptoms of 7 +/- 6.6 weeks versus 15.4 +/- 16.4 weeks for low stage patients (P < 0.01). Patients ultimately found to have MO disease were diagnosed more slowly (16.1 +/- 20 weeks) than those with M1 (7.3 +/- 5.3 weeks), M2 (6 +/- 5.3 weeks), or M3 disease (6.8 +/- 5.9 weeks) M0 vs. M1-3, P < 0.02). No patients had M4 disease. Using an alternative definition of high versus low stage (T4M0 or any TM1-4 vs. T1-3bM0) currently under consideration by pediatric oncologists, the duration of symptoms remained significantly longer for low stage disease in the CH system (high vs. low, 7.2 +/- 5.8 weeks vs. 17.5 +/- 19.1 weeks, P < 0.01) but not in the LH system (high vs. low, 10.6 +/- 16.1 weeks vs. 13.9 +/- 15.9 weeks, P not significant). A short duration of symptoms is associated with the diagnosis of more advanced medulloblastoma. This finding has significant potential implications for the identification of prognostic groups in medulloblastoma as well as medical-legal claims of "delay in diagnosis" and capitated health care issues.

BackgroundPrevious studies have shown that due to the presence of endometrium progesterone resistance in patients with endometriosis, it is considered that higher levels of progesterone may be required to achieve live birth during programmed frozen-thawed embryo transfer (FET) cycles. Currently, the optimal progesterone support in FET cycles remains a contentious issue, and it mainly focused on the general infertile population, without specific attention to infertile patients with endometriosis. This study aimed to compare the pregnancy outcomes between vaginal or intramuscular progesterone administration in patients with endometriosis, and to determine whether the stage of endometriosis moderates the differences.MethodsThis retrospective cohort study included patients with endometriosis who underwent their first single frozen-thawed blastocyst transfer in a programmed cycle from January 2018 to April 2024 at a university-affiliated reproductive medical center. According to the routes of luteal support, patients were divided into vaginal progesterone and intramuscular progesterone groups. Analyses were conducted using multivariate regression models and subgroup analysis. Interaction tests were employed to determine whether the revised American Society for Reproductive Medicine (r-ASRM) stages of endometriosis moderated the differences between the routes of progesterone administration and pregnancy outcomes.ResultsA total of 825 programmed frozen-thawed blastocyst transfer cycles were included in the analysis, with 362 cases using vaginal progesterone and 463 cases using intramuscular progesterone. In the overall cohort, clinical pregnancy rate of the vaginal progesterone group was 49.17%, comparable to 44.06% of the intramuscular progesterone group (aOR 0.82, 95% CI 0.61–1.11). Similarly, there was no statistically significant difference in miscarriage rates between the two groups (16.85% versus 24.51%; aOR 1.57, 95% CI 0.90–2.75). In the subgroup analysis in patients classified as r-ASRM stages I-II, clinical pregnancy rate of vaginal progesterone group was significantly higher than that of intramuscular group (aOR 0.74, 95% CI 0.58–0.93, P = 0.011). Whereas, in patients with stages III-IV, no significant differences in pregnancy outcomes between the two groups were detected. Interaction tests between the routes of progesterone administration and r-ASRM stages were significant (P = 0.036).ConclusionsIn the first single frozen-thawed blastocyst transfer cycles for endometriosis patients with r-ASRM stages I-II, vaginal progesterone favours a higher clinical pregnancy rate compared to the intramuscular progesterone.

Combined severe proximal left anterior descending and proximal left circumflex coronary artery disease, or left main equivalent (LMEQ) disease, defines a prognostic high-risk angiographic subset of patients with chronic ischemic heart disease. While numerous observational and randomized clinical trials showed prolonged survival in surgically compared with medically treated patients with left main coronary artery disease, relatively few observational studies compared surgical and medical therapies in patients with LMEQ disease. The present report of 912 patients with LMEQ disease in the Coronary Artery Surgery Study (CASS) Registry extends the originally published 5-year surgical and medical group survival analysis to more than 16 years of follow-up and permits analysis of LMEQ patient subgroups. The CASS Registry contains 912 patients with LMEQ disease, defined as combined stenoses of > or = 70% in the proximal left anterior descending coronary artery before the first septal perforator and proximal circumflex coronary artery before the first obtuse marginal branch, initially treated with either surgical or nonsurgical therapy. The 15-year cumulative survival estimates were 44% for the 630 patients in the surgical group and 31% for the 282 patients in the medical group. Median survival in the surgical group was 13.1 years (12.7 to 14.1 years, 95% confidence limits) compared with only 6.2 years (4.8 to 7.9 years) in the medical group (difference, 6.9 years; P < .0001). Median survival was also significantly longer in the surgical group stratified by age, sex, anginal class, left ventricular (LV) function, and coronary anatomy. However, coronary artery bypass graft (CABG) surgery did not significantly prolong median survival in patient subgroups with (1) normal LV systolic function, even if a significant right coronary artery stenosis (> or = 70%) also was present, and (2) mildly abnormal (LV score, 6 to 10) LV systolic function. The 15-year cumulative survival in patients with normal LV systolic function in the surgical and medical groups was 63% and 54%, respectively. Median survival was > 15 years in both the surgical and medical groups (P = NS). In patients with normal LV systolic function and right coronary artery stenosis > or = 70%, the 15-year cumulative survival was also similar in the surgical and medical groups (63% and 53%, respectively). Median survival was > 15 years in both the surgical and medical groups (P = NS). The 15-year cumulative survival estimates in all subgroups were affected by convergence of the surgical and medical group survival curves caused by a disproportionate increase in late surgical group mortality. Overall, 26% of patients in the medical group ultimately underwent CABG surgery. If all medical group patients had survived long enough, about 65% would be estimated to have had surgery by 15 years. When the CASS Registry patients with LMEQ disease who participated in the randomized trial or who were randomizable were analyzed, CABG surgery did not prolong the 15-year cumulative survival estimates compared with nonsurgical therapy for randomized (71% versus 67%, respectively) and for randomizable patients (62% versus 92%, respectively) with an LV ejection fraction > or = 50%. This report, which extends follow-up of more than 16 years in CASS Registry patients with LMEQ disease, shows that CABG surgery prolongs life in most clinical and angiographic subgroups. However, median survival was not prolonged by CABG surgery in patients with normal LV systolic function, even if a significant right coronary artery stenosis (> or = 70%) also was present or in patients with an LV ejection fraction > or = 50% who participated in the CASS randomized trial or who were randomizable.

Isolated Brachytherapy for Endometrial Cancer With Disease Restricted to Uterus: Oncologic Results and Toxicity Analysis

Combined spinal-epidural anaesthesia (CSEA) using a needle-through-needle technique is currently widely used. However, successful epidural needle placement does not mean a successful spinal needle placement during CSEA. Whether ultrasound assistance could increase the first-pass success rate of spinal needle placement for CSEA remains unknown. The aim of this study was to investigate if ultrasound assistance could increase the first-pass success rate of spinal needle placement through the epidural needle during CSEA performed by experienced anaesthesiologists in patients undergoing caesarean section. A prospective, randomised, double-blind study. Single centre, Department of Anaesthesiology, Shengjing Hospital, China Medical University, China, from June 2019 to September 2019. A total of 185 patients (aged 24 years to 52 years, American Society of Anesthesiologists grade (ASA) II-III, 38 to 40 weeks gestation) scheduled to undergo elective caesarean section under CSEA were enrolled. The patients were randomised to either an ultrasound group (patients received a preprocedural ultrasound scan, and the puncture site was identified by ultrasound imaging) and a palpation group (patients received a sham procedural ultrasound scan, and the puncture site was identified by conventional palpation). The primary outcome measure was the first-pass success rate for spinal needle placement through the epidural needle. Secondary outcome measures were total duration of CSEA, time required for successful epidural needle and spinal needle placement, number of epidural needle redirections and complications. Preprocedural ultrasound imaging significantly increased the first-pass success rate of spinal needle placement through the epidural needle compared with conventional palpation (93.8 vs. 68.8%, P < 0.001). Preprocedural ultrasound imaging also decreased the total duration of CSEA (186.9 ± 37.1 vs. 213 ± 60.4 s, P = 0.0015) and the time required for successful spinal needle placement (78.3 ± 22.9 vs. 100.1 ± 53.7 s, P < 0.01) compared with conventional palpation. Fewer patients in the ultrasound group needed epidural needle redirections during the spinal needle placement procedure than in the palpation group (four patients vs. 20 patients, P < 0.01). For experienced anaesthesiologists, preprocedural ultrasound imaging significantly increased the first-pass success rate of spinal needle placement through the epidural needle for obstetric patients undergoing caesarean section under CSEA. chictr.org.cn, identifier: ChiCTR1900024132.

The Illinois River is a tributary of the Mississippi River that connects Lake Michigan and the Mississippi River. Starting in 1848 when the Illinois and Michigan Canal began to open, the Illinois River has experienced some major human activities such as the Lake Michigan flow diversion, creation of levee and drainage districts on floodplains, and construction of locks and dams on the river. This paper uses Pettitt-Mann-Whitney change-point statistical analysis to identify the hydrologic change points caused by human activities and to quantify hydrologic alterations in the system. Observed stage data from 12 U.S. Army Corps of Engineers gauges and observed flows from three U.S. Geological Survey gauges were used to analyze human effects on hydrologic and hydraulic conditions in the Illinois River. The year 1938 was identified as the change point for low flows and low stages and 1972 as the change point for high flows and high stages. The low flow and stage condition changes were due to a combination of added flow from Lake Michigan, levee and drainage district construction, and construction of locks and dams, whereas the high flow and stage condition changes were due to hydroclimatic change within the Illinois River basin. Analyses based on the Indicators of Hydrologic Alteration (IHA) have shown that the magnitudes, frequency, duration, and number of reversals during low flood conditions were greatly modified by: (1) the construction of locks and dams on the Illinois River that were completed in 1938, (2) the reduction of flow diversion from Lake Michigan, and (3) the hydroclimatic condition change around 1972. The latter change probably contributed to the loss of both soil-moist plants and submerged aquatic plants that once provided several important ecosystem services in the system. The analyses described in this paper, coupled with hydraulic and ecological models, can help with site selection and management plans for the ecosystem restoration of floodplains in regulated rivers.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

Aortic stenosis (AS) is accompanied by chronically elevated LV afterload, which can lead to severe backward damage. This can be classified into distinct stages, describing the cardiopulmonary system’s involvement in AS. Also, assessing left ventricular (LV) systolic function in AS patients remains difficult even today, because the elevated afterload heavily influences conventional echocardiographic parameters. Myocardial work (MW) analysis is a cutting-edge method combining myocardial strain with instantaneous LV pressure resulting in a more load-independent evaluation of LV contractility. Accordingly, the aim of this study was to investigate the prognostic value of cardiac damage staging and MW parameters in the complex and fragile population undergoing transcatheter aortic valve replacement (TAVR). A total of 319 patients scheduled for TAVR were prospectively enrolled (79 ± 6 years; 40% female). Comprehensive echocardiographic exams were performed one day prior to the intervention. Cardiac damage staging was based on the echocardiographic data: Stage 0 - no damage, Stage 1 - LV damage, Stage 2 - mitral valve / left atrial damage, Stage 3 - pulmonary artery vasculature / tricuspid valve damage, Stage 4 - right ventricular damage. LV ejection fraction (EF) was determined, and using speckle-tracking echocardiography global longitudinal strain (GLS) was assessed. LV pressure was estimated by combining systolic blood pressure with the mean transaortic gradient, and global constructive work (GCW) was derived using dedicated software. The primary outcomes were all-cause mortality and heart failure hospitalization, the composite endpoint consisting of these was reached by 97 patients over a median follow-up of 29 months. Preoperative EF was 47±13 %, GLS was -12.3 ±4.2 %, GCW was 2033±767 mmHg%. Using univariate Cox regression both cardiac damage staging (HR 1.195 [95% CI 1.009-1.415]; p=0.039) and GCW (HR 0.970 [95% CI 0.944-0.996]; per 100-unit change p=0.023) were significant predictors of the composite endpoint. Patients were classified into two categories based on cardiac damage stage: Low Stage (Stages 0–2) and High Stage (Stages 3–4). Similarly, they were divided into Low GCW (&amp;lt; median GCW, 1979 mmHg%) and High GCW (≥ median GCW) groups. This resulted in four subgroups: Low Stage–Low GCW, Low Stage–High GCW, High Stage–Low GCW and High Stage–High GCW. Kaplan-Meier survival curves were generated to compare outcomes across these subgroups. A significant difference was observed among all groups (log-rank p=0.027), with a particularly notable difference between the Low Stage–High GCW and High Stage–High GCW groups (log-rank p=0.006). In our TAVR cohort cardiac damage stages and preoperative GCW values were predictors of the composite endpoint combining all-cause mortality and heart failure hospitalization. Moreover, there was a particularly significant difference between the outcomes of the Low Stage–High GCW and High Stage–High GCW subgroups.Kaplan-Meier curve of the subgroups

ABSTRACTObjectivesTo compare transvaginal sonography (TVS) and magnetic resonance imaging (MRI) with intraoperative measurement (IOM) using a rectal probe in the estimation of the location of rectosigmoid endometriotic lesions, i.e. lesion‐to‐anal‐verge distance (LAVD), and to compare two different MRI techniques for measuring LAVD.MethodsThis was a prospective single‐center observational study that included women undergoing surgery for symptomatic rectosigmoid endometriosis by discoid (DR) or segmental (SR) resection from December 2018 to December 2019. TVS and MRI were performed presurgically for each participant to evaluate LAVD, and the measurements on imaging were compared with IOM using a rectal probe. Clinically acceptable difference and limits of agreement (LoA) between TVS and MRI compared with IOM were set at ± 20 mm. Two different measuring methods for MRI, MRICenter and MRIDirect, were proposed and evaluated, as there is currently no guideline to describe deep endometriosis on MRI. Bland–Altman plots and LoA were used to assess agreement of TVS and both MRI methods with IOM. Systematic and proportional biases were assessed using paired t‐test and Bland–Altman plots.ResultsSeventy‐five women were eligible for inclusion. Twenty‐eight women were excluded, leaving 47 women for the analysis. Twenty‐three DR and 26 SR procedures were performed, with both procedures performed in two women. The Bland–Altman plots showed that there were no systematic differences between TVS or MRICenter when compared with IOM for all included participants. MRIDirect systematically underestimated LAVD for lesions located further from the anal verge. TVS, MRICenter and MRIDirect had LoA outside the preset clinically acceptable difference when compared with IOM. LAVD was within the clinically acceptable difference from IOM of ± 20 mm in 70% (33/47) of women on TVS, 72% (34/47) of women on MRICenter and 47% (22/47) of women on MRIDirect.ConclusionsTVS should be the preferred method to estimate the location of a rectosigmoid endometriotic lesion, i.e. LAVD, as it is more available, less expensive and has a similar accuracy to that of MRI. Estimating LAVD can be relevant for planning colorectal surgery for rectosigmoid endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.