Transvaginal Sonography Accurately Determines Infiltration Length of Rectosigmoid Deep Endometriosis.

Abstract

<h3>Study Objective</h3> Investigate agreement of the three diameters of the rectosigmoid deep endometriosis (DE) lesion size between pre-surgical evaluation with transvaginal sonography (TVS) and post-surgical specimen measurements (PSM). <h3>Design</h3> A prospective observational study. TVS was performed pre-surgically to evaluate lesion size compared to PSM in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement. The agreement between the two methods regarding lesion dimensions were assessed by Bland-Altman plots, limits of agreement, and intraclass correlation coefficient (ICC) for additional analysis. Systematic and proportional bias was assessed with paired t-test. <h3>Setting</h3> Three tertiary referral centers for endometriosis. <h3>Patients or Participants</h3> Consecutive symptomatic women undergoing surgical treatment for DE of the rectosigmoid by either discoid or segmental resection. <h3>Interventions</h3> Surgical treatment for rectosigmoid deep endometriosis by either discoid or segmental resection. TVS was performed pre-surgically to evaluate lesion size i.e., length, thickness and transverse measurement and was compared to PSM on the fresh bowel specimen. <h3>Measurements and Main Results</h3> A total of 207 consecutive women were eligible for inclusion from April 2017 to December 2019. Forty-one were excluded, leaving 166 women for final analysis. A total of 123 segmental resections and 46 discoid excisions were performed. The limits of agreement for lesion length were 0.44 mm (95% CI 0.44-0.49 mm) to 1.82 mm (95% CI 1.67-1.99 mm), lesion thickness 0.53 mm (95% CI 0.48-0.58 mm) to 2.01 mm (95% CI 1.84-2.20 mm), and lesion transverse measurement 0.37 mm (95% CI 0.33-0.41 mm) to 1.90 mm (95% CI 1.7-2.12 mm). Our study found good reliability between TVS and PSM for lesion length with ICC 0.82 (95% CI: 0.75-0.87). There was moderate reliability for lesion thickness with ICC 0.76 (95% CI: 0.67-0.82), and moderate-to-poor for transverse diameter with ICC 0.58 (95% CI: 0.39-0.71). <h3>Conclusion</h3> Pre-operative TVS accurately determines rectosigmoid DE lesion length. TVS can contribute to improved planning of surgical treatment of women with rectosigmoid DE.