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Ultrasonographic 'soft' markers for the detection of rectosigmoid endometriosis

Stefano Guerriero, Silvia Ajossa, M Angela Pascual, Ignacio Rodriguez, Alba Piras, Maura Perniciano, Luca Saba, Anna Maria Paoletti, Valerio Mais, Juan Luis Alcazar
Ultrasound in Obstetrics & Gynecology 2019 April 11

OBJECTIVES: Due to the reported high sensitivity and specificity of ultrasound in the detection rate of rectosigmoid (RS) endometriosis when performed by an ultrasonographic (US) expert, this test should be considered a gold standard comparable to laparoscopy. No information is available regarding US soft markers in this disease. The aim of this study was to evaluate the use of US soft markers as "first level" examination in the suspicion of RS endometriosis.

METHODS: We included in this prospective study all patients with clinical suspicion of deep endometriosis submitted to ultrasonographic evaluation in our academic center for ultrasonographic diagnosis of endometriosis at the Academic Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy from January 2016 to February 2017. US performed by an expert was considered as gold standard for the presence of RS endometriosis. We evaluate the following soft markers as dependent variables using a logistic regression: presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesions of the ovary to the uterus ("reduced ovarian mobility"), presence of "kissing ovaries" (KO), absence of sliding sign (SLS) for predicting the presence of RS involvement.

RESULTS: Included in the present prospective observational study were 333 patients with clinical suspicion of deep endometriosis. One hundred six patients had an US diagnosis of RS endometriosis by an expert. The only significant variables found in the prediction model were the absence of SLS odd ratio (OR): 13.95 95%CI [7.7-25.3], the presence of "KO" OR: 22.5 95%CI [4.1-124] and the interaction between both variables OR: 0.03 95%CI [0.004-0.28]. According to the interaction of both variables, the RS endometriosis was observed when KO absent/ SLS present in 10% of cases (19/190), KO present / SLS present in 71.4% (5/7), KO absent/ SLS absent in 60.8% (76/125), KO presence / SLS absence in 54.5% (6/11). Thus, when the SLS was negative or KO was present, transvaginal US showed a specificity of 75% 95%CI [69%-80%] and a sensitivity of 82% 95%CI [73%-88%]. The pretest probability of RS endometriosis was 32%, and this probability increased to 61% when at least one "soft marker" was present and fell to 10% when these ultrasonographic findings were absent.

CONCLUSIONS: Findings of absence of the SLS and/or the presence of KO are significant enough to screen patients with clinical suspicion of RS endometriosis to be referred to "second level" ultrasonography with a low rate of false negatives. This article is protected by copyright. All rights reserved.


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