Combo of physical examination, transvaginal ultrasound and pelvic MRI best for diagnosing deep endometriosis: Study

Physical exams are considered accurate for assessing endometriosis diagnosis by correlating pain with induration or nodules found on digital exams. However, this method has lower sensitivity than medical imaging techniques such as MRI or ultrasound. MRI and TVUS are also used in clinical practice. MRI is highly sensitive; however, its accessibility is less than TVUS. Meanwhile, TVUS has variable sensitivity based on the location of endometriosis.

Alexis Roditis and the research team from Paris explored the ability of the three techniques alone (transvaginal ultrasonography, physical examination and magnetic resonance imaging) and combined for the diagnosis of Deep Infiltrating Endometriosis.

For this purpose, the researchers retrospectively queried the pelvic MRI database for identifying women who underwent TVUS, physical examination, and pelvic MRI for DIE up to 12 months before surgery between 2016 and 2020. The presence of uterosacral ligaments (USL), rectosigmoid (RS), vaginal, sacrorectogenital or parametrial septum DIE shown by TVUS, physical examination, and MRI were correlated with histological and surgical findings.

The study included a total of 178 patients. The primary outcomes had specificity, sensitivity, and negative and positive predictive values, and each technique's accuracy separately and combined was assessed for each location. In the case of the combination of three methods, two models were tested; the first model comprised all three techniques positive and concordant, and the second model of at least two techniques positive and concordant.

The study revealed the following findings:

· USL, vaginal, RS, and lateral DIE prevalence were 94.4%, 20.2%, 34.3% and 32.6%, respectively.

· MRI was more sensitive than TVUS, physical examination or any combination to DIE detection.

· MRI and the second model were the most accurate for detecting USL and RS locations, with an accuracy of 90.4% and 82.6%, a sensitivity of 91.1% and 50%, and a specificity of 77.8% and 90.9%, respectively.

· Model B was the most accurate for the vaginal location, with an accuracy of 82.6%, a sensitivity of 50%, and a specificity of 90.9%.

· MRI was more accurate than any combination for identifying a lateral location, with a sensitivity of 36%, an accuracy of 75.1%, and a specificity of 93.8%.

"A combination of physical examination, a transvaginal ultrasound, and MRI more accurate than each technique separately for DIE diagnosis due to the equally high sensitivity of each, and the high specificity of PE and TVUS," the authors concluded.

Reference:

The study "Accuracy of combined physical examination, transvaginal ultrasonography, and MRI to diagnose deep endometriosis" was published in Fertility and Sterility.

DOI: https://doi.org/10.1016/j.fertnstert.2022.12.025