Ultrasonido transvaginal para la detección preoperatoria de endometriosis profunda en pacientes con dolor pélvico crónico

Abstract

Background: Deep endometriosis (DE) is defined arbitrarily as endometriosis infiltrating the peritoneum by >5 mm. Represents the most symptomatic disease and a major surgical challenge. Currently, MRI, transrectal ultrasonography and transvaginal ultrasonography (USTV), are considered appropriate diagnostic methods, however, the latter offers advantages in terms of accessibility, cost-effectiveness and tolerance. Objective: To implement and assess the ability of the USTV for detect DE having laparoscopy as the gold standard. Methods: Cross-sectional diagnostic test study that included 57 patients with suspected endometriosis and surgical indication. USTV was performed by a single operator assessing the presence, location, size and degree of infiltration of the DE. The sonographic findings were compared with surgical and histological findings. Results: The DE was confirmed surgically and histologically in 35/57 patients. Ovarian endometriosis (OE) and DE were identified and at laparoscopy in 35 and 31 women, respectively. For the diagnosis of DE, the USTV had a sensitivity (S) of 94.3%, specificity (E) 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 91.7% and accuracy (A) of 96.5%. For diagnostic DE of the uterosacral ligaments, S, E, PPV and NPV were: 85.7%, 100%, 100% and 98%, respectively. For the diagnosis of DE with intestinal involvement, S, E, PPV and NPV was 100%. Conclusion: These findings show that USTV is adequate technique for the evaluation of the EP and confirms the importance to define a surgical strategy and preoperative counseling.