Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis

S Guerriero, L Martinez, I Gomez, M A Pascual, S Ajossa, M Pagliuca, J L Alcázar, S Guerriero, L Martinez, I Gomez, M A Pascual, S Ajossa, M Pagliuca, J L Alcázar

Abstract

Objective: To evaluate the accuracy of transvaginal sonography (TVS) for detecting parametrial deep endometriosis, using laparoscopy as the reference standard.

Methods: A search was performed in PubMed/MEDLINE and Web of Science for studies evaluating TVS for detecting parametrial involvement in women with suspected deep endometriosis, as compared with laparoscopy, from January 2000 to December 2020. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity and positive and negative likelihood ratios for TVS in the detection of parametrial deep endometriosis were calculated, and the post-test probability of parametrial deep endometriosis following a positive or negative test was determined.

Results: The search identified 134 citations. Four studies, comprising 560 patients, were included in the analysis. The mean prevalence of parametrial deep endometriosis at surgery was 18%. Overall, the pooled estimated sensitivity, specificity and positive and negative likelihood ratios of TVS in the detection of parametrial deep endometriosis were 31% (95% CI, 10-64%), 98% (95% CI, 95-99%), 18.5 (95% CI, 8.8-38.9) and 0.70 (95% CI, 0.46-1.06), respectively. The diagnostic odds ratio was 26 (95% CI, 10-68). Heterogeneity was high. Visualization of a lesion suspected to be parametrial deep endometriosis on TVS increased significantly the post-test probability of parametrial deep endometriosis.

Conclusion: TVS has high specificity but low sensitivity for the detection of parametrial deep endometriosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: endometriosis; parametrium; transvaginal ultrasound.

© 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Figures

Figure 1
Figure 1
Flowchart summarizing selection of studies evaluating the diagnostic accuracy of transvaginal sonography for parametrial involvement in women with suspected deep endometriosis.
Figure 2
Figure 2
Summary of quality assessment (risk of bias and concerns regarding applicability) for studies included in the meta‐analysis, according to the Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool. , low risk; , high risk; , unclear risk.
Figure 3
Figure 3
Forest plots of sensitivity and specificity of transvaginal sonography in the detection of parametrial involvement in women with suspected deep endometriosis.
Figure 4
Figure 4
Hierarchical summary receiver‐operating‐characteristics curve () for transvaginal sonography in detecting parametrial involvement in women with suspected deep endometriosis. , study estimate; , summary point; , 95% prediction region; , 95% confidence region.
Figure 5
Figure 5
Fagan's nomogram for transvaginal sonography (TVS) in detecting parametrial involvement in women with suspected deep endometriosis. The prior probability was 18%. The post‐test probability was 79% following a positive TVS result (; positive likelihood ratio (LR) of 19) and 13% following a negative TVS result (; negative LR of 0.70).
Figure 6
Figure 6
Funnel plot for assessment of publication bias in studies evaluating the diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with suspected deep endometriosis. , study; , regression line; Deeks' funnel plot asymmetry test P = 0.44. ESS, effective sample size.

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