Transvaginal ultrasound (TVS) versus Magnetic Resonance (MR) for diagnosing deep infiltrating endometriosis: a systematic review and meta-analysis

OBJECTIVES
To perform a systematic review of studies comparing the diagnostic accuracy of TVS and MRI in Deep Infiltrating Endometriosis (DIE) including only studies in which patients have been underwent both techniques.

METHODS
An extensive search of papers comparing TVS and MRI in DIE was performed in Medline (Pubmed) and Web of Sciences from January 1989 to January 2016.

Studies were considered eligible if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE using the surgical data as a reference standard.

Quality was assessed using QUADAS-2 tool. A random-effects model was used to determine overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) and the diagnostic odds ratio (DOR).

RESULTS
Of the 375 citations identified, 6 studies (n=424) were considered eligible.

Pooled sensitivity, specificity, LR+ and LR- of MRI in detecting DIE in the recto-sigmoid for MRI were 0.85 (95% CI, 0.78-0.90), 0.95 (95% CI, 0.83-0.99), 18.4 (95% CI, 4.7-72.4) and 0.16 (95% CI, 0.11-0.24), respectively.

Pooled sensitivity, specificity, LR+ and LR- of TVS in detecting DIE in the recto-sigmoid for TVS were 0.85 (95% CI, 0.68-0.94), 0.96 (95% CI, 0.85-0.99), 20.4 (95% CI, 4.7-88.5) and 0.16 (95% CI, 0.07-0.38), respectively. DOR was 116 (95% CI, 23-585) and 127 (95% CI, 14 - 1126), respectively.

Pooled sensitivity, specificity, LR+ and LR- of MRI in detecting DIE in the rectovaginal septum for MRI were 0.66 (95% CI, 0.51-0.79), 0.97 (95% CI, 0.89-0.99), 22.5 (95% CI, 6.7-76.2) and 0.38 (95% CI, 0.23-0.52), respectively.

Pooled sensitivity, specificity, LR+ and LR- of TVS in detecting DIE in the rectovaginal septum for TVS were 0.59 (95% CI, 0.26-0.86), 0.97 (95% CI, 0.94-0.99), 23.5 (95% CI, 9.1-60.5) and 0.42 (95% CI, 0.18-0.97), respectively. DOR was 65 (95% CI, 21- 204) and 56 (95% CI, 11 - 275), respectively.

Pooled sensitivity, specificity, LR+ and LR- of MRI in detecting DIE in the uterosacral ligaments for MRI were 0.70 (95% CI, 0.55-0.82), 0.93 (95% CI, 0.87-0.97), 10.4 (95% CI, 5.1-21.2) and 0.32 (95% CI, 0.20-0.51), respectively.

Pooled sensitivity, specificity, LR+ and LR- of TVS in detecting DIE in the uterosacral ligaments for TVS were 0.67 (95% CI, 0.55-0.77), 0.86 (95% CI, 0.73-0.93), 4.8 (95% CI, 2.6-9.0) and 0.38 (95% CI, 0.29-0.50), respectively. DOR was 32 (95% CI, 12- 85) and 12 (95% CI, 7- 24), respectively.

Wide confidence intervals of pooled sensitivities, specificities and DOR were present for both techniques in all the considered locations. Heterogeneity was moderate or high for sensitivity and specificity for TVS and MRI in most locations assessed. According to QUADAS2, the quality of the studies was considered good for most domains of the included studies.

CONCLUSIONS
Overall diagnostic performance of TVS and MRI for detecting DIE involving recto-sigmoid, uterosacral ligaments and rectovaginal septum is similar.

CITA DEL ARTÍCULO  Ultrasound Obstet Gynecol. 2017 Nov 20. doi: 10.1002/uog.18961