Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery

2020 ◽  
Vol 39 (8) ◽  
pp. 1477-1490 ◽  
Author(s):  
Alison Deslandes ◽  
Nayana Parange ◽  
Jessie T. Childs ◽  
Brooke Osborne ◽  
Eva Bezak
Keyword(s):  
Transvaginal Ultrasound ◽  
Current Status ◽  
Deep Infiltrating Endometriosis ◽  
Infiltrating Endometriosis

Understanding pre-operative staging and surgical practice in advanced endometriosis: A survey of Canadian gynaecologists

2020 ◽  
Vol 12 (3-4) ◽  
pp. 134-141
Author(s):  
Andra Nica ◽  
Grace Y. Liu ◽  
Amanda Selk ◽  
Jamie Kroft
Keyword(s):  
Transvaginal Ultrasound ◽  
Uterosacral Ligament ◽  
Management Plan ◽  
Deep Infiltrating Endometriosis ◽  
Advanced Stage ◽  
Web Based ◽  
Study Objective ◽  
Survey Tool ◽  
Operative Evaluation ◽  
Infiltrating Endometriosis

Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist.

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