VP62.13: Ultrasonographic soft markers as a first‐line tool to raise suspicion of forniceal involvement in women suspected of having deep endometriosis

S. Guerriero; M. Pascual; B. Graupera; M. Neri; F. Conway; I. Rodríguez; J. Alcazar

doi:10.1002/uog.23374

Transvaginal ultrasound in deep endometriosis: pictorial essay

Radiologia Brasileira ◽

10.1590/0100-3984.2018.0019 ◽

2019 ◽

Vol 52 (5) ◽

pp. 337-341 ◽

Cited By ~ 1

Author(s):

Jorge Gilmar Amaral de Oliveira ◽

Vanessa Bonfada ◽

Janice de Fátima Pavan Zanella ◽

Janaina Coser

Keyword(s):

Preoperative Planning ◽

Low Cost ◽

Transvaginal Ultrasound ◽

Standard Test ◽

Pelvic Endometriosis ◽

First Line ◽

Deep Endometriosis ◽

Gold Standard Test ◽

Pictorial Essay ◽

Deep Pelvic Endometriosis

Abstract Endometriosis is characterized by the presence of endometrial tissue outside the uterus. When endometrial implants penetrate more than 5 mm into the peritoneum, the condition is referred to as deep pelvic endometriosis. Although laparoscopy is the gold standard test to establish a diagnosis of deep endometriosis, transvaginal ultrasound represents an alternative that can contribute to detection of the disease, because it is an accessible, low-cost, noninvasive examination that allows preoperative planning in cases requiring surgical treatment. However, in clinical practice, transvaginal ultrasound is still not widely used as the first-line examination in suspected cases of endometriosis. This essay describes the findings of deep endometriosis on transvaginal ultrasound, in order to disseminate knowledge of the utility of the technique for the diagnosis of this disease.

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Recommendations for a Combined Laparoscopic and Transanal Approach in Treating Deep Endometriosis of the Lower Rectum—The Rouen Technique

Journal of Personalized Medicine ◽

10.3390/jpm11050408 ◽

2021 ◽

Vol 11 (5) ◽

pp. 408

Author(s):

Şerban Nastasia ◽

Anca Angela Simionescu ◽

Jean Jacques Tuech ◽

Horace Roman

Keyword(s):

Circular Stapler ◽

First Line ◽

Lower Rectum ◽

Complete Excision ◽

Deep Endometriosis ◽

Invasive Approach ◽

Transanal Approach ◽

Plasma Energy ◽

Increased Risk

The complete excision of low rectovaginal deep endometriosis is a demanding surgery associated with an increased risk of intra- and postoperative complications, which can impact the quality of life. Given the choices of optimal surgery procedures available, we would like to emphasize that a minimally invasive approach with plasma medicine and a transanal disc excision could significantly improve surgery for deep endometriosis, avoiding the lateral thermal damage of vascular and parasympathetic fibers of roots S2–S5 in the pelvic plexus. The management of low rectal deep endometriosis is distinct from other gastrointestinal-tract endometriosis nodules. Suggestions and explanations are presented for this minimal approach. These contribute to individualized medical care for deep endometriosis. In brief, a laparoscopic transanal disc excision (LTADE; Rouen technique) was performed through a laparoscopic deep rectal dissection, combined with plasma energy shaving, and followed by a transanal disc excision of the low and mid-rectal deep endometriotic nodules, with the use of a semi-circular stapler. LTADE is indicated as the first-line surgical treatment for low and mid-rectal deep endometriotic nodule excisions, because it can preserve rectal length and innervation. This technique requires a multidisciplinary team with surgical colorectal training.

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Ultrasound Diagnosis of Pelvic Endometriosis

Journal of Endometriosis ◽

10.5301/je.2011.8537 ◽

2011 ◽

Vol 3 (2) ◽

pp. 105-119

Author(s):

Antonio Maiorana ◽

Domenico Incandela ◽

Laura Giambanco ◽

Walter Alio ◽

Luigi Alio

Keyword(s):

Imaging Techniques ◽

Diagnostic Technique ◽

Ultrasound Diagnosis ◽

Transvaginal Sonography ◽

Anatomical Location ◽

Deep Infiltrating Endometriosis ◽

Pelvic Endometriosis ◽

First Line ◽

Intestinal Endometriosis ◽

Deep Endometriosis

Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and patients alike. Routine clinical examination is insufficient to diagnose and evaluate the extent of pelvic endometriosis which can be assessed by means of imaging techniques, including transvaginal sonography (TVS), transrectal sonography (TRS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI). Our purpose was to analyze the different imaging techniques and their efficacy for the ultrasound diagnosis of pelvic endometriosis. Materials and methods This review examined 85 studies on the ultrasound diagnosis of endometriosis published between 2005 and 2010. The structure of the review is based first on the anatomical location of the endometriosis lesion, and then on the study of the techniques used, including transvaginal sonography, transrectal sonography, rectal endoscopic sonography, and MRI. Results TVS is the first-line imaging technique for diagnosing pelvic endometriosis. Many studies have demonstrated that sensitivities and specificities of TVS for diagnosing endometriomas range from 75% to 91% and 88% to 99%, respectively, while for RES the percentages are 88% and 90%, respectively, for the diagnosis of intestinal endometriosis. TVS and RES can correctly diagnose posterior deep infiltrating endometriosis (DIE) with an accuracy of 86.4% and 74.1%, respectively. Conclusions The analysis of these results show that ultrasound is the first-line diagnostic technique for the diagnosis of pelvic endometriosis. RES can help to identify the presence and the degree of wall infiltration of bowel sites. However, in patients with a consistent clinical suspicion of deep endometriosis, MRI is a good “all in one” examination to diagnose and define the exact extent of DIE.

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Ultrasound in the Diagnosis of Deep Endometriosis

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1004 ◽

2009 ◽

Vol 3 (1) ◽

pp. 15-20 ◽

Cited By ~ 1

Author(s):

Silvia Ajossa ◽

Anna Maria Paoletti ◽

Nicoletta Garau ◽

Valerio Mais ◽

Bruno Piras ◽

...

Keyword(s):

Gold Standard ◽

Low Cost ◽

Transvaginal Ultrasonography ◽

Rectovaginal Septum ◽

Specific Training ◽

First Line ◽

Deep Endometriosis ◽

Uterosacral Ligaments ◽

Diagnostic Capability ◽

Bladder Endometriosis

Abstract Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. Although laparoscopy and biopsy remain the gold standard for diagnosis, transvaginal ultrasonography should be considered as the first-line procedure because of its high diffusion and relatively low cost and discomfort. We analyzed in the present review the diagnostic capability of transvaginal ultrasonography in the detection of presence of deep endometriosis in some specific pelvic localizations such as bowel, uterosacral ligaments, rectovaginal septum and/or vagina. We also analyzed the few studies performed in the evaluation of bladder endometriosis. Although some studies are controversial, transvaginal ultrasonography seems to be an accurate technique in the identifications of deep endometriosis in several pelvic locations but a specific training of the operators is suggested.

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Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review

Seminars in Reproductive Medicine ◽

10.1055/s-0040-1718740 ◽

2020 ◽

Vol 38 (02/03) ◽

pp. 216-226

Author(s):

Mee Kristine Aas-Eng ◽

Eliana Montanari ◽

Marit Lieng ◽

Joerg Keckstein ◽

Gernot Hudelist

Keyword(s):

Tertiary Care ◽

Transvaginal Sonography ◽

Imaging Method ◽

First Line ◽

Deep Endometriosis ◽

Delay In Diagnosis ◽

Line Imaging ◽

Magnetic Resonance Imaging Mri ◽

Ovarian Endometriomas ◽

Sonographic Imaging

AbstractImaging of endometriosis and in particular deep endometriosis (DE) is crucial in the clinical management of women facing this debilitating condition. Transvaginal sonography (TVS) is the first-line imaging method and magnetic resonance imaging (MRI) may provide supplemental information. However, the delay in diagnosis of up to 10 years and more is of concern. This problem might be overcome by simple steps using imaging with emphasis on TVS and referral to tertiary care. Finally, TVS is crucial in mapping extent and location of disease in planning surgical therapy and counseling women regarding various therapeutic options. This review presents the available data on imaging of endometriosis with a focus on TVS and MRI for DE, adenomyosis, and ovarian endometriomas including endometriomas in pregnancy as well as the use of “soft markers.” The review presents an approach that is in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement.

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OC19.04: Soft markers as a first line ultrasonographic tool to raise suspicion of uterosacral involvement in women suspected of having deep endometriosis

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.22342 ◽

2020 ◽

Vol 56 (S1) ◽

pp. 54-54

Author(s):

S. Guerriero ◽

M. Pascual ◽

I. Rodríguez ◽

S. Ajossa ◽

M. Neri ◽

...

Keyword(s):

First Line ◽

Deep Endometriosis

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Intra- and interobserver reproducibility of pelvic ultrasound for the detection and measurement of endometriotic lesions

Human Reproduction Open ◽

10.1093/hropen/hoaa001 ◽

2020 ◽

Vol 2020 (2) ◽

Cited By ~ 2

Author(s):

E Bean ◽

P Chaggar ◽

N Thanatsis ◽

W Dooley ◽

C Bottomley ◽

...

Keyword(s):

Transvaginal Ultrasound ◽

Separate Analysis ◽

Pelvic Endometriosis ◽

Pelvic Ultrasound ◽

First Line ◽

Deep Endometriosis ◽

Nodule Size ◽

Good Level ◽

Intraobserver Reproducibility ◽

Level Of Agreement

Abstract STUDY QUESTION What is the interobserver and intraobserver reproducibility of pelvic ultrasound for the detection of endometriotic lesions? SUMMARY ANSWER Pelvic ultrasound is highly reproducible for the detection of pelvic endometriotic lesions. WHAT IS KNOWN ALREADY Transvaginal ultrasound (TVS) has been widely adopted as the first-line assessment for the diagnosis and assessment of pelvic endometriosis. Severity of endometriosis as assessed by ultrasound has been shown to have good concordance with laparoscopy (kappa 0.79). The reproducibility of TVS for assessment of ovarian mobility and pouch of Douglas obliteration using the ‘sliding sign’ has already been described in the literature. However, there is no available data in the literature to demonstrate the intraobserver repeatability of measurements for endometriotic cysts and nodules. STUDY DESIGN, SIZE, DURATION This was a prospective observational cross-sectional study conducted over a period of 12 months. We included 50 consecutive women who were all examined by two operators (A and B) during their clinic attendance. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was carried out in a specialist endometriosis centre. We included all consecutive women who had ultrasound scans performed independently by two experienced operators during the same visit to the clinic. The outcomes of interest were the inter- and intraobserver reproducibility for the detection of endometriotic lesions. We also assessed repeatability of the measurements of lesion size. MAIN RESULTS AND THE ROLE OF CHANCE There was a good level of agreement between operator A and operator B in detecting the presence of pelvic endometriotic lesions (k = 0.72). There was a very good level of agreement between operators in identifying endometriotic cysts (k = 0.88) and a good level of agreement in identifying endometriotic nodules (k = 0.61). The inter- and intraobserver repeatability of measuring endometriotic cysts was excellent (intra-class correlation (ICC) ≥ 0.98). There was good interobserver measurement repeatability for bowel nodules (ICC 0.88), but the results for nodules in the posterior compartment were poor (ICC 0.41). The intraobserver repeatability for nodule size measurements was good for both operators (ICC ≥0.86). LIMITATIONS, REASONS FOR CAUTION Within this cohort, there was insufficient data to perform a separate analysis for nodule size in the anterior compartment. All examinations were performed within a specialised unit with a high prevalence of deep endometriosis. Our findings may not apply to operators without intensive ultrasound training in the diagnosis of pelvic endometriosis. WIDER IMPLICATIONS OF THE FINDINGS These findings are important because ultrasound has been widely accepted as the first-line investigation for the diagnosis of pelvic endometriosis, which often determines the need for future investigations and treatment. The detection and measurement of bowel nodules is essential for anticipation of surgical risk and planning surgical excision. STUDY FUNDING/COMPETING INTEREST(S) The authors have no conflict of interest. No funding was obtained for this work.

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Transvaginal Ultrasound as a First-Line Approach in Deep Endometriosis: A Pictorial Essay

Diagnostics ◽

10.3390/diagnostics11030444 ◽

2021 ◽

Vol 11 (3) ◽

pp. 444

Author(s):

Bogdan Doroftei ◽

Radu Maftei ◽

Ovidiu-Dumitru Ilie ◽

Gabriela Simionescu ◽

Emil Anton ◽

...

Keyword(s):

Preoperative Planning ◽

Transvaginal Ultrasound ◽

Reproductive Age ◽

First Line ◽

Deep Endometriosis ◽

Benign Condition ◽

Hands On ◽

Pictorial Essay ◽

Optimal Approach ◽

Fertile Women

Endometriosis (EMS) is a benign condition characterized by a systemic inflammation that affects fertile women at reproductive age. Ultrasound became, in recent years, the method of choice for both effective diagnostic and preoperative planning. Therefore, accurate characterization and mapping of endometriotic lesions is imperative in such circumstances to enable optimal approach of treatment, whether surgical or non-surgical based on the severity of the findings. This pictorial essay outlines a practical approach to evaluating patients with deep endometriosis by means of transvaginal ultrasound. The technical aspects are in conjunction with both consensus of the International Deep Endometriosis Analysis (IDEA) group and the hands-on experience acquired through daily clinical practice.

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Sonographic Differential Diagnosis in Deep Infiltrating Endometriosis: The Bowel

BioMed Research International ◽

10.1155/2019/5958402 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Marco Scioscia ◽

Simone Orlandi ◽

Giamberto Trivella ◽

Antonella Portuese ◽

Stefano Bettocchi ◽

...

Keyword(s):

Differential Diagnosis ◽

Case Series ◽

Secondary Level ◽

Deep Infiltrating Endometriosis ◽

Pelvic Endometriosis ◽

Pelvic Ultrasound ◽

First Line ◽

Deep Endometriosis ◽

Operator Experience ◽

Colonic Involvement

Up to one-third of fertile-age women with severe endometriosis suffer from colonic involvement. Transvaginal ultrasonography has become a first-line diagnostic tool for the study of the pelvis and more specifically for the diagnosis of pelvic endometriosis. Accuracy of pelvic ultrasound for deep endometriosis increases with operator experience, but the difficulties in the differential diagnosis with diseases that can afflict the bowel tract remain a challenge. We reviewed noteworthy cases referred for secondary level diagnosis suspected of bowel endometriosis in which the subsequent ultrasound led to an alternative diagnosis. This case series aims to highlight awareness for both experts and less-experienced operators the possible differential diagnoses of bowel lesions that initially resemble endometriosis.

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