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Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis
Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis
REVIEWED BY | Gina Humphries ASA SIG: Gynaecology
REFERENCE | Authors: Aas-Eng MK, Lieng M, Dauser B, Diep LM, Leonardi M, Condous G, Hudelist G Journal: Ultrasound Obstet Gynecol. 2021 Dec;58(6):933–939
WHY THE STUDY WAS PERFORMED
The study by Aas-Eng et al. investigated whether there is correlation between the transvaginal ultrasound presurgical measurement of rectosigmoid deep endometrial lesions and postsurgical specimen measurement. Transvaginal ultrasound is a well-established method for the diagnosis of deep endometriosis with both high sensitivity and specificity. Endometrial lesions are seen as a hypoechoic thickening or hypoechoic nodule typically affecting the muscularis layer of the bowel wall. Assessment with transvaginal ultrasound is part of the multidisciplinary approach taken when planning deep endometrial surgical procedures. Transvaginal ultrasound plays an important role in the optimal preoperative assessment for patients as the degree of rectosigmoid deep endometriosis may be measured and described. This study aimed to assess the accuracy of transvaginal ultrasound measurement of deep rectosigmoid endometrial lesions when compared with postsurgical specimen measurement.
HOW THE STUDY WAS PERFORMED
A prospective observational methodology was used to investigate correlation between pre and postsurgical measurements. One hundred and sixty-six women scheduled for discoid resection or segmental resection were recruited from three tertiary referral centres in Austria, Norway and Australia. Participants underwent transvaginal ultrasound followed by discoid resection or segmental resection for rectosigmoid deep endometriosis.
Rectosigmoid deep endometriosis was measured using transvaginal ultrasound in all three diameters as recommended by the International Deep Endometriosis Analysis group. Length and anteroposterior thickness were measured in the midsagittal plane. The transverse diameter was then obtained after turning the probe transverse at the level of the lesions maximum thickness in its midsagittal plane. Scans were performed by gynaecological surgeons who were experienced in transvaginal ultrasound examination. Postsurgical measurement of lesions was undertaken using a ruler. The length, thickness and transverse diameter of specimens were measured after cutting the specimen in the midsagittal plane.
A variety of statistical analysis tools were used to examine the difference between and correlation in measurement between presurgical transvaginal assessment and postsurgical specimen size.
WHAT THE STUDY FOUND
This study found good agreement between transvaginal ultrasound and postsurgical specimen for lesion length measurement. Aas-Eng et al. demonstrated that transvaginal ultrasound length measurements were reliable and correlated well with postsurgical specimen length measurements. There was a greater discrepancy seen in the measurement of deep endometrial lesion thickness and diameter. Measurement of the thickness of deep endometrial lesions on transvaginal ultrasound compared to surgical specimens had only moderate to good reliability and correlation. Measurement of lesion diameter did not correlate
well having only a poor to moderate reliability when comparing the transvaginal ultrasound measurements to the postsurgical measurements.
Discrepancies in measurements may be due to variations in surgical cuts. There is also difficulty in identifying the infiltration depth of rectosigmoid deep endometriosis on transvaginal ultrasound.
Despite these limitations, Aas-Eng et al. demonstrate a clear value in using transvaginal ultrasound for measuring the length of rectosigmoid deep endometriosis prior to surgery.
RELEVANCE TO CLINICAL PRACTICE
Aas-Eng et al. have demonstrated that systemic measurement of rectosigmoid deep endometriosis with transvaginal ultrasound provides accurate assessment of the length of rectosigmoid lesions. Therefore, transvaginal ultrasound plays a vital role in surgical planning and risk assessment for optimising patient outcomes.
