Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy |
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| Institution: | 1. Department of Gynecology, Gynecology and Obstetrics Service, State Public''s Servant Medical Assistant Institute, São Paulo, Brazil;2. School of Dentistry, State University of Campinas, Campinas, Brazil;3. Department of Physiotherapy, Ibirapuera University, São Paulo, Brazil;4. Department of Psycology, Paulista University, São Paulo, Brazil;5. Institute of Education and Health Sciences, Oswaldo Cruz German Hospital, São Paulo, Brazil;1. Department of Gynecology, Center for Endometriosis, Hospital St. John of God Vienna (Drs. Hudelist, Montanari, and Nemeth), Vienna, Austria;2. Stiftung Endometrioseforschung (Drs. Hudelist and Keckstein), Westerstede, Germany;3. Department of Obstetrics and Gynecology, Medical University of Vienna (Dr. Montanari), Vienna, Austria;4. Department of Thoracic Surgery, Clinic Floridsdorf (Dr. Salama), Vienna, Austria;5. Department of General Surgery, Center for Endometriosis, Hospital St. John of God Vienna (Dr. Dauser), Vienna, Austria;6. Center for Endometriosis, Gynecological Clinic (Dr. Keckstein), Villach, Austria;1. Department of Gynecology, Hospital St. John of God, Vienna, Austria;2. Department of Obstetrics and Gynecology, Medical University of Vienna, Austria;3. Department of General Surgery, Hospital St. John of God, Vienna, Austria;4. Stiftung Endometrioseforschung (SEF), Westerstede, Germany;5. Gynecological Clinic Drs Keckstein, Villach, Austria |
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| Abstract: | Study ObjectiveTo evaluate the diagnostic accuracy of transvaginal ultrasound in predicting a laparoscopic, surgically assigned, revised American Society of Reproductive Medicine (ASRM) endometriosis stage.DesignA multicenter, retrospective, diagnostic accuracy study.SettingThe patients visited 1 of 2 academic gynecologic ultrasound units and underwent laparoscopy led by 1 of 6 surgeons in metropolitan Sydney, Australia, between 2016 and 2018.PatientsPatients with suspected endometriosis (n = 204).InterventionsUltrasound followed by laparoscopy.Measurements and Main ResultsSurgical cases were identified. The preoperative ultrasound report and surgical operative notes were each used to retrospectively assign an ASRM score and stage. The breakdown of surgical findings was as follows: ASRM 0 (i.e., no endometriosis), 24/204 (11.8%); ASRM 1, 110/204 (53.9%); ASRM 2, 22/204 (10.8%); ASRM 3, 16/204 (7.8%); ASRM 4, 32 204 (15.7%). The overall accuracy of ultrasound in predicting the surgical ASRM stage was as follows: ASRM 1, 53.4%; ASRM 2, 93.8%; ASRM 3, 89.7%; ASRM 4, 93.1%; grouped ASRM 0, 1, and 2, 94.6%; and grouped ASRM 3 and 4 of 94.6%. Ultrasound had better test performance in higher disease stages. When the ASRM stages were dichotomized, ultrasound had sensitivity and specificity of 94.9% and 93.8%, respectively, for ASRM 0, 1, and 2 and of 93.8% and 94.9%, respectively, for ASRM 3 and 4.ConclusionUltrasound has high accuracy in predicting the mild, moderate, and severe ASRM stages of endometriosis and can accurately differentiate between stages when ASRM stages are dichotomized (nil/minimal/mild vs moderate/severe). This can have major positive implications on patient triaging at centers of excellence in minimally invasive gynecology for advanced-stage endometriosis. |
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