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Diagnostic Accuracy of Transvaginal Ultrasound for Endometriosis Does Not Differ Between Women Undergoing Their First
Anais Alonso1,2, Cecilia Ng1,2,3,4, Rebecca Deans1,2,3,4
1Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.
Background:
Australian endometriosis guidelines recommend transvaginal ultrasound (TVUS) as the first-line investigation for endometriosis. Where endometriosis has been surgically treated, there is a risk of recurrent disease and repeat surgery. It is unknown if the diagnostic accuracy of ultrasound for recurrent disease is equivalent to the surgery-naïve.
Aims:
To compare the accuracy of TVUS to diagnose endometriosis in women undergoing a first versus any subsequent laparoscopy.
Materials And Methods:
Retrospective analysis of the National Endometriosis Clinical and Scientific Trials registry included women aged 18-50 years who had undergone TVUS prior to gynaecological laparoscopy. Diagnostic accuracy of TVUS was compared between women with and without a history of surgical endometriosis treatment, with laparoscopy and histopathology as the reference standards. Subgroup analysis was undertaken by disease phenotype.
Results:
There were 470 ultrasound-laparoscopy dyads included for analysis (first laparoscopy n = 245 vs. subsequent laparoscopy n = 225), with histopathology available for 443 cases (first laparoscopy n = 234 vs. subsequent laparoscopy n = 209). Diagnostic accuracy did not differ between the two groups when compared to either laparoscopy (first laparoscopy: AUC 0.58 [95% CI 0.31-0.85], sensitivity 40.7% [34.7%-47.0%], specificity 75.0% [29.0%-96.0%] vs. subsequent laparoscopy: AUC 0.60 [0.46-0.74], sensitivity 46.2% [39.6%-52.9%], specificity 73.3% [47.5%-89.3%]) or histopathology (first laparoscopy: AUC 0.54 [0.31-0.77], sensitivity 40.8% [34.6%-47.3%], specificity 66.7% [29.6%-90.4%] vs. subsequent laparoscopy: AUC 0.56 [0.45-0.67], sensitivity 47.5% [40.4%-54.8%], specificity 64.3% [45.7%-79.3%]).
Conclusions:
Diagnostic accuracy did not differ based on previous endometriosis surgery. Community-based TVUS performs considerably more poorly than research suggests, missing 55.5% of endometriosis overall and 63.2% of superficial disease, reinforcing that a negative ultrasound does not exclude endometriosis.
