Optimal Imaging Modality for the Detection of Bladder Deep E
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A recent meta-analysis suggests that aside from transvaginal ultrasound (TVS) there was a paucity of data to assess other imaging modalities for the diagnosis of bladder deep endometriosis. TVS had limited sensitivity but excellent specificity.

The study objective was to review the diagnostic accuracy and determine the optimal imaging modality for the detection of bladder deep endometriosis (DE) in women with a clinical suspicion of endometriosis.

A systematic review of studies published from inception to May 2020 using Embase, Google Scholar, Medline, PubMed, and Scopus. Prospective studies, which pre-operatively assessed any imaging modality for the presence of bladder DE, and correlated with the gold standard surgical data as a reference were included. The QUADAS-2 tool was used to assess quality.

Of the 1977 references identified, 8 studies were included in the analysis.

--The overall pooled sensitivity and specificity, from which the likelihood ratio of a positive test (LR+), the likelihood ratio of a negative test (LR-), and diagnostic odds ratio (DOR) were calculated, were as follows for all transvaginal ultrasonography (TVS) techniques were 55%, 99%, 54.5, 0.46 and 119, and for only 2D TVS 53%, 99%, 48.8, 0.47, and 104, respectively.

--Meta-analyses of the other modalities, namely MRI and transrectal endoscopic sonography (RES), were not possible due to the limited number of studies.

Whilst the sensitivity of TVS was limited, the specificity was excellent. Given that there is a paucity of literature for other imaging modalities until more studies are performed, TVS should be considered as the first-line tool given it is the only modality with sufficient evidence.

European Journal of Obstetrics & Gynecology and Reproductive Biology
Source: https://doi.org/10.1016/j.ejogrb.2021.04.030