Transvaginal ultrasound and magnetic resonance imaging in the diagnosis of endometrioma: a systematic review and meta-analysis of diagnostic test accuracy studies.
Fleur Serge Kanti, Rose Gorak Savard, Frédéric Bergeron, Hervé Tchala Vignon Zomahoun, Antoine Netter, Sarah Maheux-Lacroix
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Abstract
Introduction: The diagnosis of endometriomas in patients with endometriosis is of primary importance because it influences the management and prognosis of infertility and pain. Imaging techniques are evolving constantly. This study aimed to systematically assess the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) in detecting endometrioma using the surgical visualisation of lesions with or without histopathological confirmation as reference standards in patients of reproductive age with suspected endometriosis.
Methods: PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov databases were searched from their inception to 12 October 2022, using a manual search for additional articles. Two authors independently performed title, abstract and full-text screening of the identified records, extracted study details and quantitative data and assessed the quality of the studies using the 'Quality Assessment of Diagnostic Accuracy Study 2' tool. Bivariate random-effects models were used to determine the pooled sensitivity and specificity, compare the two imaging modalities and evaluate the sources of heterogeneity.
Results: Sixteen prospective studies (10 assessing TVUS, 4 assessing MRI and 2 assessing both TVUS and MRI) were included, representing 1976 participants. Pooled TVUS and MRI sensitivities for endometrioma were 0.89 (95% confidence interval 'CI', 0.86-0.92) and 0.94 (95% CI, 0.74-0.99), respectively (indirect comparison p-value of 0.47). Pooled TVUS and MRI specificities for endometrioma were 0.95 (95% CI, 0.92-0.97) and 0.94 (95% CI, 0.89-0.97), respectively (indirect comparison p-value of 0.51). These studies had a high or unclear risk of bias. A direct comparison (all participants undergoing TVUS and MRI) of the modalities was available in only two studies.
Conclusion: TVUS and MRI have high accuracy for diagnosing endometriomas; however, high-quality studies comparing the two modalities are lacking.
导言：子宫内膜异位症患者子宫内膜瘤的诊断至关重要，因为它影响着不孕症和疼痛的治疗和预后。成像技术在不断发展。本研究旨在系统评估经阴道超声（TVUS）和磁共振成像（MRI）在检测子宫内膜异位症方面的诊断准确性，以育龄期疑似子宫内膜异位症患者的手术肉眼观察病灶并进行或不进行组织病理学确认作为参考标准：采用人工检索的方式，对PubMed、Embase、Web of Science、Cumulative Index to Nursing and Allied Health Literature和ClinicalTrials.gov数据库从开始到2022年10月12日的所有文章进行了检索。两位作者独立对确定的记录进行了标题、摘要和全文筛选，提取了研究细节和定量数据，并使用 "诊断准确性质量评估研究 2 "工具对研究质量进行了评估。采用双变量随机效应模型确定汇总的敏感性和特异性，比较两种成像模式，并评估异质性的来源：共纳入16项前瞻性研究（10项评估TVUS，4项评估MRI，2项同时评估TVUS和MRI），代表1976名参与者。汇总的 TVUS 和 MRI 对子宫内膜瘤的敏感性分别为 0.89（95% 置信区间 'CI'，0.86-0.92）和 0.94（95% 置信区间 'CI'，0.74-0.99）（间接比较 p 值为 0.47）。TVUS和MRI对子宫内膜瘤的汇总特异性分别为0.95（95% CI，0.92-0.97）和0.94（95% CI，0.89-0.97）（间接比较p值为0.51）。这些研究的偏倚风险较高或不明确。只有两项研究对这两种检查方式进行了直接比较（所有参与者都接受了TVUS和MRI检查）：结论：TVUS和MRI诊断子宫内膜异位症的准确性很高；但目前还缺乏对这两种方法进行比较的高质量研究。
期刊介绍：
Journal of Obstetrics and Gynaecology represents an established forum for the entire field of obstetrics and gynaecology, publishing a broad range of original, peer-reviewed papers, from scientific and clinical research to reviews relevant to practice. It also includes occasional supplements on clinical symposia. The journal is read widely by trainees in our specialty and we acknowledge a major role in education in Obstetrics and Gynaecology. Past and present editors have recognized the difficulties that junior doctors encounter in achieving their first publications and spend time advising authors during their initial attempts at submission. The journal continues to attract a world-wide readership thanks to the emphasis on practical applicability and its excellent record of drawing on an international base of authors.
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