Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Protocol Registration
2.2. Eligibility Criteria
- Type of study: No restriction.
- Participants: Patients with clinical suspicion of DPE based on clinical complaints and/or physical examination.
- Index test: TVS, MRI, and RES were considered as index test.
- Reference test: Surgical procedure and histological examination were the reference standard of this meta-analysis according to literature [1].
- Outcome: According to our sections, we analyzed the diagnostic accuracy of each technique compared to one another (one-to-one comparison: TVS vs. MRI; TVS vs. RES, and MRI vs. RES) for each DPE location. The DPE locations reported and analyzed were: USLs, VW & VF, BL, RS, PoD and RVS.
- True positive (TP), false positive (FP), true negative (TN), and false negative (FN) were retrieved or calculated if necessary.
- Setting: Tertiary center hospitals
- Data required for extraction: Information sufficient to produce a 2 × 2 table for calculation of sensitivity and specificity.
- Language: No language restrictions were applied.
2.3. Information Sources and Search Strategies
2.4. Study Selection and Data Extraction
2.5. Risk of Bias in Individual Studies
2.6. Statistical Analysis
3. Results
3.1. Study Selection
3.2. Diagnostic Performance of TVS Versus MRI
- USLs endometriosis: Six studies evaluated DTA of TVS and MRI for the detection of USLs endometriosis [21,24,25,26,27,30]. Pooled sensitivity and FPR were 0.71 (95% CI 0.65–0.77) and 0.11 (95% CI 0.06–0.19) for TVS, and 0.67 (95% CI 0.54–0.77) and 0.07 (95% CI 0.05–0.11) for MRI (HSROC in Figure 2a). Heterogeneity can be evaluated by predicted ellipses in Figure 2a. Bivariate meta-regression indicated similar accuracy for TVS and MRI (p = 0.65).
- RS endometriosis: Eight studies evaluated DTA of TVS and MRI for RS endometriosis detection [17,21,23,24,26,27,30,31]. Pooled sensitivity and FPR were 0.85 (95% CI 0.76–0.90) and 0.06 (95% CI 0.02–0.15) for TVS, and 0.83 (95% CI 0.76–0.88) and 0.07 (95% CI 0.03–0.14) for MRI (HSROC in Figure 2b). Heterogeneity can be evaluated by predicted ellipses in Figure 2b. Bivariate meta-regression indicated similar accuracy for TVS and MRI (p = 0.96).RVS endometriosis: Seven studies evaluated DTA of TVS and MRI for RVS endometriosis detection [21,24,25,26,27,28,30]. Pooled sensitivity and FPR were 0.47 (95% CI 0.23–0.72) and 0.05 (95% CI 0.02–0.12) for TVS, and 0.61 (95% CI 0.48–0.72) and 0.08 (95% CI 0.04–0.15) for MRI (HSROC in Figure 2c). Heterogeneity can be evaluated by predicted ellipses in Figure 2c. Bivariate meta-regression indicated similar accuracy for TVS and MRI (p = 0.47).Other localization of endometriosis (univariate approach, TVS vs. MRI):
3.3. Diagnostic Performance of TVS Versus RES
- USLs endometriosis: Five studies evaluated DTA of TVS and RES for USLs endometriosis detection [18,21,22,24,30]. Pooled sensitivity and FPR were 0.75 (95% CI 0.69–0.70) and 0.16 (95% CI 0.08–0.31) for TVS, and 0.61 (95% CI 0.43–0.76) and 0.31 (95% CI 0.15–0.54) for RES (HSROC in Figure 3b). Heterogeneity can be evaluated by predicted ellipses in Figure 3a. Bivariate meta-regression indicated similar accuracy for TVS and RES (p = 0.29).
- RS endometriosis: Seven studies evaluated DTA of TVS and RES for RS endometriosis detection [15,18,20,21,22,24,30]. Pooled sensitivity and FPR were 0.89 (95% CI 0.84–0.93) and 0.05 (95% CI 0.02–0.14) for TVS, and 0.88 (95% CI 0.84–0.91) and 0.09 (95% CI 0.04–0.21) for RES (HSROC in Figure 3a). Heterogeneity can be evaluated by predicted ellipses in Figure 3b. Bivariate meta-regression indicated similar accuracy for TVS and RES (p = 0.68).RVS endometriosis: Five studies evaluated DTA of TVS and RES for RVS endometriosis detection [21,22,24,28,30]. Pooled sensitivity and FPR were 0.39 (95% CI 0.13–0.73) and 0.05 (95% CI 0.02–0.16) for TVS, and 0.55 (95% CI 0.22–0.84) and 0.11 (95% CI 0.05–0.25) for RES (HSROC in Figure 3c). Heterogeneity can be evaluated by predicted ellipses in Figure 3c. Bivariate meta-regression indicated similar accuracy for TVS and RES (p = 0.40).Other localization of endometriosis (univariate approach, TVS vs. RES):
- Only one study DTA of TVS and RES for PoD endometriosis [21]
3.4. Diagnostic Performance of MRI Versus RES
- RS endometriosis: six studies evaluated DTA of MRI and RES for RS endometriosis detection [16,19,21,24,29,30]. Pooled sensitivity and FPR were 0.84 (95% CI 0.79–0.88) and 0.09 (95% CI 0.04–0.20) for MRI, and 0.91 (95% CI 0.87–0.94) and 0.13 (95% CI 0.04–0.18) for RES (HSROC in Figure 4a). Heterogeneity can be evaluated by predicted ellipses in Figure 4a. Bivariate meta-regression indicated different accuracy for MRI and RES (p = 0.03). In particular, RES offered a better sensitivity than MRI (p = 0.02), while the false positive rate was similar between the two methods (p = 0.92).
- RVS endometriosis: five studies evaluated DTA of MRI and RES for RVS endometriosis detection [19,21,24,28,30]. Pooled sensitivity and FPR were 0.55 (95% CI 0.41–0.67) and 0.06 (95% CI 0.02–0.14) for MRI, and 0.55 (95% CI 0.22–0.84) and 0.11 (95% CI 0.05–0.25) for RES (HSROC in Figure 4b). Heterogeneity can be evaluated by predicted ellipses in Figure 4b. Bivariate meta-regression indicated similar accuracy for MRI and RES (p = 0.43).Other localization of endometriosis (univariate approach, MRI vs. RES):
- No study reported data for PoD endometriosis detection.
3.5. Risk of Bias Within Studies
3.6. Applicability Concerns
4. Discussion
4.1. Synthesis of the Results
4.2. Interpretation of the Results
4.3. Comparison to Other Meta-Analysis
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Study | Risk of Bias | Applicability Concerns | |||||
---|---|---|---|---|---|---|---|
Patient Selection | Index Test | Reference Standard | Flow and Timing | Patient Selection | Index Test | Reference Standard | |
Bazot et al. 2003 [15] | |||||||
Chapron et al. 2004 [16] | |||||||
Abrao et al. 2007 [17] | |||||||
Bazot et al. 2007 a [18] | |||||||
Bazot et al. 2007 b [19] | |||||||
Piketty et al. 2008 [20] | |||||||
Bazot et al. 2009 [21] | |||||||
Bergamini et al. 2010 [22] | |||||||
Saba et al. 2012 [23] | |||||||
Cazalis et al. 2012 [24] | |||||||
Fiaschetti et al. 2012 [25] | |||||||
Saccardi et al. 2012 [26] | |||||||
Vimercati et al. 2012 [27] | |||||||
Mangler et al. 2013 [28] | |||||||
Kanté et al. 2017 [29] | |||||||
Alborzi et al. 2018 [30] | |||||||
Guerriero et al. 2018 [31] |
Authors and Year | Study Design | Index Test | Patients Treated (n) | Mean/Median Age | Mean BMI (kg/m2) | DPE Confirmed Localization (% (n)) | Reference Standard |
---|---|---|---|---|---|---|---|
Abrao et al. 2007 [17] | cross-sectional study | TVS MRI | 104 | 33.8 ± 6.1 | NS | 64.3 (63) | surgery |
Bazot et al. 2009 [21] | retrospective study | TVS MRI RES | 92 | 31.8 (20–51) | NS | 97.8 (90) | histology |
Saba et al. 2012 [23] | prospective study | TVS MRI | 59 | 33 (21–44) | NS | 76.3 (45) | surgery and histology |
Cazalis et al. 2012 [24] | retrospective study | TVS MRI RES | 25 | 35.4 ± 6.1 | NS | 100 (25) | surgery and histology |
Fiaschetti et al. 2012 [25] | prospective study | TVS MRI | 58 | 34 ± 6 | NS | 71.2 (57) | surgery |
Saccardi et al. 2012 [26] | prospective study | TVS MRI | 54 | 32.3 ± 5.8 | 20.6 ± 2.2 | 85.2 (46) | surgery and histology |
Vimercati et al. 2012 [27] | prospective study | TVS MRI | 90 | 34 | NS | 82.2 (74) | surgery and histology |
Mangler et al. 2013 [28] | prospective study | TVS MRI RES | 79 | 34 (19–51) | 23 (17–35) | 61.0 (48) | surgery and histology |
Alborzi et al. 2018 [30] | prospective study | TVS MRI RES | 317 | 31 ± 5.4 | NS | 79.5 (252) | surgery and histology |
Guerriero et al. 2018 [31] | prospective study | TVS MRI | 159 | 33 ± 7 | nr | 66.6 (106) | surgery |
Authors and Year | Study Design | Test Method | Patients Treated (n) | Mean/Median Age | Mean BMI (kg/m2) | DPE Confirmed Localization (% (n)) | Reference Standard |
---|---|---|---|---|---|---|---|
Bazot et al. 2003 [15] | prospective study | TVS RES | 30 | 32 (21 ± 50) | NS | 93.0 (28) | histology |
Bazot et al. 2007a [18] | prospective study | TVS RES | 81 | 31.9 (20–51) | NS | 97.5 (79) | surgery and histology |
Bazot et al. 2009 [21] | retrospective study. | TVS MRI RES | 92 | 31.8 (20–51) | NS | 97.8 (90) | histology |
Bergamini et al. 2010 [22] | prospective study | TVS RES | 61 | 33.1 (28–37) | NS | 83.6 (51) | surgery and histology |
Cazalis et al. 2012 [24] | retrospective study. | TVS MRI RES | 25 | 35.4 ± 6.1 | NS | 100 (25) | surgery and histology |
Mangler et al. 2013 [28] | prospective study | TVS MRI RES | 79 | 34 (19–51) | 23 (17–35) | 61.0 (48) | surgery and histology |
Piketty et al. 2009 [20] | prospective study | TVS RES | 134 | 32.1 ± 5.0 (22–47) | NS | 100 (134) | histology |
Alborzi et al. 2018 [30] | prospective study | TVS MRI RES | 317 | 31 ± 5.4 | NS | 79.5 (252) | surgery and histology |
Authors and Year | Study Design | Index Test | Patients Treated (n) | Mean/Median Age | Mean BMI (kg/m2) | DPE Confirmed Localization (% (n)) | Reference Standard |
---|---|---|---|---|---|---|---|
Bazot et al. 2007b [19] | prospective study | MRI RES | 88 | 32.1 (20–51) | NS | 97.7 (86) | surgery and histology |
Bazot et al. 2009 [21] | retrospective study | TVS MRI RES | 92 | 31.8 (20–51) | NS | 97.8 (90) | surgery and histology |
Cazalis et al. 2012 [24] | retrospective study | TVS MRI RES | 25 | 35.4 ± 61 | NS | 100 (25) | surgery and histology |
Chapron et al. 2004 [16] | retrospective study | MRI RES | 81 | 31.9 ± 6.7 | 22.3 ± 3.3 | 100 (81) | histology |
Kanté et al. 2017 [29] | retrospective study | MRI RES | 239 | 33 (20–53) | 22 (16–38) | NS | surgery and histology |
Mangler et al. 2013 [28] | prospective study | TVS MRI RES | 79 | 34 (19–51) | 23 (17–35) | 61.0 (48) | surgery and histology |
Alborzi et al. 2018 [30] | prospective study | TVS MRI RES | 317 | 31 ± 5.4 | NS | 79.5 (252) | surgery and histology |
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Noventa, M.; Scioscia, M.; Schincariol, M.; Cavallin, F.; Pontrelli, G.; Virgilio, B.; Vitale, S.G.; Laganà, A.S.; Dessole, F.; Cosmi, E.; et al. Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis. Diagnostics 2019, 9, 225. https://doi.org/10.3390/diagnostics9040225
Noventa M, Scioscia M, Schincariol M, Cavallin F, Pontrelli G, Virgilio B, Vitale SG, Laganà AS, Dessole F, Cosmi E, et al. Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis. Diagnostics. 2019; 9(4):225. https://doi.org/10.3390/diagnostics9040225
Chicago/Turabian StyleNoventa, Marco, Marco Scioscia, Michele Schincariol, Francesco Cavallin, Giovanni Pontrelli, Bruna Virgilio, Salvatore Giovanni Vitale, Antonio Simone Laganà, Francesco Dessole, Erich Cosmi, and et al. 2019. "Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis" Diagnostics 9, no. 4: 225. https://doi.org/10.3390/diagnostics9040225