Specialist transvaginal ultrasound (TVUS) and MRI are valuable diagnostic tools for preoperative planning in women who have been diagnosed with deep infiltrating endometriosis, new research reveals.
Both modalities were accurate in disclosing the depth of disease and rectal wall involvement before surgery, and researchers believe the results of their work merit including TVUS and MRI as a part of preoperative protocols in women with the gynecological condition.
“For patients in whom medical management is insufficient or inappropriate, common surgical approaches include rectal shave, disc resection or segmental bowel resection,” corresponding author Samantha Sloss, MD, at Mercy Hospital for Women, and co-authors explained. “Accurate information regarding endometriotic lesion size, depth, and location is therefore essential, as it enables appropriate surgical planning and patient counseling.”
For their research, the doctors reviewed 135 cases of patients who had undergone surgery for deep infiltrating endometriosis (DIE). The preoperative imaging available was then compared to the patients’ histopathological findings.
In 92% of cases the findings in at least one of the modalities were in line with the histopathological depth of disease, showing a combined sensitivity of 94%, specificity of 50% and positive predictive values of 97.9%. Both modalities demonstrated high marks for assessing rectal wall involvement, but MRI maintained higher specificity and PPV, both at 100%.
“The finding of rectal wall involvement by either TVUS or MRI in our study is highly sensitive in predicting histological confirmation of endometriosis involving the muscularis or deeper layers of the rectal wall. This study therefore advocates for preoperative use of one or both modalities,” the doctors added.
Though the findings do support the use of TVUS and MRI as a part of preoperative protocol for DIE, the doctors caution that imaging alone should not be the sole tool guiding decisions, as many other factors could impact the exact surgical approach needed.
You can view the detailed research in the Journal of Minimally Invasive Gynecology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.