Open Access

Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‑analysis of diagnostic accuracy studies

  • Authors:
    • Xiao Zhang
    • Tao He
    • Wen Shen
  • View Affiliations

  • Published online on: July 24, 2020     https://doi.org/10.3892/etm.2020.9043
  • Pages: 3208-3220
  • Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Visual inspection via laparoscopy is considered the gold standard for the diagnosis of deep infiltrating endometriosis. Laparoscopy is an invasive procedure; therefore, it would be beneficial to patients if accurate non‑invasive modalities were available for the diagnosis of deep infiltrating endometriosis. The purpose of the current review and meta‑analysis was to assess the diagnostic accuracy of clinical examination, transvaginal ultrasound (TVUS), transrectal ultrasound (TRUS) and MRI as alternative methods for diagnosis of deep infiltrating endometriosis. A systematic search of the Medline, Scopus, Embase and Cochrane library databases, between their inception and September 2019, was performed. The quality of trials was assessed using the quality assessment of diagnostic accuracy studies‑2 tool. Meta‑analyses were conducted to obtain the pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio for each of the three imaging modalities and clinical examination. A total of 30 studies with 4,565 participants were included in the review. Physical examination had a pooled sensitivity of 71% and a specificity of 69%, with an average diagnostic accuracy [area under the curve (AUC) =0.76]. TVUS had a pooled sensitivity of 76% and a specificity of 94%, with higher diagnostic accuracy than physical examination (AUC =0.92). TRUS had a pooled sensitivity of 91% and a specificity of 80% with an AUC of 0.93. MRI had a pooled sensitivity of 82% and a specificity of 87% with higher diagnostic accuracy than physical examination (AUC =0.91). All the imaging modalities had good clinical utility, as indicated by the Fagan plot. The present analysis demonstrates that the imaging modalities TVUS, TRUS and MRI may be highly useful alternatives to laparoscopy for diagnosis of deep infiltrating endometriosis and that these techniques have a high sensitivity and specificity.
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October-2020
Volume 20 Issue 4

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Zhang X, He T and Shen W: Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‑analysis of diagnostic accuracy studies. Exp Ther Med 20: 3208-3220, 2020.
APA
Zhang, X., He, T., & Shen, W. (2020). Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‑analysis of diagnostic accuracy studies. Experimental and Therapeutic Medicine, 20, 3208-3220. https://doi.org/10.3892/etm.2020.9043
MLA
Zhang, X., He, T., Shen, W."Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‑analysis of diagnostic accuracy studies". Experimental and Therapeutic Medicine 20.4 (2020): 3208-3220.
Chicago
Zhang, X., He, T., Shen, W."Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‑analysis of diagnostic accuracy studies". Experimental and Therapeutic Medicine 20, no. 4 (2020): 3208-3220. https://doi.org/10.3892/etm.2020.9043