Ultraschall Med 2022; 43(02): 146-158
DOI: 10.1055/a-1663-6322
Guidelines & Recommendations

Qualitätsanforderungen an die gynäkologischen Ultraschalluntersuchungen der DEGUM Stufe II – Empfehlungen der Sektionen/Arbeitskreise Gynäkologie und Geburtshilfe der DEGUM, ÖGUM und SGUM

Article in several languages: English | deutsch
Markus Hoopmann
1   Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
,
2   Prof. Tutschek, Prenatal Zürich, Zürich, Switzerland
,
Eberhard Merz
3   Centre for Ultrasound and Prenatal Medicine, Frankfurt/Main, Germany
,
Karl-Heinz Eichhorn
4   Gynäkologie und Geburtshilfe, Praxis für Pränatalmedizin, Weimar, Germany
,
Karl Oliver Kagan
1   Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
,
Kai-Sven Heling
5   Praxis, Prenatal Diagnosis and Human Genetics, Berlin, Germany
,
Renaldo Faber
6   Leipzig, Center of Prenatal Medicine, Leipzig, Germany
,
Andreas Rempen
7   Frauenklinik, Evangelisches Diakoniekrankenhaus, Schwäbisch-Hall, Germany
,
Christiane Kaehler
8   Obstetrics and Gynecology, Praxis für Pränatalmedizin, Erfurt, Germany
,
9   Department of Prenatal Medicine and Gynecologic Ultrasound, University Hospital Basel, Switzerland
,
Samir Helmy
10   Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
,
11   Department of Obstetrics and Gynecology, Medical University Graz, Austria
,
Dieter Grab
12   Department of Obstetrics and Gynecology, University of Ulm, Germany
› Author Affiliations

Zusammenfassung

Die gynäkologische Sonografie ist das zentrale und am häufigsten angewandte apparative Untersuchungsverfahren der Frauenärzt*innen. Ihre Schwerpunkte sind die Abklärung von Raumforderungen des Uterus und der Adnexen, die Fertilitätsdiagnostik, Abklärung von Blutungsstörungen und chronischen wie akuten Unterbauchbeschwerden, die Beckenboden- und Inkontinenzdiagnostik sowie die Differentialdiagnostik der gestörten Frühschwangerschaft. Die Indikation zu diagnostischen und therapeutischen Interventionen, die präoperative Planung und die postoperativen Kontrollen beruhen maßgeblich auf Befunden der gynäkologischen Sonografie. Diese Untersuchungen sind im besonderen Maße von der Erfahrung des Untersuchers abhängig.

In Anlehnung an das bewährte Mehrstufenkonzept der geburtshilflichen Diagnostik sollte daher bei Patientinnen, in denen die frauenärztlichen Erstuntersuchungen noch nicht zu einer ausreichenden Einschätzung der Befunde führen, primär eine gynäkologische Sonografie durch einen erfahrenen und spezialisierten Untersucher erfolgen. Damit der hierfür erforderliche Expertenstatus eine objektivierbare Grundlage bekommt, wurde von der Sektion Gynäkologie und Geburtshilfe der DEGUM in Kooperation mit der ÖGUM und SGUM die Möglichkeit des Erwerbs der DEGUM-Stufe II für die gynäkologische Sonografie implementiert. Die Effektivität der Versorgung im Mehrstufenkonzept lebt aber von der Qualität der Ultraschalluntersuchung auf Stufe I. Qualitätsanforderungen für die Basisunteruntersuchung und die Differenzierung zwischen Basis- und weiterführender Untersuchung wurden daher bereits von der DEGUM/ÖGUM definiert. Die vorliegende Arbeit soll Qualitätsanforderungen an eine gynäkologische Sonografie der DEGUM-Stufe II und an die entsprechend zertifizierten Frauenärztinnen und Frauenärzte darlegen.

Häufige Pathologien aus der gynäkologischen Sonografie und Anforderungen an die Bildgebung und Dokumentation werden beschrieben.



Publication History

Received: 07 June 2021

Accepted: 20 September 2021

Article published online:
08 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Timmerman D, Schwärzler P, Collins WP. et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obst Gyn 1999; 13: 11-16
  • 2 Wong M, Thanatsis N, Amin T. et al. Ultrasound diagnosis of endometrial cancer by subjective pattern recognition in women with postmenopausal bleeding: prospective inter‐rater agreement and reliability study. Ultrasound Obst Gyn 2021;
  • 3 Faschingbauer F, Benz M, Häberle L. et al. Subjective assessment of ovarian masses using pattern recognition: the impact of experience on diagnostic performance and interobserver variability. Arch Gynecol Obstet 2012; 285: 1663-1669
  • 4 Holsbeke CV, Daemen A, Yazbek J. et al. Ultrasound Experience Substantially Impacts on Diagnostic Performance and Confidence when Adnexal Masses Are Classified Using Pattern Recognition. Gynecol Obstet Inves 2010; 69: 160-168
  • 5 Sayasneh A, Kaijser J, Preisler J. et al. Accuracy of ultrasonography performed by examiners with varied training and experience in predicting specific pathology of adnexal masses. Ultrasound Obst Gyn 2015; 45: 605-612
  • 6 Timmerman D, Planchamp F, Bourne T. et al. ESGO/ISUOG/IOTA/ESGE Consensus statements on the pre‐operative diagnosis of ovarian tumours*. Ultrasound Obst Gyn 2021;
  • 7 Gynecologists TAC of O and. Practice Bulletin No. 174: Evaluation und Management of Adnexal Masses. Obstetrics Gynecol 2016; 128: e210-e226
  • 8 Thomassin-Naggara I, Daraï E, Lécuru F. et al. Valeur diagnostique de l’imagerie (échographie, doppler, scanner, IRM et TEP-TDM) pour le diagnostic d’une masse ovarienne suspecte et le bilan d’extension d’un cancer de l’ovaire, des trompes ou péritonéal primitif. Article rédigé sur la base de la recommandation nationale de bonnes pratiques cliniques en cancérologie intitulée «Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire» élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY sous l’égide du CNGOF et labellisée par l’INCa. Gynécologie Obstétrique Fertilité Sénologie 2019; 47: 123-133
  • 9 Gynaecologists RC of O and. The Management of Ovarian Cysts in Postmenopausal Women. Green-top Guideline No34 2016. Im Internet: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_34.pdf
  • 10 Wattar B, Rimmer M, Rogozinska E. et al. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta‐analysis. Bjog Int J Obstetrics Gynaecol 2021; 128: 37-44
  • 11 Grimbizis GF, Sardo ADS, Saravelos SH. et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Human Reproduction 2016; 31: 2-7
  • 12 Shetty M. Imaging and differential diagnosis of ovarian cancer. Seminars Ultrasound Ct Mri 2019; 40: 302-318
  • 13 Imaging: EP on W, Atri M, Alabousi A, et al. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms. J Am Coll Radiol 2019; 16: S77-S93
  • 14 Kaijser J, Vandecaveye V, Deroose CM. et al. Imaging techniques for the pre-surgical diagnosis of adnexal tumours. Best Pract Res Cl Ob 2014; 28: 683-695
  • 15 Dodge JE, Covens AL, Lacchetti C. et al. Preoperative identification of a suspicious adnexal mass: A systematic review and meta-analysis. Gynecol Oncol 2012; 126: 157-166
  • 16 Williams P, Murchie P, Bond C. Patient and primary care delays in the diagnostic pathway of gynaecological cancers: a systematic review of influencing factors. Br J Gen Pract 2019; 69: bjgp19X700781
  • 17 Baun ML, Falborg AZ, Hjertholm P. et al. Ovarian cancer stage, variation in transvaginal ultrasound examination rates and the impact of an urgent referral pathway: A national ecological cohort study. Acta Obstet Gyn Scan 2019; 98: 1540-1548
  • 18 Verleye L, Vergote I, van der Zee AGJ. Patterns of care in surgery for ovarian cancer in Europe. European J Surg Oncol Ejso 2010; 36: S108-S114
  • 19 Grab D, Merz E, Prömpeler H. et al. Standards zur gynaekologischen Sonografie. Ultraschall in Med 2011; 32: 415-417
  • 20 de Bosch TV, Dueholm M, Leone FPG. et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obst Gyn 2015; 46: 284-298
  • 21 Munro MG, Critchley HOD, Fraser IS. et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011; 95: 2204-2208.e3
  • 22 Multinu F, Casarin J, Tortorella L. et al. Incidence of sarcoma in patients undergoing hysterectomy for benign indications: a population-based study. Am J Obstet Gynecol 2019; 220: 179.e1–e179.e10
  • 23 Ludovisi M, Moro F, Pasciuto T. et al. Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma. Ultrasound Obst Gyn 2019; 54: 676-687
  • 24 Amant F, van den Bosch T, Vergote I. et al. Morcellation of uterine leiomyomas: a plea for patient triage. The Lancet Oncology 2015; 16: 1454-1456
  • 25 Testa AC, Legge AD, Blasis ID. et al. Imaging techniques for the evaluation of cervical cancer. Best practice & research Clinical obstetrics & gynaecology 2014; 28: 741-768
  • 26 Epstein E, Testa A, Gaurilcikas A. et al. Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound – a European multicenter trial. Gynecologic oncology 2013; 128: 449-453
  • 27 Byun JM, Kim YN, Jeong DH. et al. Three-dimensional transvaginal ultrasonography for locally advanced cervical cancer. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society 2013; 23: 1459-1464
  • 28 Bakay OA, Golovko TS. Use of elastography for cervical cancer diagnostics. Experimental oncology 2015; 37: 139-145
  • 29 DGGG, OEGGG, SGGG. AWMF Leitlinie Registernr.015/052 Weibliche genitale Fehlbildungen. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/015-052l_S1_Weibliche_genitale_Fehlbildungen_2020-06.pdf
  • 30 Society TAF. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 49: 944-955
  • 31 Oppelt P, Renner SP, Brucker S. et al. The VCUAM (Vagina Cervix Uterus Adnex–associated Malformation) Classification: a new classification for genital malformations. Fertil Steril 2005; 84: 1493-1497
  • 32 Grimbizis GF, Gordts S, Sardo ADS. et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Human Reproduction 2013; 28: 2032-2044
  • 33 Imboden S, Müller M, Raio L. et al. Klinische Bedeutung des 3D-Ultraschalls neben MRI bei uterinen Fehlbildungen. Ultraschall in Med 2014; 35: 440-444
  • 34 Ghi T, Casadio P, Kuleva M. et al. Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertility and Sterility 2009; 92: 808-813
  • 35 Bermejo C, Martinez-Ten P, Recio M. et al. Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations. Ultrasound Obst Gyn 2014; 43: 336-345
  • 36 Ludwin A, Martins WP, Nastri CO. et al. Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus?. Ultrasound Obst Gyn 2018; 51: 101-109
  • 37 Bajka M, Badir S. Fundus Thickness Assessment by 3D Transvaginal Ultrasound Allows Metrics-Based Diagnosis and Treatment of Congenital Uterine Anomalies. Ultraschall in Med 2017; 38: 183-189
  • 38 Leone FPG, Timmerman D, Bourne T. et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obst Gyn 2010; 35: 103-112
  • 39 Valentin L. Ultrasound deserves to play a prominent role in the diagnosis and management of endometrial cancer. Ultrasound Obst Gyn 2014; 43: 483-487
  • 40 Epstein E, Fischerova D, Valentin L. et al. Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study. Ultrasound Obst Gyn 2018; 51: 818-828
  • 41 Bosch TVD, Verbakel JY, Valentin L. et al. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obst Gyn 2021; 57: 164-172
  • 42 Andreotti RF, Fleischer AC. Practical Applications of 3D Sonography in Gynecologic Imaging. Radiol Clin N Am 2014; 52: 1201-1213
  • 43 Epstein E, Fischerova D, Valentin L. et al. Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study. Ultrasound Obst Gyn 2018; 51: 818-828
  • 44 Weber G, Merz E, Bahlmann F. et al. Assessment of myometrial infiltration and preoperative staging by transvaginal ultrasound in patients with endometrial carcinoma. Ultrasound Obst Gyn 1995; 6: 362-367
  • 45 Timor-Tritsch IE, Monteagudo A, Tsymbal T. Three‐dimensional ultrasound inversion rendering technique facilitates the diagnosis of hydrosalpinx. J Clin Ultrasound 2010; 38: 372-376
  • 46 Chappell CA, Wiesenfeld HC. Pathogenesis, Diagnosis, and Management of Severe Pelvic Inflammatory Disease and Tuboovarian Abscess. Clin Obstet Gynecol 2012; 55: 893-903
  • 47 Taran FA, Kagan KO, Hübner M. et al. The Diagnosis and Treatment of Ectopic Pregnancy. Deutsches Ärzteblatt international 2015; 112: 693-703-quiz 704–705
  • 48 Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human reproduction update 2014; 20: 250-261
  • 49 Merz E, Weber G, Bahlmann F. et al. A New Sonomorphologic Scoring System (Mainz Score) for the Assessment of Ovarian Tumors Using Transvaginal Ultrasonography – Part I: A Comparison Between the Scoring-System and the Assessment by an Experienced Sonographer. Ultraschall in Med 1998; 19: 99-107
  • 50 Timmerman D, Valentin L, Bourne TH. et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obst Gyn 2000; 16: 500-505
  • 51 Andreotti RF, Timmerman D, Strachowski LM. et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology 2019; 294: 191150
  • 52 Sladkevicius P, Jokubkiene L, Timmerman D. et al. Vessel morphology depicted by three‐dimensional power Doppler ultrasound as second‐stage test in adnexal tumors that are difficult to classify: prospective diagnostic accuracy study. Ultrasound Obst Gyn 2021; 57: 324-334
  • 53 Ameye L, Timmerman D, Valentin L. et al. Clinically oriented three-step strategy for assessment of adnexal pathology. Ultrasound Obst Gyn 2012; 40: 582-591
  • 54 Bardin R, Perl N, Mashiach R. et al. Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. Ultraschall in Med 2019; 41: 688-694
  • 55 Guerriero S, Condous G, den Bosch TV. et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obst Gyn 2016; 48: 318-332
  • 56 Mattos LA, Goncalves MO, Andres MP. et al. Structured US and MRI imaging report for patients with suspected endometriosis: Guide for Imagers and Clinicians. J Minim Invas Gyn L 2019; 26: 1016-1025
  • 57 Ulrich U, Buchweitz O, Greb R. et al. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis*. Geburtsh Frauenheilk 2014; 74: 1104-1118