Diagnostic accuracy of the IDEA protocol for non invasive diagnosis of rectosigmoid DE – a prospective cohort study

Abstract

Objectives To test the accuracy of TVS applying the IDEA approach for suspected rectosigmoid DE and to determine the frequency of other pelvic diseases mimicking DE in patients undergoing surgery.

Materials und Methods Prospective single center observational study including consecutive women undergoing TVS for clinically suspected rectosigmoid DE followed by conservative or surgical therapy. TVS findings were compared with those obtained by laparoscopy and confirmed histologically.

Results Of the 671 included patients, 128 women opted for medical therapy, and 6 patients decided for surgery but did not give consent to participate in the study. 537 women were enrolled in the final analysis. 279 (52 %) exhibited surgically confirmed rectosigmoid DE. The sensitivity and specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio (LR+/–) and accuracy of TVS for diagnosing DE in the rectosigmoid were 93.5 %, 94.6 %, 94.9 %, 93.1 %, 17.24, 0.07, 94.04 %. 12 women who were clinically suspected for DE and mimicked sonographic signs fulfilling the IDEA criteria did exhibit other pathologies. Diagnoses were as follows: vaginal Gartner duct cyst (3/291;1.0 %), anorectal abscess (3/291; 1.0 %), rectal cancer (2/291;0.7 %), hydrosalpinx (2/291;0.7 %), metastatic endometrial cancer (1/291;0.35 %) and Crohn’s disease (1/291;0.35 %).

Conclusion TVS for diagnosing colorectal DE applying the IDEA criteria is highly accurate for presurgical diagnosis. However, additional pelvic pathologies are encountered in 4–5 % of women attending for suspected rectosigmoid DE. These need to be taken into account when investigating patients for suspected DE.

Zusammenfasung

Ziel Die Prüfung der diagnostischen Aussagekraft der TVS nach dem IDEA-Protokoll bei Verdacht auf rektosigmoidale TIE und Bestimmung der Häufigkeit möglicher anderwertiger pathologischer Veränderungen.

Material und Methode Prospektive TVS-basierte Beobachtungsstudie mit konsekutivem Einschluss von Patientinnen mit klinischem Verdacht auf rektosigmoidale TIE. Die Ergebnisse der TVS wurden mit den Ergebnissen der chirurgischen Therapie verglichen.

Ergebnisse Von den 671 Patientinnen, die sich einer TVS unterzogen, 128 Frauen entschieden sich für eine medikamentöse Therapie. 6 Patientinnen entschieden sich für einen chirurgischen Eingriff, gaben aber keine Zustimmung zur Teilnahme an der Studie. 537 Patientinnen wurden in die Studie aufgenommen. 279 (52 %) Patientinnen wiesen histologisch verifizierte rektosigmoidale TIE auf. Die Sensitivität und Spezifität, der PPV der NPV, die LR+ und die LR– sowie die Genauigkeit der TVS zur Diagnose von rektosigmoidealen TIE lagen bei 93,5 %, 91,8 %, 94,9 % 89,7 %, 11,54, 0,07, 92,9 %. 12 Frauen, bei denen ein klinischer und sonografischer Verdacht auf rektosigmoidale TIE bestand wiesen andere Pathologien auf: Gartner-Gang Zyste der Vaginalwand (3/291;1,0 %), anorektaler Abszess (3/291; 1,0 %), Rektumkarzinom (2/291;0,7 %), Hydrosalpinx (2/291; 0,7 %), metastasierendes Endometriumkarzinom (1/291; 0,35 %) und Morbus Crohn (1/291;0,35 %).

Schlussfolgerungen Die TVS zur prächirurgischen Diagnose der rektosigmoidalen TIE unter Anwendung des IDEA-Protokolls ist aussagekräftig. Bei etwa 4–5 % der Patientinnen mit sonografischen, IDEA-basierten Zeichen einer rektosigmoidalen TIE, müssen anderwertige Krankheiten in Betracht gezogen werden.

Key words

deep endometriosis - transvaginal sonography - IDEA - differential diagnosis - #ENZIAN classification

Publication History

Received: 22 November 2022

Accepted: 11 February 2023

Accepted Manuscript online:
13 February 2023

Article published online:
07 March 2023

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