1.
Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta‐analysis
Guerriero, S.; Saba, L.; Pascual, M. A. ...
Ultrasound in obstetrics & gynecology,
20/May , Letnik:
51, Številka:
5
Journal Article
Objective
To perform a systematic review of studies comparing the accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in diagnosing deep infiltrating endometriosis (DIE) ...
including only studies in which patients underwent both techniques.
Methods
An extensive search was carried out in PubMed/MEDLINE and Web of Science for papers from January 1989 to October 2016 comparing TVS and MRI in DIE. Studies were considered eligible for inclusion if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE and using surgical data as a reference standard. Quality was assessed using the QUADAS‐2 tool. A random‐effects model was used to determine pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR–) and diagnostic odds ratio (DOR).
Results
Of 375 citations identified, six studies (n = 424) were considered eligible. For MRI in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.78–0.90), specificity was 0.95 (95% CI, 0.83–0.99), LR+ was 18.4 (95% CI, 4.7–72.4), LR– was 0.16 (95% CI, 0.11–0.24) and DOR was 116 (95% CI, 23–585). For TVS in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.68–0.94), specificity was 0.96 (95% CI, 0.85–0.99), LR+ was 20.4 (95% CI, 4.7–88.5), LR– was 0.16 (95% CI, 0.07–0.38) and DOR was 127 (95% CI, 14–1126). For MRI in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.66 (95% CI, 0.51–0.79), specificity was 0.97 (95% CI, 0.89–0.99), LR+ was 22.5 (95% CI, 6.7–76.2), LR– was 0.38 (95% CI, 0.23–0.52) and DOR was 65 (95% CI, 21–204). For TVS in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.59 (95% CI, 0.26–0.86), specificity was 0.97 (95% CI, 0.94–0.99), LR+ was 23.5 (95% CI, 9.1–60.5), LR– was 0.42 (95% CI, 0.18–0.97) and DOR was 56 (95% CI, 11–275). For MRI in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.70 (95% CI, 0.55–0.82), specificity was 0.93 (95% CI, 0.87–0.97), LR+ was 10.4 (95% CI, 5.1–21.2), LR– was 0.32 (95% CI, 0.20–0.51) and DOR was 32 (95% CI, 12–85). For TVS in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.67 (95% CI, 0.55–0.77), specificity was 0.86 (95% CI, 0.73–0.93), LR+ was 4.8 (95% CI, 2.6–9.0), LR– was 0.38 (95% CI, 0.29–0.50) and DOR was 12 (95% CI, 7–24). Confidence intervals of pooled sensitivities, specificities and DOR were wide for both techniques in all the locations considered. Heterogeneity was moderate or high for sensitivity and specificity for both TVS and MRI in most locations assessed. According to QUADAS‐2, the quality of the included studies was considered good for most domains.
Conclusion
The diagnostic performance of TVS and MRI is similar for detecting DIE involving rectosigmoid, uterosacral ligaments and rectovaginal septum. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Resumen
Ecografía transvaginal versus resonancia magnética para el diagnóstico de endometriosis profunda infiltrante: revisión sistemática y metaanálisis
Objetivo
Realizar una revisión sistemática de los estudios que comparan la precisión de la ecografía transvaginal (ETV) y las imágenes por resonancia magnética (IRM) en el diagnóstico de la endometriosis profunda infiltrante (DIE, por sus siglas en inglés), en la que solo se incluyeron estudios en los que las pacientes se sometieron a ambas técnicas.
Métodos
Se realizó una búsqueda exhaustiva en PubMed/MEDLINE y Web of Science para artículos publicados desde enero de 1989 a octubre de 2016 en los que se comparan ETV e IRM para diagnóstico de la DIE. Los estudios se consideraron aptos para ser incluidos si informaban sobre el uso de ETV e IRM en el mismo grupo de pacientes para la detección preoperatoria de la endometriosis en localizaciones pélvicas en mujeres con sospecha clínica de DIE, usando los datos quirúrgicos como estándar de referencia. La calidad de los estudios se evaluó con la herramienta QUADAS‐2. Se utilizó un modelo de efectos aleatorios para determinar la sensibilidad combinada, la especificidad, los cocientes de verosimilitud positiva y negativa (LR+ y LR–) y la razón de momios del diagnóstico (DOR, por sus siglas en inglés).
Resultados
De la 375 citas identificadas, se consideraron aptos seis estudios (n = 424). Para la IRM en la detección de DIE en el rectosigmoide, la sensibilidad combinada fue 0,85 (IC 95%, 0,78–0,90), la especificidad fue 0,95 (IC 95%, 0,83–0,99), la LR+ fue 18,4 (IC 95%, 4,7–72,4), LR– fue 0,16 (IC 95%, 0.11–0.24) y la DOR fue 116 (IC 95%, 23–585). Para la ETV en la detección de DIE en el rectosigmoide, la sensibilidad combinada fue 0,85 (IC 95%, 0,68–0,94), la especificidad fue 0,96 (IC 95%, 0,85–0,99), LR+ fue 20,4 (IC 95%, 4,7–88,5), LR– fue 0,16 (IC 95%, 0.07–0.38) y la DOR fue 127 (IC 95%, 14–1126). Para la IRM en la detección de DIE en el tabique rectovaginal, la sensibilidad combinada fue 0,66 (IC 95%, 0,51–0,79), la especificidad fue 0,97 (IC 95%, 0,89–0,99), LR+ fue 22,5 (IC 95%, 6,7–76,2), LR– fue 0,38 (IC 95%, 0,23–0,52) y la DOR fue 65 (IC 95%, 21–204). Para la ETV en la detección de DIE en el tabique rectovaginal, la sensibilidad combinada fue 0,59 (IC 95%, 0,26–0,86), la especificidad fue 0,97 (IC 95%, 0,94–0,99), LR+ fue 23,5 (IC 95%, 9,1–60,5), LR– fue 0,42 (IC 95%, 0,18–0,97) y la DOR fue 56 (IC 95%, 11–275). Para la IRM en la detección de DIE en los ligamentos uterosacros, la sensibilidad combinada fue 0,70 (IC 95%, 0,55–0,82), la especificidad fue 0,93 (IC 95%, 0,87–0,97), LR+ fue 10,4 (IC 95%, 5,1–21,2), LR– fue 0,32 (IC 95%, 0,20–0,51) y la DOR fue 32 (IC 95%, 12–85). Para ETV en la detección de DIE en los ligamentos uterosacros, la sensibilidad combinada fue 0,67 (IC 95%, 0,55–0,77), la especificidad fue 0,86 (IC 95%, 0,73–0,93), LR+ fue 4,8 (IC 95%, 2,6–9,0), LR– fue 0,38 (IC 95%, 0,29–0,50) y la DOR fue 12 (IC 95%, 7–24). Los intervalos de confianza de las sensibilidades combinadas, las especificidades y la DOR fueron amplios para ambas técnicas en todos los lugares examinados. La heterogeneidad fue moderada o alta en cuanto a la sensibilidad y la especificidad para la ETV y la IRM en la mayoría de los lugares examinados. En función de QUADAS‐2, la calidad de los estudios incluidos se consideró buena para la mayoría de los dominios.
Conclusión
El desempeño del diagnóstico de la ETV y la IRM es similar para la detección de DIE cuando se examinan los ligamentos rectosigmoides, uterosacros y el tabique rectovaginal.
摘要
经阴道超声与磁共振成像诊断深部浸润性子宫内膜异位症:系统评价和meta分析
目的
对经阴道超声(transvaginal ultrasound,TVS)与磁共振成像(magnetic resonance imaging,MRI)诊断深部浸润性子宫内膜异位症(deep infiltrating endometriosis,DIE)的准确性进行比较的研究进行系统评价, 仅包括患者同时接受两种检查的研究。
方法
全面检索PubMed/MEDLINE和Web of Science数据库中1989年1月至2016年10月间收录的对DIE中TVS和MRI进行比较的文献。纳入标准:术前检查发现盆腔子宫内膜异位症的临床疑似DIE的孕妇, 同时行TVS和MRI, 并将手术资料作为参考标准。采用QUADAS‐2工具评估研究质量。采用随机效应模型检测合并敏感度、特异度、阳性和阴性似然比(LR+和LR–)及诊断比值比(diagnostic odds ratio,DOR)。
结果
检索到的375篇文献中, 6项研究(n=424)符合纳入标准。MRI检测直肠乙状结肠DIE时, 合并敏感度为0.85(95% CI,0.78~0.90), 合并特异度为0.95(95% CI,0.83~0.99), 合并LR+为18.4(95% CI,4.7~72.4), 合并LR–为0.16(95% CI,0.11~0.24), 合并DOR为116(95% CI,23~585)。TVS检测直肠乙状结肠DIE时, 合并敏感度为0.85(95% CI,0.68~0.94), 合并特异度为0.96(95% CI,0.85~0.99), 合并LR+为20.4(95% CI,4.7~88.5), 合并LR–为0.16(95% CI,0.07~0.38), 合并DOR为127(95% CI,14~1126)。MRI检测直肠阴道隔DIE时, 合并敏感度为0.66(95% CI,0.51~0.79), 合并特异度为0.97(95% CI,0.89~0.99), 合并LR+为22.5(95% CI,6.7~76.2), 合并LR–为0.38(95% CI,0.23~0.52), 合并DOR为65(95% CI,21~204)。TVS检测直肠阴道隔DIE时, 合并敏感度为0.59(95% CI,0.26–0.86), 合并特异度为0.97(95% CI,0.94~0.99), 合并LR+为23.5(95% CI,9.1~60.5), 合并LR–为0.42(95% CI,0.18~0.97), 合并DOR为56 (95% CI,11~275)。MRI检测子宫骶韧带DIE时, 合并敏感度为0.70(95% CI,0.55~0.82), 合并特异度为0.93(95% CI,0.87~0.97), 合并LR+为10.4(95% CI,5.1~21.2), 合并LR–为0.32 (95% CI,0.20~0.51), 合并DOR为32(95% CI,12~85)。TVS检测子宫骶韧带DIE时, 合并敏感度为 0.67(95% CI,0.55~0.77), 合并特异度为0.86(95% CI,0.73~0.93), 合并LR+为4.8(95% CI,2.6~9.0), 合并LR–为0.38(95% CI,0.29~0.50), 合并DOR为12(95% CI,7~24)。两种检查方法在所有检查部位的合并敏感度、特异度和DOR的置信区间宽。在大多评估部位中, TVS和MRI敏感度和特异度的异质性为中度或高度。根据QUADAS‐2, 纳入研究的大部分内容质量较高。
结论
TVS和MRI对直肠乙状结肠、子宫骶韧带、直肠阴道隔DIE的诊断能力相似。
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več
2.
Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta‐analysis
Guerriero, S.; Ajossa, S.; Minguez, J. A. ...
Ultrasound in obstetrics & gynecology,
November 2015, Letnik:
46, Številka:
5
Journal Article
ABSTRACT
Objective
To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of endometriosis in the uterosacral ligaments (USL), rectovaginal septum (RVS), ...
vagina and bladder in patients with clinical suspicion of deep infiltrating endometriosis (DIE).
Methods
An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. Studies were considered eligible if they reported on the use of TVS for the preoperative detection of endometriosis in the USL, RVS, vagina and bladder in women with clinical suspicion of DIE using the surgical data as a reference standard. Study quality was assessed using the PRISMA guidelines and QUADAS‐2 tool.
Results
Of the 801 citations identified, 11 studies (n = 1583) were considered eligible and were included in the meta‐analysis. For detection of endometriosis in the USL, the overall pooled sensitivity and specificity of TVS were 53% (95%CI, 35–70%) and 93% (95%CI, 83–97%), respectively. The pretest probability of USL endometriosis was 54%, which increased to 90% when suspicion of endometriosis was present after TVS examination. For detection of endometriosis in the RVS, the overall pooled sensitivity and specificity were 49% (95%CI, 36–62%) and 98% (95%CI, 95–99%), respectively. The pretest probability of RVS endometriosis was 24%, which increased to 89% when suspicion of endometriosis was present after TVS examination. For detection of vaginal endometriosis, the overall pooled sensitivity and specificity were 58% (95%CI, 40–74%) and 96% (95%CI, 87–99%), respectively. The pretest probability of vaginal endometriosis was 17%, which increased to 76% when suspicion of endometriosis was present after TVS assessment. Substantial heterogeneity was found for sensitivity and specificity for all these locations. For detection of bladder endometriosis, the overall pooled sensitivity and specificity were 62% (95%CI, 40–80%) and 100% (95%CI, 97–100%), respectively. Moderate heterogeneity was found for sensitivity and specificity for bladder endometriosis. The pretest probability of bladder endometriosis was 5%, which increased to 92% when suspicion of endometriosis was present after TVS assessment.
Conclusion
Overall diagnostic performance of TVS for detecting DIE in uterosacral ligaments, rectovaginal septum, vagina and bladder is fair with high specificity. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
več
6.
Influence of cryopreservation on perinatal outcome after blastocyst‐ vs cleavage‐stage embryo transfer: systematic review and meta‐analysis
Alviggi, C.; Conforti, A.; Carbone, I. F. ...
Ultrasound in obstetrics & gynecology,
January 2018, 2018-01-00, 20180101, Letnik:
51, Številka:
1
Journal Article
ABSTRACT
Objective
To compare the perinatal outcomes of singleton pregnancies resulting from blastocyst‐ vs cleavage‐stage embryo transfer and to assess whether they differ between fresh and frozen ...
embryo transfer cycles.
Methods
A systematic review of the literature was carried out using the Scopus, MEDLINE and ISI Web of Science databases with no time restriction. We included only peer‐reviewed articles involving humans, in which perinatal outcomes of singleton pregnancies after blastocyst‐stage embryo transfer were compared with those after cleavage‐stage embryo transfer. Primary outcomes were preterm birth before 37 weeks and low birth weight (< 2500 g). Secondary outcomes were very preterm birth before 32 weeks, very low birth weight (< 1500 g), small‐for‐gestational‐age (SGA), large‐for‐gestational‐age (LGA), perinatal mortality and congenital anomaly. A meta‐analysis was performed using a random‐effects model. Three subgroups were evaluated: fresh only, frozen only and fresh plus frozen embryo transfer cycles.
Results
From a total of 3928 articles identified, 14 were selected for qualitative/quantitative analysis. Significantly higher incidences of preterm birth < 37 weeks (11 studies, n = 106 629 participants; risk ratio (RR), 1.15 (95% CI, 1.05 − 1.25); P = 0.002) and very preterm birth < 32 weeks (seven studies, n = 103 742; RR, 1.16 (95% CI, 1.02–1.31); P = 0.03) were observed after blastocyst‐ than after cleavage‐stage embryo transfer in fresh cycles. However, the risk of preterm and very preterm birth was similar after blastocyst‐ and cleavage‐stage transfers in frozen and fresh plus frozen cycles. Overall effect size analysis revealed fewer SGA deliveries after blastocyst‐ compared with cleavage‐stage transfer in fresh cycles but a similar number in frozen cycles. Conversely, more LGA deliveries were observed after blastocyst‐ compared with cleavage‐stage transfer in frozen cycles (two studies, n = 39 044; RR, 1.18 (95% CI, 1.09–1.27); P < 0.0001) and no differences between the two groups in fresh cycles (four studies, n = 42 982; RR, 1.14 (95% CI, 0.97–1.35); P = 0.11). There were no differences with respect to low birth weight, very low birth weight or congenital anomalies between blastocyst‐ and cleavage‐stage transfers irrespective of the cryopreservation method employed. Only one study reported a higher incidence of perinatal mortality after blastocyst‐ vs cleavage‐stage embryo transfer in frozen cycles, while no differences were found in fresh cycles.
Conclusions
Our results suggest that cryopreservation of embryos can influence outcome of pregnancy conceived following blastocyst‐ vs cleavage‐stage embryo transfer in terms of preterm birth, very preterm birth, LGA, SGA and perinatal mortality. Caution should be exercised in interpreting these findings given the low level of evidence and wide heterogeneity of the studies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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