Better imaging techniques, together with clinical examinations, may allow physicians to diagnose deep infiltrating endometriosis without the need for laparoscopic surgery, write researchers from the Pierre-and-Marie-Curie University in France.
Their review of data examining how well these examinations perform — published in the journal Fertility and Sterility — suggest that there might be a need to reconsider using diagnostic surgery, currently considered the gold standard.
The review, “Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques,” used a definition from a recent study to define methods that potentially could replace laparoscopic diagnostic surgery, also known as keyhole surgery.
The earlier study, performed by Cochrane — a research network working to provide health research evidence — offered values of specificity and sensitivity of tests to rule out and rule in deep endometriosis.
With these values as a guide, the French team showed that transvaginal sonography (TVS), used together with magnetic resonance imaging (MRI), detected deep endometriosis with an accuracy of 95 percent.
The combination of TVS and MRI reached the value of a replacement test set up by the Cochrane study. Earlier studies of the two methods show they offer at least similar sensitivity and specificity to laparoscopic surgery.
But surgery, even when using laparoscopic techniques, is always linked to risks, the team underscored.
The combination of TVS and MRI imaging has the best value for rectosigmoid colon endometriosis, they said, as diagnosing the condition using imaging in this area would not require further invasive investigations.
The team, however, admitted that their review may overestimate the relevance of imaging techniques, as most included studies were performed by specialized teams that hold a high degree of expertise.
Studies are also not in agreement regarding how effective imaging is for the detection of deep endometriosis in various locations.
Moreover, to advance imaging analysis of deep endometriosis, the team said it is crucial to revise the definition of the diagnosis. Currently, deep infiltrating endometriosis is defined as that infiltrating the peritoneum by more than 5 mm — a rather arbitrary definition, they argued.
Instead, they maintained that deep endometriosis would be better defined as a “fibrous or muscular infiltration of organs and anatomical structures containing endometrial tissue below the peritoneum, regardless the depth of infiltration.”
With this revision, it may also be possible to revise the gold standard of laparoscopic surgery for deep endometriosis diagnostics.