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International and multicenter prospective diagnostic accuracy of transvaginal ultrasound for endometriosis using the International Deep Endometriosis Analysis (IDEA) terminology: pilot study.

OBJECTIVES
To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) to predict ovarian endometriomas (OE), overall deep endometriosis (DE), and DE locations by following the International Deep Endometriosis Analysis (IDEA) consensus statement.


METHODS
This was an international, multicenter prospective diagnostic accuracy study involving eight centers across six countries (August 2018-November 2019). Consecutive participants were enrolled. Only participants with suspected endometriosis based on clinical symptoms or historical diagnosis of endometriosis were included. The index test was TVS performed pre-operatively in accordance with the IDEA consensus statement. At each center, the index test was interpreted by a single sonologist. The reference standards used were 1) direct visualization of endometriosis at laparoscopy as determined by a non-blinded surgeon with expertise in endometriosis surgery and 2) histological assessment of biopsied/excised tissue. All surgeries were performed within 12 months of the index test TVS. Accuracy (Acc), sensitivity (Sens), specificity (Spec), positive and negative predictive values (PPV/NPV), and positive and negative likelihood ratios (LR+/LR-) of TVS were measured.


RESULTS
273 participants were included in the study with complete clinical, TVS, laparoscopic, and histological data. 256/273 (93.8%) participants were confirmed to have endometriosis histologically. Based on surgical visualization, 139/273 (50.9%) had an OE and 207/273 (75.8%) had DE. 190/273 (69.6%) had DE confirmed histologically. For overall DE, diagnostic performance of TVS based on surgical visualization as a reference was as follows: Acc 86.1%; Sens 88.4%; Spec 78.8%; PPV 92.9%; NPV 68.4%; LR+ 4.17; LR- 0.15. Diagnostic performance of TVS based on histology as a reference standard was as follows: Acc 85.9%; Sens 89.8%; Spec 75.9%; PPV 90.4%; NPV 74.6%; LR+ 3.71; LR- 0.14.


CONCLUSION
A systematic approach to DE TVS is paramount, and the IDEA consensus approach allows for strong diagnostic accuracy. This study has found a higher TVS detection rate of overall DE than reported by the most recent meta-analysis on the topic (sensitivity 79%) but a lower specificity. This article is protected by copyright. All rights reserved.