Accuracy of transvaginal ultrasound and magnetic resonance imaging for diagnosis of deep endometriosis in bladder and ureter: a meta-analysis

This meta-analysis aimed to determine the accuracy of transvaginal ultrasound (TVS) and pelvic magnetic resonance imaging (MRI) in diagnosing urinary tract endometriosis (UTE). A comprehensive search of the Pubmed and Embase was conducted between January 1989 and June 2020. Studies that described the accuracy of MRI or TVS for the diagnosis of UTE using surgical data as the reference standard were included. Of the 913 citations identified, 23 studies were analysed. For detection of endometriosis in bladder endometriosis (BE), the overall pooled sensitivities of TVS and MRI were 72% and 68% respectively, and their specificities were 99% and 100% respectively. For detection of endometriosis in the ureteral endometriosis (UE), the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%. In conclusion, both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective. Besides, pelvic MRI and TVS are more accurate for predicting UTE localised in the ureter than bladder, especially in terms of sensitivity.IMPACT STATEMENT<b>What is already known on this subject?</b> Previous studies have confirmed high diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) on bladder endometriosis (BE) respectively. However, high heterogeneity was found for both sensitivity and specificity and no meta-analysis has yet been performed to test the diagnostic value of TVS and MRI for ureteral endometriosis (UE).<b>What the results of this study add?</b> In this meta-analysis, we firstly confirmed high diagnostic value of TVS and MRI on UE respectively. For detection of UE, the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%.<b>What the implications are of these findings for clinical practice and/or further research?</b> Early preoperative diagnosis and accurate understanding of the widespread distribution of endometriosis are prerequisites for radical surgical in UTE. In the present study, we updated the previous results on the accuracy of TVS and MRI for the diagnosis of BE and firstly confirmed high diagnostic value of TVS and MRI on UE. Both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective. <b>What is already known on this subject?</b> Previous studies have confirmed high diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) on bladder endometriosis (BE) respectively. However, high heterogeneity was found for both sensitivity and specificity and no meta-analysis has yet been performed to test the diagnostic value of TVS and MRI for ureteral endometriosis (UE). <b>What the results of this study add?</b> In this meta-analysis, we firstly confirmed high diagnostic value of TVS and MRI on UE respectively. For detection of UE, the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%. <b>What the implications are of these findings for clinical practice and/or further research?</b> Early preoperative diagnosis and accurate understanding of the widespread distribution of endometriosis are prerequisites for radical surgical in UTE. In the present study, we updated the previous results on the accuracy of TVS and MRI for the diagnosis of BE and firstly confirmed high diagnostic value of TVS and MRI on UE. Both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective.

本项荟萃分析旨在明确经阴道超声（transvaginal ultrasound, TVS）与盆腔磁共振成像（pelvic magnetic resonance imaging, MRI）诊断尿路子宫内膜异位症（urinary tract endometriosis, UTE）的准确性。研究于1989年1月至2020年6月间，对Pubmed及Embase数据库开展全面检索，纳入以手术数据作为参考标准、阐述MRI或TVS诊断UTE准确性的相关研究。最终从检索获得的913篇文献中，纳入23项研究进行分析。

针对膀胱子宫内膜异位症（bladder endometriosis, BE）病灶的检出，TVS与MRI的汇总合并灵敏度分别为72%与68%，特异度分别为99%与100%。针对输尿管子宫内膜异位症（ureteral endometriosis, UE）病灶的检出，TVS与MRI的汇总合并灵敏度分别为97%与87%，特异度均为100%。

综上，TVS与MRI在诊断UTE时均具备良好的诊断准确性，且各有独特优势，从临床视角来看是颇具实用价值的一线检查手段。此外，相较于膀胱部位的UTE病灶，盆腔MRI与TVS对输尿管部位异位病灶的预测准确性更高，尤以灵敏度层面更为显著。

<b>What is already known on this subject?</b> 既往研究已分别证实经阴道超声（TVS）与磁共振成像（MRI）对膀胱子宫内膜异位症（BE）具有较高的诊断价值。但现有研究的灵敏度与特异度均存在较高异质性，且目前尚无荟萃分析用以验证TVS与MRI对输尿管子宫内膜异位症（UE）的诊断价值。
<b>What the results of this study add?</b> 本项荟萃分析首次分别证实了TVS与MRI对UE的高诊断价值。针对UE病灶的检出，TVS与MRI的汇总合并灵敏度分别为97%与87%，特异度均为100%。
<b>What the implications are of these findings for clinical practice and/or further research?</b> 早期术前诊断与精准明确子宫内膜异位症的广泛分布范围，是根治性治疗UTE的前提条件。本研究更新了既往关于TVS与MRI诊断BE的准确性研究结果，并首次验证了二者对UE的诊断价值。TVS与MRI在诊断UTE时均具备良好的准确性且各有专属优势，从临床视角而言是极具应用价值的一线检查手段。
<b>What is already known on this subject?</b> 既往研究已分别证实经阴道超声（TVS）与磁共振成像（MRI）对膀胱子宫内膜异位症（BE）具有较高的诊断价值。但现有研究的灵敏度与特异度均存在较高异质性，且目前尚无荟萃分析用以验证TVS与MRI对输尿管子宫内膜异位症（UE）的诊断价值。
<b>What the results of this study add?</b> 本项荟萃分析首次分别证实了TVS与MRI对UE的高诊断价值。针对UE病灶的检出，TVS与MRI的汇总合并灵敏度分别为97%与87%，特异度均为100%。
<b>What the implications are of these findings for clinical practice and/or further research?</b> 早期术前诊断与精准明确子宫内膜异位症的广泛分布范围，是根治性治疗UTE的前提条件。本研究更新了既往关于TVS与MRI诊断BE的准确性研究结果，并首次验证了二者对UE的诊断价值。TVS与MRI在诊断UTE时均具备良好的准确性且各有专属优势，从临床视角而言是极具应用价值的一线检查手段。