Double-contrast barium enema and transrectal endoscopic ultrasonography in the diagnosis of intestinal deeply infiltrating endometriosis.
OBJECTIVE
To evaluate the sensitivity, specificity, negative predictive value, positive predictive value, association, and agreement of double-contrast barium enema (DCBE) and transrectal endoscopic ultrasonography (Tr EUS) in the diagnosis of rectosigmoid colon endometriosis.


METHODS
Prospective nonrandomized (Canadian Task Force classification II-2).


METHODS
University hospital.


METHODS
We evaluated 37 patients with clinically suspected deeply infiltrating endometriosis (DIE) from January 2004 through January 2005.


METHODS
Clinical examination, DCBE, Tr EUS, and laparoscopy for histologic confirmation.


RESULTS
Deeply infiltrating endometriosis was confirmed by laparoscopic visualization and by histopathologic examination in all patients. Intestinal endometriosis was observed in 27 patients (72.9%). DCBE showed abnormalities suggestive of bowel endometriosis in 24 patients (64.9%) and Tr EUS in 28 patients (75.7%). Considering the DCBE findings we observed among the 24 abnormal examination results, 16 (42.3%) had spiculation, 16 (42.3%) had circumferential narrowing of the bowel, and 4 (10.8%) had the mass effect sign. For DCBE the sensitivity was 88%, the specificity was 54%, the negative predictive value (NPV) was 70%, and the positive predictive value (PPV) was 78%. For Tr EUS the sensitivity, specificity, NPV, and PPV were 96%, 100%, 90%, and 100%. A significant association of the DCBE and the Tr EUS in the diagnosis of intestinal DIE (p = .017) and a moderate agreement of the methods (kappa = 0.44) was also observed.


CONCLUSIONS
Our data, although limited by sample size, confirmed that DCBE has a good sensitivity and a low specificity in the diagnosis of intestinal DIE. The Tr EUS proved to have a higher sensitivity and specificity with elevated NPV and PPV. A significant association of the DCBE and the Tr EUS in the diagnosis of intestinal DIE and a moderate agreement of the methods was also observed.
Ribeiro
Helizabet Salomão Abdalla Ayroza
HS
Obstetrics and Gynecology Department, Santa Casa Medical School, São Paulo, Brazil. hsabdalla@uol.com.br
Ribeiro
Paulo Ayroza
PA
Rossini
Lucio
L
Rodrigues
Francisco Cesar
FC
Donadio
Nilson
N
Aoki
Tsutomu
T
D000328:Adult; D001466:Barium Sulfate; D004715:Endometriosis / Q000000981:diagnostic imaging*; D019160:Endosonography / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography
D001466:Barium Sulfate