title: Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination.
abstract: BACKGROUND
  Transvaginal ultrasonography (TVUS) has important advantages compared with transrectal ultrasonography (TRUS): it is less invasive, is cost-effective, is a familiar and well-accepted approach, and anesthesia is not required. We compared the accuracy of TVUS and TRUS for diagnosing rectal wall involvement in patients presenting with histologically proved deeply infiltrating endometriosis (DIE).
  
  
  METHODS
  Prospective study of 134 patients with histologically proved DIE underwent preoperative investigations using both TVUS and TRUS. The radiologist (TVUS) and sonographer (TRUS) were unaware of the clinical findings but knew that DIE was suspected.
  
  
  RESULTS
  DIE was confirmed histologically for all the patients. A rectal wall involvement was histologically proved for 75 patients (56%). For the diagnosis of infiltration of the intestinal wall, TVUS and TRUS, respectively, had a sensitivity of 90.7% and 96.0%, a specificity of 96.5% and 100.0%, a positive predictive value of 97.1% and 100.0% and a negative predictive value of 88.9% and 95.2%.
  
  
  CONCLUSIONS
  TVUS and TRUS have similar degrees of accuracy for predicting intestinal involvement. TVUS must be the first-line imaging process to perform for patients presenting with clinically suspected DIE. The question for the coming years is to define if it is necessary for TRUS to be carried out systematically in cases of clinically suspected DIE.
authors.affiliation: Department of Gynecology, Obstetrics II and Reproductive Medicine, Université Paris Descartes, Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Piketty
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chopin
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Anne-Elodie
authors.initials: AE
authors.lastname: Millischer-Bellaische
authors.forename: Gilles
authors.initials: G
authors.lastname: Roseau
authors.forename: Mahaut
authors.initials: M
authors.lastname: Leconte
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000379:methods; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012007:Rectum / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D014621:Vagina / Q000000981:diagnostic imaging*