Ultrasound is Highly Accurate at Predicting the American Society of Reproductive Medicine (AARM) Stage of Endometriosis.

We aimed to evaluate the diagnostic accuracy of deep endometriosis transvaginal ultrasound (DE TVS) in predicting a surgically-apportioned ASRM endometriosis stage. Multicenter retrospective diagnostic accuracy study. Patients attended one of two gynecology-focused ultrasound practices and underwent laparoscopy by one of six surgeons in the Sydney metropolitan area between 2016 and 2018. Patients with suspected endometriosis. DE TVS followed by laparoscopy. An ASRM stage was apportioned to each patient based on the surgical report. An ultrasound-based ASRM stage was also apportioned using the preoperative DE TVS report. Where details on size of lesions was missing, the range of possible points for that region was used to calculate a minimum and maximum ASRM stage. The diagnostic accuracy (accuracy, sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios) was calculated for each ASRM stage and dichotomized ASRM stages (0/1/2 and 3/4) at the minimal and maximum ASRM stages. An advanced ASRM stage, called ASRM +, was allocated when rectal, vaginal, or ureteral endometriosis was noted and combined with the base ASRM stage (1-4). 204 patients were included. The breakdown of surgical findings is as follows: normal (i.e. no endometriosis, referred to as ASRM 0) 24/204 (11.8%), ASRM 1 110-127/204 (53.9-62.3%), ASRM 2 8-22/204 (3.9-10.8%), ASRM 3 15-16/204(7.4-7.8%), ASRM 4 30-32/204 (14.7-15.7%). Overall, DE TVS had better test performance in higher disease stages. When the ASRM stages are dichotomized, DE TVS has sensitivity/specificity for ASRM 3/4 of 96.2%/93.4% and ASRM 0/1/2 of 94.9%/93.8%. Ultrasound has excellent test performance in predicting a dichotomized ASRM stage state, which can have major positive implications on patient triaging to centers of excellence in minimally-invasive gynecology for advanced stage endometriosis. This may have a downstream positive effect on patient outcomes. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Minimally Invasive Gynecology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)