Proposed technique to visualize and classify uterosacral ligament deep endometriosis with and without infiltration into parametrium or torus uterinus

Mathew Leonardi, Wellington P. Martins, Mercedes Espada, M Arianayagam, Mohan Arianayagam, G. Condous
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2019 · vol. 55(1) , pp. 137–139 · doi:10.1002/uog.20300 · PMID:31008537 · W2941584470
article OA: bronze CC0 ⤵ 30 in-corpus citations
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This paper proposes a standardized technique and classification system for visualizing and classifying deep endometriosis in the uterosacral ligaments with and without parametrial or torus uterinus infiltration.

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Abstract

The uterosacral ligaments (USL) have been reported to be the most common site of deep endometriosis (DE) in the pelvis1. A nodule within the USL may infiltrate the parametrium, increasing the complexity of surgical resection, and larger nodules (≥ 17 mm) noted on transvaginal ultrasound (TVS) should raise suspicion of ureteral involvement2. Nodules may also invade the torus uterinus, which is the thickening between the insertion of the USL behind the posterior cervix. The diagnostic test accuracy of TVS for USL DE is only moderate, with sensitivity and specificity of 67% and 86%, respectively3, which may be related to the absence of a standardized technique for its assessment. We present a method that allows easier identification of normal and abnormal USL and classification of USL DE nodules. We believe that the proposed USL DE classification system (Table 1) provides a simple and standardized approach to describe such lesions, which may assist sonographers and surgeons in predicting ureteral involvement and/or the need for ureterolysis. Corresponding surgical images of USL DE with parametrial involvement are shown in Figure S6. Of course, evaluation of the USL DE classification system for its utility in diagnosis and/or preoperative planning is required before clinical implementation is considered. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Ligaments Endometriosis Endometriosis Female Humans Ligaments Ligaments Sacrum Ultrasonography Uterus

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (5)

Cited by (30)

Source provenance

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License: CC0 · commercial use OK