MRI and rectal endoscopy sonography performance to diagnose the digestive depth infiltration of pelvic endometriosis

Introduction The main objective of this study was to evaluate the performances of MRI and rectal endoscopy sonography (RES) in predicting the depth of bowel wall infiltration by deep infiltrating endometriosis (DIE).

and method We conducted a single center retrospective study from April 2014 to March 2020 including all patients who had undergone digestive tract resection (discoid or segmental) for DIE removal and who had benefited from full preoperative imaging workup based on both pelvic MRI and RES.

Fifty two patients were enrolled in the study. Median age was 35.8 years (26.1–44.5 years). Indications for surgery mainly comprised chronic pelvic pain (94.2%) and infertility (36.5%). Overall, pathological examination showed digestive involvement in 92.3% of patients, while transmural infiltration was found in 38.4% of cases. In contrast, both MRI and RES suspected transmural involvement in 42 patients (80.8%). Corresponding sensitivity and specificity were 0.95 [95% CI (0.751–0.999)] and 0.28 [95% CI (0.137–0.467)], respectively. Our results revealed agreement between MRI and RES in 85% of cases with a kappa at 0.5 [95% CI (0.207–0.803), moderate agreement]. Subgroup analysis in patients with transmural MRI lesions showed a sensitivity of 0.95 [95% CI (0.740–0.999)] and a specificity of 0.13 [95% CI (0.028–0.336)].

Our study suggests that performing a second-line examination is not useful if there is no transmural impairment in MRI or RES. Nevertheless, the combination of these two preoperative examinations seems to be essential for the evaluation of the depth of digestive involvement of endometriosis to guide surgical management as effectively as possible. The constitution and training of multidisciplinary expert groups must be developed to be able to offer optimal patient management. Similar content being viewed by others Data availability Data available on request.

Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S et al (2019) Endometriosis. Endocr Rev 40(4):1048–79 Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10(5):261–275 Chapron C, Bourret A, Chopin N, Dousset B, Leconte M, Amsellem-Ouazana D et al (2010) Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Hum Reprod Oxf Engl 25(4):884–889 Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC et al (2006) Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod Oxf Engl 21(7):1839–1845 Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod Oxf Engl 18(1):157–161 Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B et al (2018) Management of endometriosis: CNGOF/HAS clinical practice guidelines—short version. J Gynecol Obstet Hum Reprod 47(7):265–274 Gourbail L (2017) Haute Autorité de Santé. HAS, Saint-Denis, p 39 Krüger K, Behrendt K, Niedobitek-Kreuter G, Koltermann K, Ebert AD (2013) Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosis. Eur J Obstet Gynecol Reprod Biol 169(1):93–98 Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E (2009) Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 92(6):1825–1833 Kim A, Fernandez P, Martin B, Palazzo L, Ribeiro-Parenti L, Walker F et al (2017) Magnetic resonance imaging compared with rectal endoscopic sonography for the prediction of infiltration depth in colorectal endometriosis. J Minim Invasive Gynecol 24(7):1218–1226 Chapron C, Vieira M, Chopin N, Balleyguier C, Barakat H, Dumontier I et al (2004) Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol 24(2):175–179 Desplats V, Vitte R-L, du Cheyron J, Roseau G, Fauconnier A, Moryoussef F (2019) Preoperative rectosigmoid endoscopic ultrasonography predicts the need for bowel resection in endometriosis. World J Gastroenterol 25(6):696–706 Bazot M, Bornier C, Dubernard G, Roseau G, Cortez A, Daraï E (2007) Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod Oxf Engl 22(5):1457–1463 Dumontier I, Chapron C, Chaussade S, Dubuisson JB (2002) Utility of rectal endoscopic ultrasonography for digestive involvement of pelvic endometriosis. Technique and results. Gynecol Obstet Fertil 30(12):979–84 Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S (2012) Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications. World J Gastroenterol 18(34):4659–4676 Lakhtakia S (2016) Complications of diagnostic and therapeutic endoscopic ultrasound. Best Pract Res Clin Gastroenterol 30(5):807–823 Abrao MS, da Gonçalves MOC, Dias JA, Podgaec S, Chamie LP, Blasbalg R (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod Oxf Engl 22(12):3092–7 Biscaldi E, Ferrero S, Remorgida V, Rollandi GA (2011) MDCT enteroclysis urography with split-bolus technique provides information on ureteral involvement in patients with suspected bowel endometriosis. AJR Am J Roentgenol 196(5):W635-640 Working group of ESGE, ESHRE, and WES, Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF et al (2020) Recommendations for the surgical treatment of endometriosis Roman H, FRIENDS group (French coloRectal Infiltrating ENDometriosis Study group) (2017) A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: a multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod 46(2):159–165 Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A et al (2017) European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 27(7):2765–2775 Landis JR, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174 Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A et al (2018) Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol 218(6):549–562 Sandré A, Philip C-A, De-Saint-Hilaire P, Maissiat E, Bailly F, Cortet M et al (2019) Comparison of three-dimensional rectosonography, rectal endoscopic sonographyand magnetic resonance imaging performances in the diagnosis of rectosigmoid endometriosis. Eur J Obstet Gynecol Reprod Biol 240:288–292 Medeiros LR, Rosa MI, Silva BR, Reis ME, Simon CS, Dondossola ER et al (2015) Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic reviewand meta-analysis. Arch Gynecol Obstet 291(3):611–621 Moura APC, Ribeiro HSAA, Bernardo WM, Simões R, Torres US, D'Ippolito G, Bazot M, Ribeiro PAAG (2019) Accuracy of transvaginal sonography versus magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: systematic review and meta-analysis. PLoS One 14(4):e0214842. https://doi.org/10.1371/journal.pone.0214842 (Erratum in: PLoS One 14(8):e0221499) ChenY-H Wang D-B, Guo C-S (2019) Accuracy of physical examination, transvaginalsonography, magnetic resonance imaging, and rectal endoscopic sonography for preoperative evaluation of rectovaginal endometriosis. Ultrasound Q 35(1):54–60 Kanté F, Belghiti J, Roseau G, Thomassin-Naggara I, Bazot M, Daraï E et al (2017) Comparison of the accuracy of rectal endoscopic sonography andmagnetic resonance imaging in the diagnosis of colorectal endometriosis. Gynecol Obstet Fertil Senol 45(3):131–136 Maggiore ULR, Biscaldi E, Vellone VG, Venturini PL, Ferrero S (2017) Magnetic resonance enemavs rectal water-contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis. Ultrasound Obstet Gynecol 49(4):524–532 Rossi L, Palazzo L, Yazbeck C, Walker F, Chis C, Luton D et al (2014) Can rectal endoscopicsonography be used to predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? Ultrasound Obstet Gynecol 43(3):322–327 Chamié LP, Ribeiro DMFR, Ribeiro GMPAR, Serafini PC (2020) Postoperative imaging findings after laparoscopic surgery for deeplyinfiltrating endometriosis. Abdom Radiol N Y 45(6):1847–1865 Chapron C, Marcellin L, Borghese B, Santulli P (2019) Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 15(11):666–682 Funding No funding was provided. Author information Authors and Affiliations Contributions AB: data collection or management, manuscript writing/editing. AW: manuscript writing/editing. AV: data collection and management. JM: data collection and management. AP: data collection and management. RG: data analysis. EC: protocol and project development. FV: protocol and project development. Corresponding author Ethics declarations Conflicts of interest The authors declare that they have no conflict of interest. Ethical approval In conformity with the reference methodology MR-004, this work is registered in the retrospective studies register of the Toulouse University Hospital under the CNIL Number 2206723v0. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Buffeteau, A., Weyl, A., Vavasseur, A. et al. MRI and rectal endoscopy sonography performance to diagnose the digestive depth infiltration of pelvic endometriosis. Arch Gynecol Obstet 307, 51–58 (2023). https://doi.org/10.1007/s00404-022-06532-1 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06532-1