The Benefit of Transvaginal Elastography in Detecting Deep Endometriosis: A Feasibility Study

Abstract

Objectives This study aimed to evaluate elastography features of deep infiltrating endometriosis (DIE), and to define whether this technique may discriminate lesions from surrounding non-endometriotic tissue.

Methods This was an exploratory observational study on women affected by DIE treated in a third-level academic hospital gynaecology outpatient facility between 2020 and 2021. Strain elastography (SE) was conducted via transvaginal probe. Tissue deformation of DIE and surrounding tissue was expressed as percentage tissue deformation or as subjective colour score (CS; from blue=stiff to red=soft, assigned numerical values from 0 to 3). Ratios of normal tissue/DIE were compared to ratio of normal tissue/stiffer normal tissue area.

Results Evaluations were performed on 46 DIE nodules and surrounding tissue of the uterosacral ligaments (n=21), parametrium (n=7), rectum (n=14), and recto-vaginal septum (n =4). Irrespective of location, DIE strain ratio (3.09, IQR 2.38–4.14 vs. 1.25, IQR 1.11–1.48; p<0.001) and CS ratio (4.62, IQR 3.83–6.94 vs. 1.13, IQR 1.06–1.29; p<0.001) was significantly higher than that of normal tissue. ROC AUC of CS ratio was higher than ROC AUC of strain ratio (99.76%, CI.95 99.26–100% vs. 91.35%, CI.95 85.23–97.47%; p=0.007), and best ROC threshold for CS ratio was 1.82, with a sensitivity of 97.83% (CI.95 93.48–100%) and a specificity of 100% (CI.95 100–100%).

Conclusions Both strain and CS ratios accurately distinguish DIE nodules at various locations. Applications of elastography in improving the diagnosis DIE, in distinguishing different DIE lesions and in monitoring DIE evolution can be envisioned and are worthy of further evaluation.

Zusammenfassung

Ziel Ziel dieser Studie war es, die elastografischen Merkmale der tief infiltrierenden Endometriose (TIE) zu untersuchen und festzustellen, ob diese Technik die Läsionen von umgebendem nicht-endometriotischem Gewebe unterscheiden kann.

Methoden Dies war eine explorative Beobachtungsstudie an Frauen mit TIE, die zwischen 2020 und 2021 in einer gynäkologischen Ambulanz eines Universitätskrankenhauses der Tertiärversorgung behandelt wurden. Die Strain-Elastografie (SE) wurde über eine transvaginale Sonde durchgeführt. Die Gewebedeformation der TIE und des umgebenden Gewebes wurde als prozentuale Gewebedeformation oder als subjektive Farbscala (CS; von blau=steif bis rot=weich, mit Zahlenwerten von 0 bis 3) angegeben. Das Verhältnis Normalgewebe/TIE wurde mit dem Verhältnis Normalgewebe/steiferes normales Gewebe verglichen.

Ergebnisse Es wurden 46 TIE-Knoten und das sie umgebende Gewebe von Ligamentum sacrouterinum (n=21), Parametrium (n=7), Rectum (n=14) und Septum rectovaginale (n=4) ausgewertet. Unabhängig von der Lokalisation waren die Strain-Ratio (3,09; IQR 2,38–4,14 vs. 1,25; IQR 1,11–1,48; p < 0,001) und CS-Ratio (4,62; IQR 3,83–6,94 vs. 1,13; IQR 1,06–1,29; p<0,001) der TIE signifikant höher als bei Normalgewebe. Die ROC-AUC der CS-Ratio war höher als die ROC-AUC der Strain-Ratio (99,76%; 95% CI=99,26–100 vs. 91,35; 95% CI=85,23–97,47; p=0,007), und der optimale ROC-Schwellenwert für die CS-Ratio betrug 1,82 bei einer Sensitivität von 97,83% (95%CI=93,48–100) und einer Spezifität von 100% (95% CI=100–100).

Schlussfolgerung Sowohl die Strain- als auch die CS-Ratio ermöglichen eine genaue Differenzierung von TIE-Knoten an verschiedenen Stellen. Der Einsatz der Elastografie zur Verbesserung der TIE-Diagnose, zur Unterscheidung verschiedener TIE-Läsionen und zur Überwachung der TIE-Entwicklung kann in Betracht gezogen werden und sollte weiter untersucht werden.

Keywords

deep endometriosis - color score ratio - strain elastography - strain ratio - endometriotic lesion

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