Diagnostic accuracy of sonography for detecting parametrial involvement in women with pelvic endometriosis: a systematic review and meta-analysis

Objective The aim of this meta-analysis is to evaluate the diagnostic accuracy of transvaginal ultrasonography (TVS) to detect parametrial endometriosis, using laparoscopy as the reference standard. Methods A search for studies evaluating the TVS for assessing parametrial endometriosis compared to surgery from January 2000 to December 2020 was performed in PubMed/MEDLINE and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies 2 evaluated the quality of the studies (QUADAS-2). All analyses were performed using MIDAS and METANDI commands. Results We identified 133 citations. Finally, four studies comprising 560 patients were included. Mean prevalence of parametrial endometriosis was 17%. Overall, the pooled estimated sensitivity, specificity, positive likelihood, and negative likelihood ratio of TVS for detecting parametrial endometriosis were 31% (95% confidence interval [CI]= 10% -64%), 98% (95% CI= 95%-99%), 18.5 (95% CI= 8.8-38.9), 0.70 ( 95% CI=0.46-1.06), respectively. Diagnostic odds ratio (DOR) was 26 (95% CI=10-68). Heterogeneity was high. The visualization of a lesion suspected to be parametrial endometriosis increases significantly the pretest probability of parametrial endometriosis at laparoscopy. Conclusions The use of TVS for the detection of parametrial endometriosis have a high specificity but a low sensitivity. This article is protected by copyright. All rights reserved.