According to the review results (analysis of eight studies, 765 participants), TVUS had a sensitivity of 0.93 and specificity of 0.96 for diagnosing endometriotic cysts, and MRI (three studies, 179 participants) had a sensitivity of 0.95 and specificity of 0.91. Notably, high sensitivity and specificity of transvaginal ultrasonography (TVUS) and MRI were determined in detecting ovarian endometriomas. A 2016 Cochrane review analyzed 49 studies that involved 4807 women. According to Russian and international researchers, the diagnostic accuracy of the contemporary US was comparable to the MRI of the pelvic organs (retrocervical endometriosis 80% and 95%, adenomyosis 85% and 95%, endometriotic cysts 75% and 100%, respectively).
The accuracy of US depends largely on the location of endometriotic foci and increases with an increase in the total number of lesions. Notably, data of US performed by an experienced operator can be used along with the history and gynecological examination to improve the diagnostic accuracy of genital endometriosis. Nevertheless, foci of endometriosis, including extragenital, in the form of nodules, infiltrates, as well as cystic formations that have a cavity filled with fine hemorrhagic contents, with an infiltrating or cystic disease can be visualized using modern methods of radiation diagnostics, namely US studies, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography. However, the absence of ultrasound (US) signs of endometriosis cannot be the basis for ruling out this diagnosis, and laparoscopy should be performed in women with distinct symptoms. There is an opinion that none of the modern imaging methods can replace laparoscopic diagnostics for detecting peritoneal pelvic endometriosis. External genital and infiltrating endometriosis Hence, to accurately diagnose the location and extent of endometriosis foci, non-invasive imaging techniques must be applied. This recommendation necessitates a reliable preoperative assessment system that would promptly identify localization and disease severity. The recently issued consensus decree of the World Society for the Study of Endometriosis recommended creating highly specialized centers for the treatment of advanced endometriosis, particularly its infiltrative forms. In addition, if surgical treatment is warranted, it must be implemented fully.
Establishing an accurate niveau diagnosis of endometriosis is essential in determining the appropriate treatment approach. Endometriosis represents a severe problem in modern gynecology, especially its widespread infiltrative forms.
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