Transvaginal ultrasound and magnetic resonance imaging in the diagnosis of endometrioma: a systematic review and meta-analysis of diagnostic test accuracy studies

Figures & data

Figure 1. Flow diagram according to PRISMA (preferred reporting items for systematic review and meta-analysis) 2020. CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Table 1. Characteristics of included studies.

First author and publication year	Population characteristics					Index tests	Reference tests^d	Prevalence n (%)^e
	Sample		Age (years)^b		Symptoms^c
	Enrolment	Size^a	Mean	Range
Guerriero 1996b	Consecutive	101/101	NA	20–49	NA	5 MHz TVUS	LS/LT + H	29 (29)
Guerriero 1996a	Consecutive	118/118	33	14–54	Inf.	5 MHz TVUS	LS/LT + H	39 (33)
Ubaldi et al. 1998	Consecutive	133/133	NA	21–41	PP, Inf.	5 MHz TVUS	LS + H	10 (30)
Exacoustos 2003	NA	567/567	NA	NA	NA	5–7.5 MHz TVUS	LS + H	196 (35)
Guerriero 2007	Consecutive	50/50	33	22–41	PP, Inf.	6.5–7 MHz TVUS	LS + H	9 (18)
Hottat 2009	Consecutive	41/106/	33	20–46	PP	3 T MRI	LS/LT + H	21 (51)
Grasso 2010	NA	33/33	35	22–53	PP, Inf.	1.5 T MRI	LS + H	24 (73)
Hudelist 2011	NA	129/155	32	17–44	PP, sub-inf.	5–9 MHz TVUS	LS + H	27 (21)
Manganaro 2012	NA	46/46	30	20–43	PP, Inf.	3 T MRI	LS	20 (43)
Scarella 2013	Consecutive	57/100	NA	NA	PP, Inf.	5–9 MHz TVUS	LS/LT ± H	31 (54)
Piessens 2014	Consecutive	85/205	NA	18–48	PP, Inf.	4–8 MHz TVUS	LS + H	17 (20)
Khan 2018	Consecutive	287/435	32	NA	PP, Inf.	MRI	LS	66 (23)
Sofic 2018	NA	74/74	37	17–53	NA	7 MHz TVUS, 1.5 T MRI	LS/LT + H	25 (34)
Bhatty 2020	NA	100/100	NA	NA	PP, Inf.	TVUS	H	16 (16)
Goncalves 2021	Consecutive	120/129	NA	18–45	NA	TVUS	LS ± H	19 (16)
Puri 2022	NA	40/40	31	21–40	NA	3.5 MHz TVUS, 1.5 T MRI	LS + H	32 (80)

Abbreviations: n, absolute number of positive cases of ovarian endometriosis identified by the reference test; NA, not available; MHz, megahertz; TVUS, transvaginal ultrasound; LS, laparoscopy; LT, laparotomy; H, histology; Inf., infertility; PP, pelvic pain (involving at least one of the following symptoms: dysmenorrhoea, dyspareunia, dyschezia, dysuria and chronic pelvic pain); T, Tesla; MRI, magnetic resonance imaging; sub-inf., sub-infertility.

^aValues are number of participants analysed/enrolled.

^bMean values are rounded to the nearest integer; range represents the minimum–maximum age value.

^cSymptoms varied in the studies beyond pelvic pain and infertility summarised here.

^dReference tests are presented as laparoscopy or (/) laparotomy with (+) or ‘with or without’ (±) histology.

^eThe prevalence was estimated in the sample by dividing the number of positive cases of ovarian endometriosis identified by the reference test divided by the size of the sample analysed and multiplied by 100 (values in parentheses are percentages).

Figure 2. Risk of bias and applicability concerns summary: review authors’ judgements about each domain for each study (A) and presented for each domain as percentages across all studies (B). Note: The numbers on the bar for each domain represent the number of studies scored as high, unclear or low risk of bias or applicability.

Figure 3. Forest plot exhibiting study‐specific estimates and pooled sensitivity and specificity for TVUS (A) and MRI (B) in diagnosing ovarian endometriosis. TP, true positive; FP, false positive; FN, false negative; TN, true negative; CI, confidence interval. Notes: Studies are presented for TVUS and MRI and are ordered according to the year of publication. Summary or pooled values for sensitivity and specificity are represented by polygons (black dashed vertical lines mark the point estimates for sensitivity and specificity) and study-specific estimates of sensitivity and specificity are represented by squares with 95% confidence intervals (black solid horizontal lines).

Figure 4. Summary receiver operating characteristic plot of TVUS and MRI for detection of ovarian endometriosis. TVUS, transvaginal ultrasound; MRI, magnetic resonance imaging. Notes: The markers for each test on the summary receiver operating characteristic plots represent pairs of sensitivity and specificity from the included studies. The size of each marker was scaled based on the sensitivity and specificity of the study. The solid circles (summary points) represent the summary (pooled) estimates of the sensitivity and specificity for each test. Each summary point is surrounded by a dotted line representing the 95% confidence region and a dashed line representing the 95% prediction region (the region within which it is 95% certain that the results of a new study will lie).

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Data availability statement

The authors confirm that data supporting the findings of this study are available within the article and its supplementary materials.