Diagnostic Performance of Saline/Gel Sonovaginography in Assessment of Deep Infiltrating Endometriosis at Posterior Compartments; A Systematic Review and Meta‐Analysis

ABSTRACT

Sonovaginography (SVG) is a specialized ultrasound technique for evaluating certain locations of deep endometriosis (DE) in the posterior compartments. In this study, we assessed the diagnostic accuracy of saline/gel SVG in the detection of DE lesions at the rectovaginal septum (RVS) and rectosigmoid (RS). A systematic search of PubMed, Embase, and Scopus yielded 10 eligible studies with a total of 1221 patients. For gel‐SVG, meta‐analysis was performed and sensitivity, specificity, and diagnostic odd ratio (DOR) were calculated using a random‐effects model and bivariate binomial model (95% confidence interval). To assess study quality and risk of bias, the QUADAS‐2 tool was used. Based on our results, the meta‐analysis on Gel‐SVG studies showed for RVS a pooled specificity of 99% (94%–100%), sensitivity of 82% (44%–96%), and DOR of 274 (95.87–786.51); For RS lesions of six studies, the overall specificity, sensitivity, and DOR were 96% (93%–97%), 87% (81%–92%), and 118.79 (41.68–338.52), respectively. For vaginal fornices, pooled data from five studies showed perfect specificity of 99% (98%–100%), with a moderate sensitivity of 65% (33%–88%). Eventually, Uterosacral ligament (USL) lesions had the least DOR ratio at 31.45 (15.79–62.63), with a specificity of 97% (91%–99%) and sensitivity of 55% (31%–76%). SVG, as a low‐cost, widely available, non‐invasive technique, yields high diagnostic accuracy in detecting the posterior compartment DE lesions, particularly RVS and RS lesions, enhancing the accuracy of DE mapping and supporting the treatment planning.