A Meta-analysis Of Diagnosis Of Deep Infiltrating Endometriosis

Objective:To Investigate the diagnostic methods of Deep infiltrating endometriosis (DIE).Methods:According to the principles of evidence-based medicine,we had a META analysis of the diagnosis of deep infiltrating endometriosis by searching for medical literature about diagnostic sensitivity of deep infiltrating endometriosis in MEDLINE (1966-2008),EMBASE(1980-2008),the collaborative network to Cochrane,as well as Chinese databases such as Chinese Biomedical Literature Database(CBM) (1978-2008),CNKI(1994-2009),VIP(1989-2008).We used deep infiltrating endometriosis,deeply infiltrating endometriosis,deep endometriosis,recto-vaginal septum endometriosis,rectovaginal endometriosis,vagina rectum endometriosis,uterosacral ligament endometriosis,endometriosis nodules,intestinal endometriosis as key words.Quality of studies was assessed and statistical analysis software revman 4.2 was used to perform meta-analysis.Results:A total of 1199 papers were enrolled and six studies(486 patients)met the inclusion criteria.By using physical examination(PE),transvaginal sonography(TVS), rectal endoscopic sonography(RES),and magnetic resonance imaging examination(MRI),compare the sensitivity of the various supplementary examinations. All cases were confirmed with histological findings for deep infiltrating endometriosis. The results showed that:Compared to PE,TVS has a higher sensitivity,Q=7.34,P=0.03, RR=0.78,95%CI(0.70-0.87),Z=4.58,P＜0.00001.When PE compared to RES,there was no significant difference,Q=1.24,P=0.27,RR=1.14,95%CI(0.92-1.40),Z=1.2,P =0.23.Compared to PE,MRI has a significantly higher sensitivity,Q=4,P=0.05, RR=0.78,95%CI(0.69-0.89),Z=3.72,P=0.0002.Compared to RES,TVS has a significantly higher sensitivity,Q=2.32,P=0.31,RR=1.25,95%CI(1.09-1.43),Z=3.21, P=0.001.When TVS compared to MRI,there was no significant difference,Q=11.46, P=0.0007,RR=1.05,95%CI(0.77-1.43),Z=0.29,P=0.77.When RES Compared to MRI,there was no significant difference,Q=32.59,P＜0.00001,RR=0.81,95% CI(0.50-1.32),Z=0.85,P=0.39.Conclusions:There are many different diagnostic methods of deep infiltrating endometriosis.All diagnostic methods have their own respective advantages and disadvantages,moreover,this article analysis some diagnostic methods according meta-analysis method.We draw a conclusion that TVS have a higher sensitivity in the diagnosis of DIE than RES and PE.MRI has a higher sensitivity in the diagnosis of DIE than PE.But there is no significant difference on sensitivity in the diagnosis of DIE between MRI and TVS,MRI and RES,PE and RES.In addition,there are some other diagnostic methods such as rectal endoscopic ultrasound combined with fine needle aspiration cytology(REU-FNA),double contrast barium enema,transvaginal ultrasonography combined with water-contrast in the rectum.Further studies need to be done to make a better result.