Transvaginal ultrasound for detecting parametrial involvement in suspected deep pelvic endometriosis: updated meta-analysis.

Objective: To perform an updated meta-analysis evaluating the diagnostic performance of transvaginal ultrasound (TVS) for detecting lateral parametrial involvement in women with suspected deep pelvic endometriosis.

Methods: A literature search was performed in the Web of Science, PubMed and Scopus databases from January 2021 to May 2024 for studies evaluating TVS for detecting parametrial involvement in women with suspected deep pelvic endometriosis, using laparoscopy with or without histology as the reference standard. The information gathered was combined with data from our previous meta-analysis on this topic. Pooled sensitivity and specificity were calculated overall and for subgroup analyses considering parametrial laterality. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate study quality.

Results: After exclusions, four new studies fulfilling the selection criteria were identified. Combined with the four studies included in our previous meta-analysis, eight studies including a total of 6728 women (13 456 parametria) were included. The mean prevalence of parametrial involvement was 21.3%. The pooled sensitivity and specificity of TVS for detecting parametrial involvement were 63% (95% CI, 31-86%) and 98% (95% CI, 96-99%), respectively. When considering only the five studies that reported laterality, the corresponding values were 85% (95% CI, 64-95%) and 98% (95% CI, 92-99%) for the left parametrium and 84% (95% CI, 61-94%) and 97% (95% CI, 92-99%) for the right parametrium. Heterogeneity was high for the overall analysis and subgroup analyses.

Conclusions: The diagnostic performance of TVS for detecting parametrial involvement in women with suspected deep pelvic endometriosis is better than that reported previously. This may be attributable to the use of a standardized TVS scanning technique and improved knowledge of pelvic ultrasound anatomy. Accurate parametrial assessment could improve surgical planning and patient outcome. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.