Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research

Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

A phenomenological study to explore the experiences of U gandan women that have undergone transvaginal ultrasound

Introduction

Transvaginal ultrasound (TVUS) is an important examination of the female pelvis that involves the transducer being inserted into the vagina to obtain more detailed images of the pelvic organs. Unfortunately, this examination has received mixed experiences from the women who have undergone it. This study set out to explore the lived experiences of Ugandan women who have undergone TVUS.

Methods

It was a phenomenological exploratory study involving 20 women in Uganda that had previously undergone TVUS. Data were collected using in-depth individual interviews. The responses from the women were audio-recorded and later transcribed. Thematic analysis was used to interpret and make meaning of the data collected.

Results

Analysis of data revealed mostly negative experiences of the women who were included in this study. Key words from the participating women that illustrated the negative experiences included: fear, vulnerability, guilt, anxiety and embarrassment. It was also observed that these initial negative experiences are likely to reduce the women's acceptability and compliance to TVUS even when it is needed for better clinical management. Data were categorised into the following three thematic areas: (1) broken communication, (2) anxiety and discomfort and (3) cultural influence.

Conclusion

Women in this study portrayed negative experiences of undergoing TVUS. Key suggestions like informed consent are recommended to improve compliance of the women to this type of procedure.

Screening for Ovarian Cancer

The efficacy of ovarian cancer screening remains to be proven. Advances in ultrasound and tumor marker technology, combined with complex statistical analysis have facilitated 2 large ongoing randomized controlled trials of screening which are powered to determine the impact on mortality. Serum proteomics seems to be a promising area for biomarker discovery, but requires more rigorous validation before it can be used in clinical trials. Current screening tests, clinical trials in the general and high-risk populations, screening acceptability and costs are reviewed in this article.