Notice bibliographique
Résumé
We appreciate the feedback from Prof. Guerriero and colleagues and would like to take the opportunity to address their concerns. We agree that the International Deep Endometriosis Analysis (IDEA) consensus opinion1 has contributed significantly to advancing ultrasound for endometriosis. Transvaginal ultrasound for endometriosis (eTVUS) is performed to investigate diagnostically for endometriosis1 and/or map endometriosis preoperatively for surgery2. For the latter, as detailed in our original manuscript3, we believe unequivocally that an IDEA-guided comprehensive eTVUS should always be performed. From years of teaching IDEA-guided eTVUS, we have seen how challenging it is, particularly for general imaging centers with lower volumes of gynecological scans and endometriosis cases, compared with those in specialized or tertiary-level centers. Whilst it would be ideal for everyone to perform comprehensive IDEA-guided eTVUS, we now believe this is currently, and will remain, unattainable. Our simplified approach does not intend to replace the IDEA consensus opinion, but rather to use its ‘common language’ to offer an alternative in non-expert centers or in environments in which a comprehensive scan is not feasible, such as regional centers. Our protocol is designed to make the diagnosis of endometriosis more accessible, helping to reduce diagnostic delays and patient suffering. Regarding the concerns about omitting certain areas of the pelvis, we aimed to prioritize the regions most affected by endometriosis. Evidence shows that disease in the anterior compartment or parametrium rarely occurs without uterosacral ligament deep endometriotic nodules or pouch of Douglas obliteration. The most commonly impacted segment of the bowel – the upper rectum – is also covered by our simplified approach, which is likely sufficient for initial endometriosis diagnosis. Like Prof. Guerriero and colleagues, we acknowledge the importance of rigorous training. However, the IDEA consensus opinion involves mastering many anatomical structures that are beyond what is typically taught in gynecological ultrasound training (which generally covers just the uterus and ovaries). Our proposed protocol involves mastering less. There is no need for a learning-curve study to know that learning to do fewer things is easier than learning to do many. Furthermore, we carefully crafted this proposal to ensure that the descriptors and methodology remain consistent with the IDEA consensus opinion, to allow a smooth segue to performing comprehensive eTVUS, once proficiency of this simplified approach has been obtained. Whilst it is fair to criticize the introduction of an opinion by only two authors, the IDEA consensus opinion was similarly published prior to any supporting prospective studies. Furthermore, the IDEA pilot study, whilst showing good sensitivity for the detection of disease (88.4%), had suboptimal specificity (78.8%)2. In the context of surgical planning, this is not problematic, as overpreparation is preferable to underpreparation. However, in general screening, a low false-positive rate is crucial to avoid inaccurate diagnoses, unnecessary interventions and, potentially, harm. We appreciate the dialogue this Correspondence has sparked, and we hope it will lead to further studies that explore the balance between accessibility and thoroughness in ultrasound protocols for endometriosis. Furthermore, we look forward to working with the IDEA team in the future as these techniques evolve further.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,079 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,005 | 0,006 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,016 | 0,025 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,054 | 0,042 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».