HAMBURG, GERMANY — Transvaginal ultrasound is a useful method for detecting severe pelvic endometriosis and rectosigmoid involvement, according to a study of about 200 women.
Transvaginal ultrasound (TVS) is thought to be reliable for the diagnosis of ovarian endometriosis, but laparoscopy is still the standard for the diagnosis of pelvic endometriosis.
In a prospective, observational study of 201 women examined with TVS before undergoing laparoscopy for evaluation of pelvic pain lasting more than 6 months, 62 (31%) had no endometriosis at laparoscopy according to the revised American Fertility Association classification system, 33 (16%) had minimal disease, 31 (15%) mild, 27 (13%) moderate, and 48 (24%) severe disease, according to data presented at the World Congress on Ultrasound in Obstetrics and Gynecology. Percentages total less than 100% because of rounding.
With laparoscopy as the accepted standard, TVS had a sensitivity of 57% and specificity of 95% to diagnose the absence or presence of endometriosis, reported lead author Dr. Tom Holland of the Early Pregnancy and Gynecology Assessment Unit, University College London Hospitals.
The sensitivity and specificity to diagnosis absent to mild versus moderate to severe disease were 89% and 97%, and 85% and 98% for absent to moderate versus severe endometriosis. The positive and negative likelihood ratios for severe disease were 43.5 and 0.15, respectively.
“TVS performed by experienced operators has a high sensitivity and specificity at detecting severe pelvic endometriosis,” Dr Holland said. “TVS is a good method for triaging women with pelvic endometriosis for optimal surgical care.”
In a separate retrospective, observational study of 72 women, mean age 31 years, who had a bowel resection for presumed deep infiltrating endometriosis, preoperative TVS could detect deep infiltrating endometriosis of the rectosigmoid colon in 79% of cases, Dr. Dominique Van Schoubroeck reported during the same session at the meeting.
Deep endometriosis nodes were recorded by ultrasound as “yes” in 51 women, “possible” in 6, and “no” in 15 cases, with yes and possible cases considered abnormal. Histology reported deep nodes as present in 88% and absent in 12% of cases, said Dr. Van Schoubroeck, obstetrics and gynecology unit, University Hospitals, Catholic University Leuven, Leuven, Belgium. Accurate detection of nodes could help with surgical planning, she said.
Dr. Holland and Dr. Van Schoubroeck disclosed no conflicts of interest.