{"paper_id":"7c0c4ee5-7fe2-487d-bc3a-ec74b0918e9d","body_text":"Ultrasonographic evaluation of endometrioma\ncurrent updates and clinical relevance without the need for histopathological diagnosis\nDOI:\nhttps://doi.org/10.57153/v33n39e26358Keywords:\nEndometrioma, Endovaginal Ultrasonography, Diagnostic Imaging, Endometriosis, Ovarian Reserve, Doppler Ultrasonography, Magnetic Resonance ImagingAbstract\nINTRODUCTION: La endometriosis es una enfermedad prevalente que causa dolor crónico e infertilidad, afectando significativamente la calidad de vida de las mujeres en edad reproductiva. El endometrioma, manifestación ovárica de la enfermedad, presenta características ecográficas bien definidas que facilitan su diagnóstico no invasivo. Aunque la laparoscopia se considera el patrón oro, los avances en la ecografía endovaginal (USEV) han demostrado una alta precisión que, en la mayoría de los casos, cuestiona la necesidad de confirmación anatomopatológica. OBJECTIVES: To review and update the role of endovaginal ultrasonography (EVUS) in the diagnosis of endometrioma, assessing whether histopathological examination is still required for confirmation and highlighting the associated clinical implications. METHODS: A critical review of the current literature, including international consensus statements and diagnostic accuracy studies evaluating ultrasonography and magnetic resonance imaging in the diagnosis of endometrioma and its differentiation from other ovarian lesions. RESULTS: Endometriomas exhibit well-defined ultrasonographic features, including homogeneous hypoechoic content with a characteristic \"ground-glass\" appearance, regular margins, absence of internal vascularity on Doppler imaging, and occasional hyperechoic foci within the cyst wall. Endovaginal ultrasonography (EVUS) demonstrates sensitivity and specificity exceeding 90%, with diagnostic performance comparable to that of magnetic resonance imaging (MRI), while offering greater accessibility and lower cost. When performed by experienced examiners, ultrasonography provides a reliable diagnosis in the majority of typical cases, eliminating the routine need for histopathological confirmation, which is invasive, costly, and has recognized diagnostic limitations. Furthermore, ultrasonographic assessment performed according to standardized protocols, such as the IDEA consensus proposed by the ISUOG, enables accurate disease staging and guides clinical management, particularly in view of the association between endometrioma, infertility, and the increased risk of diminished ovarian reserve. CONCLUSION: Endovaginal ultrasonography, when combined with operator expertise and standardized imaging protocols, is the noninvasive modality of choice for the diagnosis and management of endometrioma, making histopathological confirmation unnecessary in the majority of typical, asymptomatic cases. The judicious integration of imaging modalities optimizes clinical care and improves patient outcomes.\nReferences\n1. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-2398.\n2. Chapron C, Santulli P, de Ziegler D, Noel JC, Anaf V, Streuli I, Foulot H, Souza C, Borghese B. Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod. 2012 Mar; 27(3): 702-711.\n3. Moini A, Malekzadeh F, Amirchaghmaghi E, Kashfi F, Akhoond MR, Saei M, Mirbolok MH. Risk factors associated with endometriosis among in¬fertile Iranian women. Arch Med Sci. 2013 Jun 20; 9(3):506-514.\n4. Bazot M, Daraï E. 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Ultrasound Obstet Gynecol. 2018 May; 51(5): 586-595.\nDownloads\nPublished\nIssue\nSection\nLicense\nCopyright (c) 2026 Revista Brasileira de Ultrassonografia\nThis work is licensed under a Creative Commons Attribution 4.0 International License.","source_license":"CC0","license_restricted":false}