VP05.09: Anatomical distribution of deep endometriosis on transvaginal ultrasound and clinical features: implications on non‐invasive diagnosis

The study aims to determine the anatomic distribution of DE, provide an epidemiological overview based on advanced transvaginal ultrasound (aTVS), and describe the possible relationship with clinical features obtained with the World Endometriosis Foundation (WERF) questionnaire. A cross-sectional study associating the findings of aTVS and answers to the WERF clinical questionnaire were reviewed and study data extracted. Descriptive analysis of the DE lesions' anatomical distribution will be presented, and correlations between pared TVS results and patient's responses will be analysed. Preliminary analysis showed that, from 327 (n = 327) complete WERF Questionnaire and aTVS data, the most frequent DE lesions were found in at least one of these locations: right uterosacral ligament, 24.4%; left uterosacral ligament, 22.9%; bowel 21.4% (predominantly upper rectum, 17.7%); and ovaries (left ovary,14.8%; right ovary, 15.9%). The most frequent dynamic abnormalities were found in the pouch of Douglas (POD), with a negative “sliding sign”: 26.6% (complete obliteration, 14.7%; and partial obliteration, 11.9%). Medially reduced ovarian mobility is also common (right ovary 18.0% and left ovary 20.8%). The most significant symptoms identified were severe dysmenorrhoea and dyspareunia, referred by 72.8% and 77.4% of the patients, respectively. The identification of pelvic abnormalities through aTVS in this specific population is notably high. Thus, previous knowledge of the typical anatomical distribution of DE has the potential to provide an orientation to guide a more targeted diagnosis, likely reducing the number of false negatives of diagnostic tests and increasing the chances of a more satisfactory outcome in surgical procedures. Furthermore, with the highly detailed WERF questionnaire associated with the thorough aTVS findings, we aim to provide evidence to fill a long-term knowledge gap between clinical features and symptoms to specific pelvic endometriosis distribution characteristics.