OC13.06: Can anyone screen for deep infiltrating endometriosis (DIE) with transvaginal ultrasound (TVUS)?

Surgical treatment of DIE is complex and preoperative diagnosis benefits both surgeon and patient. Several studies have reported high accuracy for the TVUS diagnosis of DIE, however, these studies were performed by experts who developed these novel techniques. The clinical utility and external validity can only be determined if such results can be replicated by others. The aim of this study was to assess how fast this level of diagnostic accuracy could be achieved by other centers with no prior experience. Following 1 week of training with Dr Goncalves and Prof Abrao, who published their technique in 2009 [Goncalves et al. Int J Gynaecol Obstet. 2009;104:156], all TVUS in this study were performed by a single sonologist (SP). Patients with symptoms or a past history of endometriosis were referred for TVUS after minimal bowel preparation. The decision to perform surgery was based on clinical and imaging findings. When surgery was performed, the TVUS was compared with the laparoscopy to assess the accuracy of TVUS in the diagnosis of pouch of Douglas (POD) obliteration and bowel nodules. The results of this study were compared with previously published results. 205 consecutive patients referred for DIE-TVUS between Nov 2009 and Sep 2011 were included. Feedback was obtained for all patients. 85 patients underwent surgery. The prevalence of bowel nodules was 29% and of POD obliteration 40%. The results for the diagnosis of bowel nodules (sens 88%, spec 97%, PPV 92%, NPV 95%) and POD obliteration (sens 88.2%, spec 90%, PPV 85.7%, NPV 91.8%) compared well with published literature. The learning curve to diagnose POD obliteration and bowel nodules was only10 patients. After 1 week of training and a learning curve of 10 patients, TVUS in the hands of someone with general TVUS experience allows diagnosis of DIE with a similar diagnostic accuracy as published by centres of excellence. This study supports the proposition that DIE-TVUS should be performed routinely for patients who present with significant pain and/or infertility.