P15.09: Multicentre retrospective study to assess diagnostic accuracy of ultrasound for superficial endometriosis: are we any closer?

To establish whether a correlation exists between pre-operative ultrasound assessment and laparoscopic findings in women referred to specialist gynecologists with symptoms suggestive of endometriosis. 53 patients who had laparoscopy to investigate pelvic pain were reviewed. Laparoscopies were performed by surgeons in a tertiary endometriosis unit. Patients with deep infiltrative endometriosis, endometriomas or non- endometriosis pelvic pathology on ultrasound or MRI were excluded. Ultrasounds were performed by a single sonologist with expertise in endometriosis. Ultrasound markers were – utero sacral ligament thickness, thickened peri colic fat, ovarian mobility and focal tenderness. This was compared with operative findings of those patients with superficial endometriosis. Age, BMI and symptoms: dysmenorrhea, dyschezia, dyspareunia were collated. Seventy nine % (42 / 53) of the patients had laparoscopic findings consistent with their ultrasound findings (95% CI 68-90%, p < 0.0001). Utero sacral thickening (p < 0.05) and thickened peri colic fat (p < 0.05) were the most associated with superficial endometriosis at the time of laparoscopy. Dysmenorrhoea had the highest sensitivity (0.98, 95% CI 0.87-0.99) but a very low specificity (0.18, 95% CI 0.02-0.52). There are no specific non-invasive methods of diagnosing superficial forms of endometriosis, whilst the ability to reliably detect deep infiltrative endometriosis on ultrasound is well established. Superficial endometriosis is an inflammatory disease affecting the pelvic peritoneum. Markers on ultrasound that reliably demonstrated that inflammation were shown to be significantly associated with the disease. We believe that accurate assessment of utero sacral ligaments is the key to identifying this peritoneal or superficial endometriosis. This study has identified patients with superficial endometriosis, who may with appropriate medical treatment avoid unnecessary laparoscopy and have the origins of their pelvic pain more clearly understood.