OC11.02: Determining the best diagnostic approach for deep infiltrating endometriosis

To assess the most accurate diagnostic tool in diagnosing deep infiltrating endometriosis (DIE). A longitudinal prospective study between May 2005 and January 2011, in which 54 women suspected to have DIE on the basis of clinical symptoms, underwent transvaginal ultrasound, sonovaginography and RMI to evaluate presence, localization and rectal infiltration. Laparoscopic surgery was performed in all women. Sensitivity, specificity, positive LR and total accuracy were compared to assess the better diagnostic method. In detecting presence of DIE, digital vaginal examination showed sensitivity of 87%, specificity of 75%, positive LR of 3.5 and total accuracy of 85.2%; transvaginal ultrasound showed sensitivity of 73.9%, specificity of 87.5%, positive LR of 5.9 and total accuracy of 75.9%; sonovaginography demonstrated sensitivity of 93.5%, specificity of 87.5%, positive LR of 7.5 and total accuracy of 92.6%; while RMI showed sensitivity of 91.3%, specificity of 75%, positive LR of 3.7 and total accuracy of 88.9%. Data about the localization of endometriotic lesions are summarized in Table 1. As regards rectal wall infiltration, sonovaginography showed sensitivity of 66.7%, specificity of 93.8%, positive LR of 10.7 and total accuracy of 90.7%, whereas RMI demonstrated sensitivity of 66.7%, specificity of 95.8%, positive LR of 16 and total accuracy of 92.6%. Our data show that digital vaginal examination is quite accurate for the detection of deep pelvic endometriosis, despite other diagnostic techniques should be available to assess the precise localization DIE. Sonovaginography and RMI showed to be comparable in the diagnosis DIE.