Ultrasound in Deep Endometriosis: A Narrative Review

Stefano Guerriero, S. Guerriero, Fernanda Harumi Oyarce, Francesca Filippi, Martino Rolla, Marcelo Pedrassani, Juan Luis Alcázar, M. Pascual, M. Pagliuca, M Angela Pascual, Mariachiara Pagliuca, Antonietta Borzacchelli, Fabio Deiala, Annalisa Pisu, Alessandra Pisu, Alessandra Medas, Barbara Piras, Cristina Desogus, Camilla Desogus, S. Ajossa, Silvia Ajossa
Gynecologic and obstetric investigation · 2025 · vol. 90(6) , pp. 560–575 · doi:10.1159/000543342 · PMID:39827862 · W4406499172
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review evaluates the current state of transvaginal ultrasound for diagnosing deep endometriosis, highlighting its increased accuracy, broader compartment evaluation, and utility as a first-line diagnostic tool.

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Abstract

BACKGROUND: Over the past decade, transvaginal ultrasound (TVUS) has revolutionized the diagnosis of deep endometriosis. We can now accurately describe and evaluate lesions in multiple compartments of the pelvis, increasing diagnostic capacity without the need for initial laparoscopy. Recent consensus and publications support the new and growing evidence for this technique. Research into deep endometriosis has increased substantially, and new diagnostic evidence is now available. OBJECTIVES: The aim of this article was to review the state of the art in ultrasound diagnosis of deep endometriosis. METHODS: We performed a detailed search of the PubMed database to identify eligible primary studies. We included English-language publications with the following terms: "endometriosis" AND "deep" AND "ultrasound" AND "transvaginal." Studies focusing on ultrasound in deep endometriosis were included; we selected them based on title reading, then narrowed the selection by reading the abstract. We excluded publications that did not use TVUS as one of the main techniques to evaluate deep endometriosis. RESULTS: Two hundred forty-three studies were identified and selected as described above, resulting in a total of 73 studies included in this review. CONCLUSIONS: Our understanding of deep endometriosis has evolved over the past decade. Efforts have been made to reduce the diagnostic delay in this common disease, particularly with the increased use of imaging, especially TVUS, as a first-line diagnostic modality because of its availability, good test performance, cost-effectiveness, and low environmental impact compared to other imaging modalities. This statement is supported by recent publications and guidelines from some medical societies. Advances in technology, equipment and research have allowed us to identify additional compartments involved, including the parametrium. The progress made in recent years offers hope for earlier detection and improved management of patients with suspected endometriosis who suffer not only from pelvic pain but also from infertility.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (73)

Source provenance

europepmc
last seen: 2026-06-11T06:19:48.454388+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-06-11T06:16:54.801207+00:00
License: CC0 · commercial use OK