OP15.01: Transvaginal ultrasound soft markers for the prediction of endometriosis type and location

To determine whether the presence of transvaginal sonographic (TVS) soft markers of ovarian mobility, site specific tenderness (SST) are significantly associated with endometriosis type and location at surgery. Multicentre prospective observational study of women presenting with chronic pelvic pain from January 2009 to February 2013. All women with symptoms of chronic pelvic pain +/− history of endometriosis and a plan for laparoscopic endometriosis surgery underwent a specialised TVS in a tertiary referral unit prior to laparoscopy. During TVS, soft markers such as ovarian mobility and SST were assessed. Main outcome measures were the relationship between TVS soft markers and the following surgical findings: endometrioma, isolated peritoneal endometriosis (PE) and posterior compartment deep infiltrating endometriosis (DIE). 189/220 (86%) women with preoperative TVS and laparoscopic outcomes were included in the final analysis. Unilateral/bilateral ovarian fixation was significantly associated with: unilateral/bilateral endometrioma, rectal and rectosigmoid DIE, pouch of Douglas (POD) obliteration and the need for bowel surgery (all p < 0.05). Right ovarian fixation was also significantly associated with right uterosacral ligament (USL) PE (p = 0.03). When ovarian mobility was analysed in the absence of endometrioma (n = 143), unilateral/bilateral ovarian fixation was significantly associated with PE in the corresponding right or left USL, rectal and rectosigmoid DIE, POD obliteration and the need for bowel surgery (p < 0.05). The only SST location at TVS that corresponded to disease location for PE was left adnexal tenderness and left pelvic sidewall PE (p = 0.03). SST did not correlate with any pelvic DIE location. Ovarian fixation, in the presence or absence of endometrioma, appears to be a significantly associated with USL PE, posterior compartment DIE, POD obliteration and the need for bowel surgery. SST may be a potential TVS marker for pelvic sidewall PE, but does not appear to correlate with pelvic DIE location.