Reply

We thank Drs Exacoustos, Lazzeri and Zupi for their comments on our study and apologize for not citing their publication1. We agree that preoperative sonographic mapping should be mandatory in cases of suspected deep infiltrating endometriosis (DIE). The aim of their study was to assess the accuracy of transvaginal sonography (TVS) in defining the size and location of DIE with laparoscopic/histological confirmation. This is different from the primary aim of our study, which was to develop and assess the performance of a preoperative ultrasound-based endometriosis-staging system (UBESS) to predict the level of complexity of laparoscopic surgery for endometriosis. Studies published to date, including that of Exacoustos et al., have looked specifically at the performance of TVS to predict different locations of DIE1-4. To the best of our knowledge, our study is the first to utilize specifically preoperative ultrasound to predict the subsequent likelihood of a straightforward or difficult laparoscopic surgery. In the grander scheme, however, this is not the point. The most pressing issue in the field of ‘endometriosis ultrasound’ is the lack of clear terminology and the absence of a consensus classification for the lesions5. The consensus opinion published recently by the International Deep Endometriosis Analysis (IDEA) group6 addresses these concerns. In the absence of a robust prospective multicenter study which incorporates the terms and definitions described by the IDEA group, different units around the world will continue to publish data on small cohorts which will not change current practice. Collaborations between luminary units from different continents will go a long way to not only reaffirm the benefit of preoperative ultrasound but also have an impact on changing clinical practice and, in turn, potentially improve surgical outcome. S. Reid†, B. Gerges‡ and G. Condous*‡§ †Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia; ‡Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean University of Sydney, Nepean Hospital, Kingswood, NSW, Australia; §OMNI Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy, St Leonards, Sydney, NSW, Australia *Correspondence. (e-mail: [email protected])