OC10.04: Can we predict posterior compartment deep infiltrative endometriosis using sonovaginography in women undergoing laparoscopy for chronic pelvic pain?

To use sonovaginography (SVG) to predict posterior compartment deep infiltrative endometriosis (DIE) in women undergoing laparoscopy for chronic pelvic pain. This is a continuing, prospective observational study, which began in June 2009. All women included in this study were of reproductive age, had history of chronic pelvic pain, and had a plan for laparoscopic endometriosis surgery. A history was obtained and SVG was performed on all women prior to laparoscopy. During SVG, a transvaginal (TV) ultrasound was performed with the introduction of gel into the posterior fornix of the vagina. The gel created an acoustic window between the TV probe and the surrounding structures of the vagina, allowing for visualization of the posterior compartment. SVG was then used to predict posterior compartment DIE. Women underwent laparoscopic surgery for diagnosis and, if necessary, surgical treatment of endometriosis. The correlation between SVG findings and laparoscopic findings was then analysed to assess the ability of SVG to predict posterior compartment DIE. To date, complete SVG and laparoscopic data was available for 21 women. The sensitivity and specificity for SVG in the prediction of posterior compartment DIE, as defined as rectovaginal, retrocervical and rectosigmoid nodules, were 80% and 100%, respectively. The PPV and NPV were 100% and 94%, respectively. When SVG was used to predict DIE in both midline (i.e. rectovaginal, retrocervical and rectosigmoid nodules) and lateral regions (i.e. uterosacral ligaments), the sensitivity and specificity were 45% and 100% respectively. The PPV and NPV were 100% and 63%, respectively. SVG appears to be more effective in predicting DIE in the midline posterior compartment in comparison to lateral regions. SVG provides additional diagnostic information to conventional pelvic sonography, which may allow for the planning of specific endometriosis surgery and the need for colorectal input.