The use of transvaginal ultrasound and biochemical markers in the diagnosis of endometriosis

Endometriosis is the presence of endometrial-like tissue outside the uterus, whichinduces a chronic, inflammatory reaction. It is a common and debilitatinggynaecological condition, which may cause severe pain, significant impairment ofquality of life and infertility.Non-invasive techniques to establish the presence and severity of pelvicendometriosis would be valuable to patients in a number of ways: to guide patient choice regarding treatment; to plan fertility or medical treatment; to enable referral to the most appropriate centre and surgeon if surgery is chosen; to enable pre-operative counselling; and better plan the operation including the involvement of other specialties as indicated.This thesis aims to assess: the ability of ultrasound to pre-operatively predict thepresence and severity of pelvic endometriosis; the reproducibility of these findings; the benefit of tenderness mapping, symptomatology and serum CA125 measurement both on their own and in addition to ultrasound.The introduction to this thesis discusses: the pathogenesis and impact ofendometriosis; the literature regarding the diagnostic tests available including MRIand ultrasound; and the usefulness of serum markers. Study one assesses the reproducibility of the assessment of severity of pelvic endometriosis by transvaginal ultrasound. Study two assesses the accuracy of the ultrasound diagnosis of the specific features of pelvic endometriosis and assesses theimpact on the diagnostic accuracy of lesion location and total number of lesions.Study three assesses the ability of ultrasound to accurately assess the overall severity of pelvic endometriosis and therefore to enable preoperative triaging of patients.Study four assesses if symptoms alone or in combination with the ultrasound findings are diagnostically useful. In addition, tenderness mapping is assessed as an addition to the ultrasound findings. Lastly, in study five CA125 is assessed as a test for endometriosis on its own and as an addition to the ultrasound findings.