EP27.07: TV‐US prediction of pouch of Douglas obliteration in deep infiltrating endometriosis

Surgical treatment of deep infiltrating endometriosis (DIE) is complex, and preoperative diagnosis benefits both surgeon and patient. The aim of this study was to analyse ultrasound models to determine whether a combination of TVS markers could improve the prediction of pouch of Douglas (POD) obliteration in women with suspected endometriosis. A prospective observational study undertaken between 2005 and 2015 in a tertiary university referral centre with a high number of advanced cases of DIE. Women with suspected endometriosis and scheduled for laparoscopy underwent detailed preoperative TVS, evaluating the “sliding sign” and other possible markers of obliteration of Douglas, such as bowel or retrocervical nodules, monolateral or bilateral ovarian fixation, rectovaginal septum and uterosacral ligaments nodules. Preoperative TVS findings were compared to gold standard laparoscopy. A total of 122 consecutive women with preoperative TVS and laparoscopic outcomes were included in the analysis; in 103 cases (85%) there was DIE. The sonographic sliding sign of obliterated POD was found in 88 cases (75%), presenting an accuracy of 88%, sensitivity of 85% and specificity of 100% (PPV 100%, PNV 56%); the addition of other US variables improved the accuracy without statistical significance. Preoperative TVS evaluation seems to have a high predictive value for obliteration of Douglas. It would be appropriate to identify predictive diagnostic ultrasound criteria that could make non-invasive diagnosis of the extension in the pelvis of endometriosis and facilitate the choice of a safe and adequate surgical or medical treatment.