OC15.05: Prevalence of deep infiltrating endometriosis in patients with endometriotic ovarian cyst

The association between endometriotic ovarian cysts (EOC) and deep infiltrating endometriosis (DIE) is well known, although DIE is still often under diagnosed. The objective of this study is to evaluate the performance of transvaginal ultrasound (TUS) for diagnosis of DIE in patients presenting with EOC, with surgery results as the gold standard. We studied 290 patients with diagnosis of EOC. In these patients the presence of DIE was evaluated in the following regions: rectosigmoid (RS), sigmoid, rectum, rectovaginal septum (RVS), uterosacral ligaments, vaginal fornix, posterior uterine wall, anterior uterine wall and vesicouterine region. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for DIE diagnosis relative to surgical results. We found DIE in 197(67%) patients among 290 patients with EOC. The median age was 36 (+/-6.7) years. One hundred twenty-six (40.9%) patients had RS lesions, 13 (4.2%) with sigmoid lesions, 5 (1.6%) with rectum lesions, 33 (10.7%) with RVS lesions, 110 (55.8%) with uterosacral ligaments lesions, 12 (3.9%) with vaginal fornix lesions, 1 (0.3%) with posterior uterine wall lesions, 3 (1%) with anterior uterine wall and 5 (1.6%) with vesicouterine region lesions. One hundred and twenty three (42.4%) patients underwent surgery. The sensitivity of TUS for diagnosis of deep endometriosis was 96.9%, specificity 85.2%, PPV 95.9% and NPV 88.5%. Transvaginal ultrasound shows good performance for the diagnosis of surgically confirmed DIE in patients with endometriotic ovarian cyst.