OC15.07: Ultrasonographic “soft” markers for the detection of rectosigmoid endometriosis

S. Guerriero, S. Ajossa, M. Pascual, Ignacio Rodríguez, M Perniciano, Andrea Piras, Valerio Mais, Luca Saba, Juan Luis Alcázar
In: Ultrasound in Obstetrics & Gynecology · 2018 · vol. 52(S1) , pp. 37–38 · doi:10.1002/uog.19310 · W2897437509
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The absence of the sliding sign and presence of "kissing ovaries" on ultrasound efficiently predict rectosigmoid endometriosis in patients with suspected deep endometriosis.

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Abstract

Due to the high sensitivity and specificity reported, the detection rate of rectosigmoid (RS) endometriosis by an ultrasonographic (US) evaluation of an expert have to be considered a gold standard comparable to laparoscopy. No information is present regarding the use of US soft markers in this kind of disease. The aim of the study was to evaluate the use of US soft markers as “first level” examination in the suspicion of RS endometriosis. We included in the present study 259 patients with clinical suspicion of deep endometriosis. Considering US by expert as gold standard for RS endometriosis we evaluate the following soft markers as dependent variables using a logistic regression: presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesions of the ovary to the uterus, presence of “kissing ovaries”, absence of sliding sign for predicting the presence of RS involvement. Seventy-two patients had US diagnosis of RS endometriosis by an expert. The only significant variables included in the prediction model were the absence of sliding sign OR: 12.77 95%CI [6.3-25.6] and the presence of “kissing ovaries” OR: 53.84%CI [7.8-496.2] and the interaction between both variables OR: 0.01 95%CI [0.001-0.24]. According to the interaction of both variables, the RS endometriosis was observed when Kissing ovaries absent/ sliding sign present in 8.5% of cases (13/153), Kissing present / sliding sign present in 83.3% (5/6), Kissing absent/ sliding sign absent in 54.3% (51/94), Kissing presence / sliding sign absence in 50% (3/6). Thus, when the sliding sign was negative or “kissing ovaries” was present, transvaginal US showed a specificity of 74.9% and a sensitivity of 81.9%. The use of presence of at least of the absence of sliding sign and/or the presence of “kissing ovaries” seems to be a efficient system to screen the patients with clinical suspicion of RS endometriosis to be referred to “second level” ultrasonography with a low rate of false negatives.

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endometriosisadenomyosisendometrioma

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