OC070: Can transvaginal ultrasound detect and localize endometriosis in women with chronic pelvic pain?

To detect the presence and location of endometriosis in women undergoing diagnostic laparoscopy for chronic pelvic pain (CPP). Prospective study. 120 consecutive women with CPP had TVS 1–2 weeks before laparoscopy. All patients had a negative pelvic infection screen. During the transvaginal scan (TVS), the presence or absence of an endometrioma was documented; the pelvis was also assessed for ultrasound “soft markers” (reduced ovarian mobility and site-specific pelvic tenderness). The laparoscopic surgeon was blind to the soft marker findings. The average age of the patients was 31 years (range 18–50 years) and the average duration of pain was 46 months (range 6–180 months). Fifty-nine patients had endometriosis at Laparoscopy. Of these women 18 patients had an endometrioma, all of which were confirmed at laparoscopy and by histological analysis (100% accuracy). Of the remaining 41 with endometriosis, 34 (83%) had an abnormal scan based on the presence of soft markers. The false negative rate of the TVS was 17%. There was significant correlation between site-specific tenderness (right adnexa/ovary, left adnexa/ovary and pouch of Douglas) and the site endometriosis (right adnexa/ovary, left adnexa/ovary and pouch of Douglas) respectively (p < 0.01, OR 1.2–1.3). The combination of transvaginal ultrasound based hard and soft markers can detect pelvic endometriosis. 34/41 (83%) of women who have an abnormal scan will have endometriosis. This novel approach facilitates the triage of patients for operative Laparoscopy.