Interobserver agreement of non-invasive diagnosis of endometriosis by transvaginal sonography (TVS)

Ayman Tammaa, N Fritzer, Pablo Andrés Ordóñez Lozano, A Krell, H. Sälzer, M. Salama, Gernot Hudelist
In: Geburtshilfe und Frauenheilkunde · 2015 · vol. 75(07) · doi:10.1055/s-0035-1558372 · W2618731545
article OA: closed CC0 ⤵ 3 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This study evaluated the interobserver agreement and accuracy of transvaginal sonography for diagnosing deep infiltrating endometriosis and endometriomas.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-16 · read from full text ⓘ

This prospective study evaluated interobserver agreement and diagnostic accuracy of transvaginal sonography (TVS) for diagnosing deep infiltrating endometriosis (DIE) and endometriomas, using two blinded, experienced sonographers to assess findings in 65 women referred from a pelvic pain clinic and scheduled for laparoscopy. Interobserver agreement measured by Gwet’s AC1 was high across several locations, including vagina, bladder, adnexa, rectovaginal septum, and rectosigmoid, and TVS sensitivity/specificity were also reported for observer A and B when compared with laparoscopy. A stated caveat was that results were excepted for DIE affecting the rectovaginal septum, where performance was less consistent. This paper is centrally about endometriosis — it assesses how reproducible and accurate TVS is for non-invasive diagnosis of DIE (and related endometriosis features) compared with laparoscopy.

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Abstract

Evaluation of the interobserver agreement and accuracy of transvaginal sonography (TVS) for deep infiltrating endometriosis (DIE) and endometriomas.
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Objectives

Evaluation of the interobserver agreement and accuracy of transvaginal sonography (TVS) for deep infiltrating endometriosis (DIE) and endometriomas.

Methods

Sixty-seven consecutive patients were enrolled from January 2013 to January 2014 referred to a pelvic pain clinic and scheduled for laparoscopy and were prospectively examined by two experienced sonographers (observer A and B) independently and blinded to the others results. Gwet's first order agreement coefficient (Gwet's AC1) was used to calculate interobserver agreement and diagnostic accuracy of TVS as well as sensitivity, specificity, positive and negative predictive value (PPV, NPV) of TVS (observer A and B) when compared to laparoscopy.

Results

Sixty-five out of 67 patients were finally analysed. The level of agreement between observer A and B (Gwet's AC1), sensitivity/specificity were as following: vagina (Gwet's AC1: 0.933; 62%/94%; 82%/94%), bladder (Gwet's AC1: 1.00; 67%/97%; 67%/97%), uterosacral ligaments (USL) (Gwet's AC1: 0.84; 73%/83%; 53%/93%), adnexia (Gwet's AC1: 0.95; 71%/93%; 71%/93%), rectovaginal septum (RVS) (Gwet's AC1: 0.95; 40%/90%; 33%/87%) and rectosigmoid (Gwet's AC1: 0.98; 93%/96%; 94%/98%) reflecting high interobserver agreement. With the exception of DIE affecting the RVS, similar results were observed when TVS was compared with laparoscopy.

Conclusions

TVS is a highly accurate and reproducible method for non-invasive diagnosis of DIE in well-trained staff.

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Condition tags

endometriosisdie_deep_infiltrating

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