OP19.03: Elastosonography for the evaluation of endometriosis involving uterosacral ligaments

To determine if transvaginal elastosonography is useful in evaluating uterosacral ligaments involvement by endometriotic nodules. In September 2011, we began a perspective study involving patients referred to our centre with suspected deep endometriosis. Inclusion criteria was the need for surgery. Exclusion criteria were contraindications for surgery and previous surgery for endometriosis. After a standard US B-mode study of the pelvis each suspected endometriotic nodule was studied by elastosonography. All laparoscopic findings and the histological specimen were compared with US. For this paper, we reported only the preliminary data concerning the involvement of uterosacral ligaments of the first 50 enrolled patients. We relate about the uterosacral involvement because they are a difficult site for US evaluation of deep endometriosis with a reported sensitivity of 64% and specificity of 88%. The study is still ongoing. Histology confirmed uterosacral involvement in 35 cases. B mode examination found 24 cases of uterosacral involvement (sensitivity 69%, specificity 80%); elastosonography found a 26 case of uterosacral involvement (sensitivity 74%, nspecificity 67%). The elastosonographic picture showed increased stiffness for all nodules found with B mode US. The interesting data is that the picture of the suspected nodule obtained with elastosonography is almost completely superimposable on the picture obtained with B mode; and moreover the borders of the lesion are also the same in both the procedures. Visualizing the pelvis in display B mode is sufficient for evaluating the size and anatomic relationships of endometriotic nodules. Nevertheless, elastosonography could be an additional tool for assessing pelvic endometriosis in those sites that are usually difficult to evaluate, such as the utero-sacral ligaments. These preliminary data must be supported by larger case studies, also including cases of previous surgery.