EP27.06: Interrater agreement for the prediction of pelvic adhesions and deep infiltrating endometriosis using specialised transvaginal ultrasound: a pilot study

To determine interrater agreement for gynecologists with >10 years' experience in transvaginal ultrasound (TVU), upon adopting specialised TVU (S-TVU), for the prediction of ovarian mobility, uterine “sliding sign” (i.e. POD obliteration) and posterior compartment deep infiltrating endometriosis (DIE). Inter-rater reliability study performed at a tertiary referral centre for women with chronic pelvic pain (CPP). Two gynecologists, examiner 1 and examiner 2, with prior experience in TVU, underwent 20 and 13 supervised training sessions in S-TVU, respectively. S-TVU examinations were then performed independently by each examiner to assess for ovarian mobility, uterine “sliding sign” and posterior compartment DIE in women with CPP. Each S-TVU scan was first performed by examiner 1 or examiner 2, followed by the expert sonologist. The gold standard was the expert sonologist's S-TVU findings. Interrater reliability (i.e. Cohen's kappa) and percent agreement between each examiner and the expert was calculated. S-TVU results were available for 40 women. The expert's S-TVU findings were: 12/40 (30%) with posterior compartment DIE, 9/40(23%) with bowel DIE, 13/40 (33%) with POD obliteration, 23/40(58%) with ovarian immobility. Interrater agreement for gynecologists with limited experience in specialised TVU, compared to an expert sonologist, ranged from substantial to almost perfect for prediction of posterior compartment DIE and POD obliteration using the “sliding sign”, and from moderate to substantial for ovarian immobility.