OC13.06: Transvaginal sonography and double-contrast barium enema in the diagnosis of intestinal deeply infiltrating endometriosis

To compare the diagnostic features of transvaginal sonography (TVS) and double-contrast barium enema (DCBE) in the diagnosis of posterior deeply infiltrating endometriosis (DIE). Sixty nine patients with symptoms suggestive of DIE and scheduled for operative laparoscopy were prospectively enrolled. TVS and DCBE were performed within two weeks before surgery by gynecologists and radiologist with a special interest in endometriosis who were blind to the results of the opposite examination but were aware of patients anamnesis. Results were compared to surgical and pathologic outcome. The sensitivity, specificity, positive and negative predictive values and test accuracies were calculated for both TVS and DCBE. 67/69 women had at least one nodule of DIE confirmed at laparoscopy and histopathologic examination. DIE was located in the rectosigmoid colon in 30 women, in the uterosacral ligaments in 21, in the rectum in 18, the vagina in 3. Five patients had two endometriostic nodules in the posterior compartment. TVS showed abnormalities suggestive of posterior DIE in 57 patients (82%) while DCBE revealed a lesion suggestive of DIE in 24 women (35%). The sensitivity, specificity, positive and negative predictive values and accuracy for TVS and DCBE were respectively 85% and 36%, 100% and 100%, 17% and 4%, 85% and 38%. Our study demonstrates that TVS is an accurate imaging modality in detecting the presence of posterior DIE, with a better diagnostic performance than DCBE.