OC065: Negative predictive value of transvaginal ultrasound in women with chronic pelvic pain. Can we reduce the number of laparoscopies?

To develop transvaginal ultrasound scan (TVS) based “soft markers” to improve the definition of a normal scan in women undergoing diagnostic laparoscopy for chronic pelvic pain (CPP). 120 consecutive patients had TVS 1–2 weeks before diagnostic laparoscopy for CPP. Anatomical abnormalities (hard markers) were documented; the presence of “soft markers” (reduced ovarian mobility, site-specific pelvic tenderness and free fluid) was also assessed. Average age of the patients was 31 years (18–50), the average duration of pain was 45 months (6–180). 24 (20%) had hard markers for pelvic pathology (18 endometriomas, 6 hydrosalpinges). 96 (80%) had a normal conventional scan, of which 53 (55%) had soft markers for pelvic pathology while 43 (45%) did not. At laparoscopy, 51 had endometriosis, 7 endometriosis/pelvic adhesions, 6 pelvic adhesions, 1 hydrosalpinx/endometriosis and 5 hydrosalpinx/pelvic adhesions. The sensitivity and specificity of TVS to detect pathology based on hard markers was 68.5% and 100% respectively. The positive and negative predictive value of was 100%, and 49.3% respectively. The sensitivity and specificity of TVS to detect pathology based on soft markers was 87.5% and 78% respectively. The positive and negative predictive value of was 75.7% and 80% respectively. 80% of women who have a normal scan will have a normal laparoscopy. A pelvic scan should report on the presence of site-specific pelvic tenderness and ovarian mobility. This novel approach improves the predictive value of transvaginal ultrasound and reduces the need for unnecessary laparoscopy in women with chronic pelvic pain.