P29.03: Ultrasonography in deep endometriosis: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. A preliminary statement

To define the sonographic morphological description and localization of deep endometriosis in a preliminary consensus statement. After a preliminary request of participation, we received several suggestions from participants about definitions of lesions in different locations and we proposed a preliminary statement regarding the appearance, localization and extension of different types of lesions to be preliminarily approved by all the authors including also the different kind of examining techniques present in the literature. From the morphological point of view we identify hypoechoic or sonolucent lesions, sessile or plaque lesions, exophytic or nodular lesions, but also nodules with adhesions (‘Indian head dress’). The following locations were included: 1. Uterosacral ligaments 2. Vagina 3. Rectovaginal septum and retrocervical region 4. The rectum/sigmoid colon. 5. Bladder involvement. We also have to evaluate ovaries, ureters and associated adenomyosis. The largest diameter of the lesions and infiltration of adjacent organs should be always recorded. Regarding the modality of the examination the transducer is first positioned in the posterior cul-de-sac of the vagina and then slowly withdrawn through the vagina to allow the visualization of the posterior part. Finally, the transducer is positioned in the anterior cul-de-sac of the vagina to analyze the vesicouterine septum. We also identified the following examination techniques: tenderness guided examination, evaluation of pelvic organs mobility, transvaginal ultrasonography with bowel preparation, transvaginal ultrasonography with water-contrast, vaginosonography and introital three dimensional ultrasonography. This preliminary consensus statement should be useful in multicenter studies and in clinical practice. Careful definition of ultrasound detected deeply infiltrating endometriosis will enhance interpretation of research and lead to improved clinical care.