OC171: Ovarian endometrioma vascularization as assessed by transvaginal color Doppler and serum VEGF levels in patients with endometriosis and pelvic pain

To assess ovarian endometrioma vascularization by transvaginal color Doppler (TVCD) and serum VEGF levels and its correlation with pelvic pain. Fifty-three women (mean age: 34.3 years, range: 20 to 49 years) with sonographically suspected ovarian endometrioma were evaluated by TVCD prior to surgery. According to color Doppler mapping endometriomas were classified as avascular (no flow), poorly vascularized (1–2 color spots), moderately vascularized (3–5 color spots) or highly vascularized (> 5 color spots). Lowest RI and PI as well as highest PSV found in vascularized endometriomas were used for analysis. The same day of ultrasound blood samples were collected for serum VEGF levels determination. Patients were classified as “asymptomatic” (no pelvic pain or mild-moderate dysmenorrhea) or “symptomatic” (severe dysmenorrhea, dyspareunia, chronic pelvic pain). All ultrasound examinations were performed by the same examiner who was unaware for patient's complaints. Definitive histologic diagnosis was obtained in every case. In four patients histology revealed haemorrhagic cyst and were excluded from analysis. In 49 women histology confirmed ovarian endometrioma. Thirty-two (65%) women were asymptomatic and 17 (35%) were symptomatic. 97% (31/32) asymptomatic women had avascular or poorly vascularized endometriomas. 94% (16/17) symptomatic women had moderately or highly vascularized endometriomas. RI and PI were significantly lower in symptomatic women. No differences were found in PSV and serum VEGF levels. Ovarian endometriomas in women with pelvic pain showed a higher vascularization, as assessed by TVCD, than asymptomatic women. TVCD may be an activity marker. No correlation was found with serum VEGF.