OC13.02: Office sonovaginography: redefining the concept of a normal pelvis on transvaginal ultrasound in women with suspected endometriosis

To use sonovaginography (SVG) to predict endometriosis location and severity in women planned for laparoscopic endometriosis surgery. Ongoing, multi-centre prospective observational study (June 2009–November 2011). All women included were of reproductive age, had a history of chronic pelvic pain, and had a plan for laparoscopy. A history was obtained and an ultrasonographic evaluation with office SVG was performed on all women prior to laparoscopy. During SVG, 20 mL of ultrasound gel was inserted into the posterior fornix of the vagina, followed by the insertion of a transvaginal (TV) ultrasound probe. The gel created an acoustic window between the TV probe and surrounding structures of the vagina, allowing for visualization of the posterior compartment. SVG was used to predict posterior compartment deep infiltrating endometriosis (DIE) prior to laparoscopy. The correlation between SVG findings and laparoscopic findings was analyzed to assess the ability of SVG to predict posterior compartment DIE. 100 consecutive women with pre-operative SVG and laparoscopic outcomes were included in the final analysis. At laparoscopy, 84/100 (84%) women had endometriosis (73% peritoneal endometriosis, 35% ovarian endometrioma/s, 34% deep infiltrating endometriosis). 30/100 (30%) had POD obliteration and 20/30 (66.7%) of these women also had evidence of bowel endometriosis. Sensitivity, specificity, PPV and NPV for SVG in the prediction of midline posterior compartment DIE (rectovaginal, retrocervical, rectosigmoid nodules) was 78.3%, 90.9%, 72.0% and 93.3%, respectively. Sensitivity, specificity, PPV and NPV for SVG in the prediction of lateral DIE (uterosacral ligament nodules) was 40.0%, 95.6%, 50.0% and 93.5%, respectively. SVG demonstrated a high specificity/NPV, i.e. correlates highly with a “normal pelvis”. Office SVG provides additional diagnostic information to conventional pelvic sonography, which allows for the planning of specific endometriosis surgery and the need for colorectal input.