OC13.05: Ultrasound evaluation of localization of pelvic deep infiltrating endometriosis (DIE) and correlation to surgical classifications

Transvaginal sonography (TVS) in expert hands is very accurate to evaluate the pelvic extension of DIE. However the TVS findings are often not comprehensive to the surgeon in order to establish accurate management and counseling of the patients. The aim of this study was to assess by ultrasound pelvic DIE localization and to compare this diagnosis to surgical laparoscopic/histological findings according to the Enzian classification. 114 patients with pelvic DIE underwent sonographic evaluation prior to laparoscopic surgery, using a transvaginal sectorial probe, first transvaginally (TVS) than transrectally (TRS). An accurate mapping of the extension of the disease was based on a detailed list of locations, according to Enzian classification, which described DIE in terms of presence or absence and infiltration, on different sides of the posterior and anterior pelvis. Furthermore size of the DIE lesions and infiltration of the intestinal wall was evaluated by TVS/TRS. The overall concordance rate of TVS/TRS to surgical and histological findings was 83%. The concordance rate to Enzian score Ea (1–4) was 81%, for Eb it was 73% and for Ec 88%. We observed a significant differences in the concordance rate between TVS/TRS and the different grade of Eb (Eb1 82%, Eb2 65%, Eb3 62%, Eb4 86%) due to the difficulties to assess by ultrasound the infiltration size of the USL and the invasion of the cardinal ligament and pelvic side walls. TVS/TRS performed by skilled sonographer provide accurate informations about the presence and the extension of pelvic DIE and the ultrasound assessment of the DIE location is very similar the surgical score according Enzian classification. However the grade of infiltration and extension of the lesion especially of the USL, vagina and pelvic side wall is difficult to assess by ultrasound. An ultrasound classification or scheme is needed to describe pelvic DIE and to make the ultrasound report better comprehensive to the surgeons.