The use of transvaginal ultrasound and biochemical markers in the diagnosis of endometriosis

Endometriosis is the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. It is a common and debilitating gynaecological condition, which may cause severe pain, significant impairment of quality of life and infertility. Non-invasive techniques to establish the presence and severity of pelvic endometriosis would be valuable to patients in a number of ways: to guide patient choice regarding treatment; to plan fertility or medical treatment; to enable referral to the most appropriate centre and surgeon if surgery is chosen; to enable pre-operative counselling; and better plan the operation including the involvement of other specialties as indicated. This thesis aims to assess: the ability of ultrasound to pre-operatively predict the presence and severity of pelvic endometriosis; the reproducibility of these findings; the benefit of tenderness mapping, symptomatology and serum CA125 measurement both on their own and in addition to ultrasound. The introduction to this thesis discusses: the pathogenesis and impact of endometriosis; the literature regarding the diagnostic tests available including MRI and ultrasound; and the usefulness of serum markers. Study one ... (continues)