OP16.05: Diagnostic accuracy of presence of kissing ovaries at transvaginal ultrasonography as a soft marker of posterior severe deep endometriosis

To evaluate diagnostic accuracy of presence of kissing ovaries at transvaginal ultrasonography as a markers of posterior severe deep endometriosis as described by Ghezzi et al in 2005. In this prospective study, performed between January 2009 and September 2012, a total of 204 premenopausal women scheduled for laparoscopic surgery because of clinical suspect of deep endometriosis, on the basis patient history and/or clinical examination, were submitted to transvaginal sonography (TVS) by a single examiner and the presence of kissing ovaries was recorded. We evaluated the diagnostic accuracy of this ultrasonographic finding and additionally the operating time at surgery. Kissing ovaries were diagnosed at ultrasound in 8 (4%) patients according with the rate reported by Ghezzi et al.. Rectosigmoid endometriosis was significantly more frequent in patients with kissing ovaries than in patients without kissing ovaries (87% vs. 36%, p = 0.004). Also the mean (+/−SD) operative time was significantly higher (210 +/− 27 min vs 147 +/− 67 min, p = 0.042) in patients with kissing ovaries. Unfortunately the sensitivity was poor (9% , 95%CIs 0.05% - 10%) with a specificity of 99% (95%CIs 97% - 100%), a positive predictive value of 87% (95%CIs 47% - 99%), a negative predictive value of 64% (95%CIs 62% - 64%) a positive likelihood ratio LR + of 11 (95%CIs 1.41-90) and negative likelihood ratio LR- of 0.92 (95%CIs 0.85-0.99), respectively. The pretest probability of presence of rectosigmoid endometriosis was 38%, and this probability increased to 87% when kissing ovaries were present but fell only to 36% when this ultrasonographic finding was absent. The detection of kissing ovaries at TVS is confirmed to be associated with the presence of intestinal deep endometriosis and longer operating time but its diagnostic accuracy in term of sensitivity is poor and it cannot used in the clinical practice as “soft marker” of rectosigmoid endometriosis. This study was supported in part by the Regione Autonoma della Sardegna (project code CPR-24750).