Diagnostic Accuracy of TVS-based Soft Markers in the Evaluation of Women with Chronic Pelvic Pain

Objective: To determine the diagnostic accuracy of transvaginal ultrasonography (TVS)-based soft markers and its correlation with diagnostic laparoscopy in the detection of pelvic pathology and the evaluation of women with chronic pelvic pain (CPP).Materials and methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, in which a total of 100 women between the ages of 18 and 50 with complaints of CPP lasting for more than 6 months, fulfilling the inclusion criteria were enrolled.Women were first subjected to clinical examination followed by TVS soft marker analysis, i.e., site-specific pelvic tenderness, ovarian mobility, and presence of loculated peritoneal fluid in the pelvis.Those who had either presence of TVS soft markers or clinical findings, or both, underwent diagnostic laparoscopy to see for pelvic pathology.Transvaginal ultrasonography soft marker findings were correlated with diagnostic laparoscopy and subjected to statistical analysis.Results: The mean age of the total study population was 30.9 + 4.02 years and mean duration of abdominal pain was 3.66 + 3.06 years.Transvaginal ultrasonography soft markers were present in 85 women in whom Laparoscopy confirmed pelvic pathology in 75 women, with 51 had minimal adhesions, 14 had subtle endometriotic lesions, and 10 had pelvic congestion.The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TVS soft markers were 100%, 68%, 90%, and 100% with p < 0.001.The diagnostic accuracy of TVS soft markers was 92% with a likelihood ratio of 3.13 and a good correlation was established between TVS soft markers and laparoscopic findings (κ = 0.69) (p < 0.001). Conclusion:In conclusion, TVS-based soft markers should be regarded as the first line imaging modality in the evaluation of patients with suspected endometriosis and pelvic adhesions as this could facilitate more effective triaging of women, resulting in shorter, safer, more rational, and cost-effective management and in turn reduce the need for invasive procedures like laparoscopy for evaluation of CPP.