OC16.06: Can we use the soft marker, site‐specific tenderness at TVS, in the preoperative mapping of peritoneal endometriosis?

To determine whether the presence of site-specific tenderness during transvaginal scan (TVS) corresponds with the location of peritoneal endometriosis at laparoscopy in women with normal POD and no deep infiltrating endometriosis. Multi-center prospective observational study over 5 years. This study included 189 women with symptoms of chronic pelvic pain +/- history of endometriosis who had laparoscopy +/- excision of peritoneal endometriosis. All women underwent preoperative TVS, where site-specific tenderness was elicited in six pelvic locations viz uterus, right adnexa, Left adnexa, right USL, Left USL, and POD. Site specific tenderness was elicited by placing gentle pressure with the TV probe against each of these six locations. Women rated their pain score from 0 (no pain) to 10 (worst pain) for each of the six locations. VAS of more than 0 was considered positive for the purposes of this study. Only women with peritoneal disease were included in this study. Women with either an endometrioma and/or posterior compartment deep infiltrating endometriosis (DIE) at laparoscopy were excluded from analysis. The relationship between site-specific tenderness at TVS and location of peritoneal endometriosis at surgery was then analysed. 100 women were found to have isolated peritoneal endometriosis. The most common location of peritoneal endometriosis was the posterior pelvic compartment. The only positive association between site-specific tenderness at TVS and peritoneal endometriosis location at surgery was for site-specific tenderness at the posterior vaginal fornix and the presence of peritoneal endometriosis in the POD (p = 0.0486) (figure 1). The use of site-specific tenderness during TVS appears to be useful in the mapping of peritoneal endometriosis involving the POD.