OP17.02: ‘Tenderness‐guided’ transvaginal sonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain?

To determine the accuracy of transvaginal sonography in the diagnosis of deep endometriosis of the cul-de-sac, retrocervical region and rectovaginal septum using a modified and ‘tenderness-guided’ approach. In a prospective study 30 women scheduled for laparoscopic surgery because of rectovaginal endometriosis, suspected on the basis of patient history of pelvic pain and/or clinical examination, underwent transvaginal sonography (TVS). The modified ‘tenderness-guided’ approach consisted of TVS combined with the introduction of 12 ml of ultrasound gel instead than usual 4 ml in the glove to create a stand-off to visualize near field area. The posterior fornix was evaluated accurately with a sliding up and down movement of the probe. In addition the patient was asked to inform the operator about the onset and site of tenderness eventually evocated by the probe's pressure in the posterior fornix. When tenderness was evocated, the sliding movement was stopped and a particular attention was given to the painful site for the detection of endometriosis lesions with a gentle pressure of the probe's tip. The overall agreement between the test result and the actual outcome was calculated by kappa statistics (± 95% CI). Of the 18 patients suspected by ultrasonography, all were confirmed by laparoscopy. Of the 12 patients considered negative by ultrasonography, 10 were confirmed as negative and in 2 patients endometriosis was present. Using this new approach we obtained a specificity of 100% with a sensitivity of 90% (95% CI, 75%–95%) a positive predictive value of 100% and negative predictive value of 83% associated with a kappa value of 0.86. The use of our new approach seems to be an accurate, not expensive and low invasive method for the diagnosis of deep endometriosis of the cul-de-sac, retrocervical region and rectovaginal septum.