OC07: Diagnosis of location of deep infiltrating endometriosis by transvaginal tenderness‐guided ultrasonography

To evaluate the diagnostic accuracy of transvaginal tenderness-guided ultrasonography in the identification of location of deep endometriotic implants. Sixty-five patients suspected to have deep pelvic endometriosis with or without infertility, underwent preoperative modified transvaginal ultrasonography, as previously described by our group, using a larger amount of ultrasound gel in the glove; this creates a stand-off with better visualization of the vaginal walls and posterior fornix. In addition, the operator evaluated with particular attention the painful sites, as indicated by patients and evoked by gentle pressure. Using this approach, we suspected the presence of deep endometriosis in five locations: vaginal walls, rectovaginal septum, rectum, uterosacral ligaments and anterior compartment. Using ultrasonography deep endometriosis implants were defined by the presence of hypoechoic linear thickening or nodules with or without regular contours. The sensitivity, specificity, positive (LR+) and negative (LR−) likelihood ratios for the five evaluated location are reported in the Table. In particular the pretest probability of a vaginal location of deep pelvic endometriosis in our population was 45%, and this probability of disease nose to 87% with a positive test and decreased to 9% with a negative test. The use of our ultrasonographic modified approach shows good accuracy in the detection of endometriosis in all locations evaluated. In the detection of vaginal endometriosis this technique shows a high specificity and sensitivity. On the contrary, a good specificity associated with lower sensitivity is obtained in the diagnosis of deep endometriosis of the uterosacral ligaments and rectovaginal septum. In the detection of anterior deep endometriosis, this approach shows a good accuracy only in the detection of vesicular endometriosis and not in the evaluation of the entire anterior pouch.