Preoperative Triple Pelvic Examination and Transvaginal Sonography: Diagnostic Predictive Value for Posterior Pelvic Deep Endometriosis

STUDY OBJECTIVE: To evaluate the predictive value of preoperative triple pelvic examination combined with transvaginal sonography (TVS) for posterior pelvic deep endometriosis (DE). DESIGN: A prospective randomized controlled clinical study comparing preoperative and intraoperative Enzian scores. SETTING: the Affiliated Hospital of Qingdao University. PATIENTS: Eighty-five patients who underwent surgical treatment for endometriosis between June 2022 and December 2024. INTERVENTIONS: Patients were randomized into two groups: Group A (n = 42) underwent TVS and triple pelvic examination separately and independently; Group B (n = 43) had TVS with prior provision of triple pelvic examination findings to sonographers. Preoperative Enzian scoring integrated clinical and TVS findings, and intraoperative Enzian scores were recorded. MEASUREMENTS AND MAIN RESULTS: In both Group A and Group B, the triple pelvic examination demonstrated significantly higher sensitivity than TVS for detecting utero-sacral ligament (USL) lesions (p = .002 and p = .049, respectively). In contrast, TVS was markedly superior to the triple pelvic examination in diagnosing DE lesions in the POD (p = .001 and p = .049, respectively). The combination of the triple pelvic examination and TVS improved both the sensitivity and accuracy for detecting deep pelvic endometriotic lesions, particularly for USL involvement (p = .002 and p = .049, respectively). For USL lesions, the sensitivity of TVS performed after clinical examination in Group B was 68.18%, which was significantly higher than the 38.10% achieved by TVS alone in Group A (p = .023). CONCLUSION: Combining TVS with triple pelvic examination for preoperative Enzian scoring improves the sensitivity of posterior pelvic DE detection, with complementary advantages at different lesion sites.