OC19.04: Soft markers as a first line ultrasonographic tool to raise suspicion of uterosacral involvement in women suspected of having deep endometriosis

The aim of this study was to evaluate the use of ultrasound (US) soft markers to raise suspicion of uterosacral involvement in women suspected of having deep endometriosis. We included in this prospective observational study all patients with clinical suspicion of deep endometriosis who underwent diagnostic transvaginal US evaluation from January 2016 to February 2017 in two academic department as a part of SANABA (Sardinia-Navarra-Barcelona) collaborative study. Several US soft markers were evaluated for prediction of uterosacral involvement (presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesion of the ovary to the uterus, presence of ‘kissing ovaries’ and absence of the ‘sliding sign’) using as the gold standard surgical evaluation for the presence of uterosacral endometriosis. We included 194 patients with clinical suspicion of deep endometriosis. Of these, 96 had an surgical diagnosis of uterosacral endometriosis. Only the absence of sliding sign showed a significant difference between patients with or without uterosacral lesions (55% vs. 29% respectively, P = <0.001). The only significant variable found in the prediction model were absence of the sliding sign, odds ratio (OR), 3.06 95% CI 1.63-5.84. Thus, when the sliding sign was absent, transvaginal US showed a specificity of 71% and a sensitivity of 55%. US findings of absence of the sliding sign in patients with clinical suspicion of endometriosis multiply by 3 the probability of presence of uterosacral involvement and indicate referral for expert US examination. This study was partly supported by Fondazione di Sardegna grant F74I19001010007.