P28.03: The performance of ultrasound hard marker: endometrioma as a triage tool for laparoscopic treatment of women with higher stage endometriosis

To determine the performance of endometrioma as a tool for triaging women with severe endometriosis to the appropriate surgical expertise. 200 women with complete ultrasound and surgical data undergoing laparoscopy for suspected endometriosis. Ultrasound data was obtained by the same sonologists using a systematic approach. The level of training appropriate for laparoscopic treatment of endometriosis was determined based on the operative findings described in the database and consistent with the recommendations of the Society of Reproductive Surgeons on the stratification of laparoscopic procedures. There are 3 levels of training appropriate for laparoscopic treatment of endometriosis. 58 women had 78 endometriomas confirmed at laparoscopy compared to 52 women with 70 endometriomas on ultrasound. The accuracy, sensitivity, specificity, PPV and NPV for predicting endometriomas using TVS was 85%, 75.6% 90.9%, 84.3% and 85.4% respectively. 31(53.4%) women had endometrioma associated with POD obliteration at laparoscopy compared to 27(51.9%) on ultrasound. The accuracy, sensitivity, specificity, PPV and NPV for predicting POD obliteration in the presence of endometrioma using the real time dynamic sliding sign was 88.5%, 90.2%, 91.4%, 90.5% and 88.9% respectively. Applying current protocols for evaluating the pelvis with transvaginal ultrasound, only 29/70 (41.4%) endometriomas will be accurately triaged to the appropriate surgical expertise. The real time dynamic sliding sign improves the performance of endometrioma as a tool for triaging women with higher stage disease to appropriate surgical expertise. P28.03: Table 1. Ultrasound based markers Vs. appropriate level of training required for treatment