EP31.10: Easily detectable ultrasound markers of deep infiltrating endometriosis (DE) in patients without endometrioma at initial transvaginal scan (TVUS)

It is well known that many cases of DE in women without endometrioma are often missed at pelvic ultrasound or only detected for the first time at the laparoscopy. This study aims to examine the prevalence of 3 important ultrasound markers that can be relatively easily detected/ suspected at initial TVUS. 114 patients had undergone surgery for ultrasound diagnosis of DE. We analysed 3 ultrasound markers such as obliteration of POD, suspicion of uterosacral ligament thickening/ nodule and bowel tethering/ nodule that could be easily visualised on routine examination of POD at their initial TVUS. There were 59 (52%) patients with endometrioma in this study group. More interestingly 55 (48%) had no endometrioma at initial TVUS. In patients without an endometrioma, 28 (51%) had partial/ complete obliteration of pouch of Douglas, 43 (78%) had uterosacral ligament thickening/ nodule and 30 ( 50%) had bowel tethering/ nodule at time of initial TVUS. The sensitivity, specificity, positive predictive value and negative predictive value for overall detection as well as individual lesions in this group were calculated. Very interestingly 29% (2 out of 7) of these patients without endometrioma at initial TVUS had no clinical suspicion of endometriosis raised at referral. Our findings highlight the importance of careful routine assessment of POD at the time of initial TVUS for any gynecological indication especially in patients of reproductive age group. This particular approach to every pelvic scan would greatly improve detection of DE even in the absence of endometrioma.