Hum. Reprod. Advance Access originally published online on July 29, 2008
Human Reproduction 2008 23(11):2452-2457; doi:10.1093/humrep/den293
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Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis
Department of Obstetrics and Gynaecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy
1 Correspondence address. Tel: +39-070-6092467; Fax: +39-070-668575; E-mail: gineca.sguerriero{at}tiscali.it
BACKGROUND: The aim was to evaluate the diagnostic accuracy of transvaginal tenderness-guided ultrasonography in the identification of location of deep endometriosis.
METHODS: Consecutive women scheduled for surgery in our Department for clinically suspected endometriosis were included in this prospective study. All women underwent modified transvaginal ultrasonography using a stand-off in the week before surgery, which also evaluated the painful sites evocated by a gentle pressure of the probe. Five locations of deep endometriosis were considered: vaginal walls, rectovaginal septum, rectosigmoid involvement, uterosacral ligaments and anterior compartment (anterior pouch and/or bladder). Sensitivity, specificity and likelihood ratios (LR+/–) were calculated with 95% confidence intervals (CIs).
RESULTS: We included 88 women; surgery associated with histopathological evaluation revealed deep endometriosis in different pelvic locations in 72 patients. With respect to the vaginal walls, transvaginal ultrasonography had a sensitivity of 91% (95% CI, 79–97%), specificity of 89% (95% CI, 81–93%), an LR+ of 8.2 and an LR– of 0.09. For endometriosis of rectovaginal septum, transvaginal ultrasonography had a sensitivity of 74% (95% CI, 64–80%), specificity of 88% (95% CI, 4–8%), an LR+ of 6.2 and an LR– of 0.3. For other locations, the sensitivity was lower (ranging from 67% to 33%) with a comparable specificity.
CONCLUSIONS: This technique shows a high specificity and sensitivity in the detection of vaginal and rectovaginal endometriosis. Good specificity associated with a lower sensitivity was obtained in the diagnosis of deep endometriosis of uterosacral ligaments, rectosigmoid involvement or anterior deep endometriosis.
Key words: transvaginal ultrasonography/deep endometriosis/sensitivity/specificity
Submitted on April 18, 2008; resubmitted on June 16, 2008; accepted on July 4, 2008.
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