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Hum. Reprod. Advance Access published online on July 29, 2008
Human Reproduction, doi:10.1093/humrep/den293
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis

Stefano Guerriero1, Silvia Ajossa, Marta Gerada, Bruna Virgilio, Stefano Angioni and Gian Benedetto Melis

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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