Guerriero S , Ajossa S, Gerada M et al.

This study was undertaken in a University Hospital in Italy. Three of the six authors had published a paper on endometriosis in 1996. In this prospective study, they undertook an evaluation of deep endometriosis by using a ‘tenderness-guided ‘ approach. The 50 studied women had been scheduled for laparoscopy, for chronic pelvic pain.

Preoperative evaluation of these patients potentially enables appropriate treatment. Transvaginal ultrasonography (TVUS) due to its low cost, discomfort and high diffusion is often considered a first-line procedure.

A TVUS exam was carried out 7 days before laparoscopic surgery.

To improve sensitivity and specificity during this examination, an acoustic window was created by increasing the amount of ultrasound gel in the probe cover (from 4 mls to 12mls). Patients were asked to indicate tender points during gentle pressure from ultrasound probe during TVUS exam. Different stages were assigned to rectovaginal endometriosis on the basis of ultrasonographic images. Suspicion of presence of ovarian endometriosis was also recorded.

A single, experienced investigator performed all scans.

Deep endometriosis was eventually diagnosed during laparoscopy if the biopsy sample showed endometrial tissue, fibrosis or complete cul-de-sac obliteration on observation.

Specificity of 95% and sensitivity of 90% with a positive predictive value 97% and a negative predictive value of 86% was achieved by this new technique. Sensitivity and specificity reached 100% for diagnosis of ovarian endometriosis.

Although this study showed an increasing value of TVUS as a pre-operative tool, the limitations must be borne in mind. A single clinician performed the TVUS, there was significant patient imput and, the number of women studied, was small. Clearly, more studies are needed.